Ruling Relations of Nurses’ Scope of Practice in Hospitals: An Institutional Ethnography
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Abstract
Introduction: Few studies in nursing sciences focus on the hospital as a sociopolitical context of regulation.
Objective: This article presents the results of an institutional ethnography of nursing work in a hospital environment.
Method: The observational data, interviews and institutional documents collected were analyzed through the feminist lens of institutional ethnography (Smith, 1987, 2018).
Results: The results, presented in the form of vignettes, provide three ways in which the hospital regulates the scope of practice of bedside nurses daily; self-regulation, invisible work and the institutional regulation.
Discussion and Conclusion: The vignettes presented make it possible to identify points of tensions in bedside nurses’ scope of practice, which suggest that nurses directly perpetuate the relations of their own subordination, through their socialization in the hospital structure. Avenues for historical and feminist research are suggested to further study nursing in its socio-political context.
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References
Abbott, A. (1988). The system of professions: An essay on the division of expert labor. The University of Chicago Press.
Ashley J. A. (1980). Power in structured misogyny: implications for the politics of care. ANS. Advances in nursing science, 2(3), 3–22.
Aubry, M., Richer, M.-C. et Lavoie-Tremblay, M. (2014). Governance performance in complex environment: The case of a major transformation in a university hospital. International Journal of Project Management, 32(8), 1333–1345. https://doi.org/10.1016/j.ijproman.2013.07.008
Bernays, E. L. (1945). The Medical Profession and Nursing. The American Journal of Nursing, 45(11), 907–914. https://doi.org/10.2307/3416955
Biurrun-Garrido, A., Llena-Riu, A., Feijoo-Cid, M., Torrente-Jimenez, R. S., Cámara-Liebana, D. et Gasch-Gallén, Á. (2024). Everyday sexism in nursing degrees: A cross-sectional, multicenter study. Nurse education today, 132, 106009. https://doi.org/10.1016/j.nedt.2023.106009
Bloom-Christen, A. et Grunow, H. (2022). What’s (in) a Vignette? History, Functions, and Development of an Elusive Ethnographic Sub-genre. Ethnos, 1–19. https://doi.org/10.1080/00141844.2022.2052927
Bourdieu, P. (1994). Raisons pratiques. Sur la théorie de l’action. Éditions du Seuil.
Carter, M. A. et Haji Assa, A. S. (2023). The problem of comparing nurse practitioner practice with medical practice. Nursing inquiry, 30(3), e12551. https://doi.org/10.1111/nin.12551
Campbell, M. et Gregor, F. (2004). Mapping Social Relations: A Primer in Doing Institutional Ethnography. University of Toronto Press.
Chapman, L. R., Mellow, S. et Coombridge, H. (2019). Symbolic sexism: superficial or serious bias? An investigation into images on patient call bells. The Medical journal of Australia, 211(11), 514–517. https://doi.org/10.5694/mja2.50418
Coburn D. (1988). The development of Canadian nursing: professionalization and proletarianization. International journal of health services: planning, administration, evaluation, 18(3), 437–456. https://doi.org/10.2190/1BDV-P7FN-9NWF-VKVR
Daigle, J. (2021). Réflexion. L’engagement social en héritage : retour sur l’univers infirmier au Québec, 1870-1970. Revue d’histoire de l’Amérique française, 75(1-2), 153–179. https://doi.org/10.7202/1088212ar
D’Amour, D., Dubois, C. A., Déry, J., Clarke, S., Tchouaket, E., Blais, R. et Rivard, M. (2012). Measuring actual scope of nursing practice: a new tool for nurse leaders. The Journal of nursing administration, 42(5), 248–255. https://doi.org/10.1097/NNA.0b013e31824337f4
Déry, J., Paquet, M., Boyer, L., Dubois, S., Lavigne, G. et Lavoie-Tremblay, M. (2022). Optimizing nurses' enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis. Journal of nursing management, 30(1), 205–213. https://doi.org/10.1111/jonm.13473
Déry, J. (2013). L’étendue effective de la pratique d’infirmières en pédiatrie : ses déterminants et son influence sur la satisfaction professionnelle [thèse de doctorat, Université de Montréal]. Papyrus. http://hdl.handle.net/1866/10843
Déry, J., DʼAmour, D., Blais, R. et Clarke, S. P. (2015). Influences on and outcomes of enacted scope of nursing practice: a new model. ANS. Advances in nursing science, 38(2), 136–143. https://doi.org/10.1097/ANS.0000000000000071
Dock, L. L. (1903). Hospital Organization. The American Journal of Nursing, 3(6), 413–421. https://doi.org/10.2307/3402285
Dock, S. E. (1917). The Relation of the Nurse to the Doctor and the Doctor to the Nurse. The American Journal of Nursing, 17(5), 394–396. https://doi.org/10.2307/3405170
Durand, S. (dir.). (2016). Le champ d’exercice et les activités réservées des infirmières et infirmiers (3e éd.). Ordre des infirmières et infirmiers du Québec. https://www.oiiq.org/documents/20147/237836/1466_doc.pdf/be5377c8-a8cd-79d9-2620-d0cd12bfe471
Fealy, G. M., Casey, M., O'Leary, D. F., McNamara, M. S., O'Brien, D., O'Connor, L., Smith, R. et Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of clinical nursing, 27(19-20), 3797–3809. https://doi.org/10.1111/jocn.14550
Fédération des Médecins spécialistes du Québec. (2024). Les effectifs médicaux. https://fmsq.org/fr/notre-profession/les-effectifs-medicaux
Federici, S. (2004). Caliban and the Witch. Autonomedia.
Foucault, M. (1963). Naissance de la clinique. Une archéologie du regard médical. Presses universitaires de France.
Geertz, C. (2008). Thick Description: Toward an Interpretive Theory of Culture. Dans T. Oakes, P. L. Price (dir.), The cultural geography reader (p. 41-51). Routledge.
Grose, E., Chen, T., Siu, J., Campisi, P., Witterick, I. J. et Chan, Y. (2022). National Trends in Gender Diversity Among Trainees and Practicing Physicians in Otolaryngology-Head and Neck Surgery in Canada. JAMA otolaryngology-- head & neck surgery, 148(1), 13–19. https://doi.org/10.1001/jamaoto.2021.1431
Hershey N. (1980). Defining the scope of nursing practice: actors, criteria and economic implications. Nursing law & ethics, 1(7), 3–12.
Jeffery, N., Donald, F., Martin-Misener, R., Bryant-Lukosius, D., Johansen, E. A., Egilsdottir, H. Ö., Honig, J., Strand, H., Jokiniemi, K., Carter, N., Roodbol, P. et Rietkoetter, S. (2020). A Comparative Analysis of Teaching and Evaluation Methods in Nurse Practitioner Education Programs in Australia, Canada, Finland, Norway, the Netherlands and USA. International journal of nursing education scholarship, 17(1), /j/ijnes.2020.17.issue-1/ijnes-2019-0047/ijnes-2019-0047.xml. https://doi.org/10.1515/ijnes-2019-0047
Langer, P. C. (2016). The Research Vignette: Reflexive Writing as Interpretative Representation of Qualitative Inquiry—A Methodological Proposition. Qualitative Inquiry, 22(9), 735–744. https://doi.org/10.1177/1077800416658066
Laschinger, H. K. et Havens, D. S. (1996). Staff nurse work empowerment and perceived control over nursing practice, Conditions for work effectiveness. The Journal of nursing administration, 26(9), 27–35. https://doi.org/10.1097/00005110-199609000-00007
Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Inouye, S. K., Greenough, W. B., 3rd, Guido, S., Langston, C., Frick, K. D., Steinwachs, D. et Burton, J. R. (2005). Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of internal medicine, 143(11), 798–808. https://doi.org/10.7326/0003-4819-143-11-200512060-00008
Loi sur les infirmières et infirmiers, RLRQ, c. I-8. https://www.legisquebec.gouv.qc.ca/fr/document/lc/i-8
McCarroll, Z., Townson, J., Pickles, T., Gregory, J. W., Playle, R., Robling, M., et Hughes, D. A. (2021). Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial. BMJ open, 11(5), e043523. https://doi.org/10.1136/bmjopen-2020-043523
Melon, K. A., White, D. et Rankin, J. (2013). Beat the clock! Wait times and the production of 'quality' in emergency departments. Nursing philosophy: an international journal for healthcare professionals, 14(3), 223–237. https://doi.org/10.1111/nup.12022
Mussallem H. K. (1969). The changing role of the nurse. The American journal of nursing, 69(3), 514–517.
n.d. (2022). Le personnel infirmier réglementé, 2022 : tableaux de données sur les infirmières autorisées et les infirmières praticiennes. https://www.cihi.ca/sites/default/files/document/nursing-in-canada-2013-2022-data-tables-fr.xlsx
Nugus P. (2019). Re-structuring the negotiated order of the hospital. Sociology of health & illness, 41(2), 378–394. https://doi.org/10.1111/1467-9566.12838
Nurse Or Minor Medical Practitioner? (1911). The British Medical Journal, 1(2622), 771–772. http://www.jstor.org/stable/25286021
Porter, S. (1992). Women in a women's job: the gendered experience of nurses. Sociology of Health & Illness, 14(4), 510–527. https://doi.org/10.1111/1467-9566.ep10493131
Purvis J. K. (2023). Applying a Foucauldian lens to the Canadian code of ethics for registered nurses as a discursive mechanism for nurses professional identity. Nursing inquiry, 30(2), e12536. https://doi.org/10.1111/nin.12536
Rankin, J. (2017). Conducting Analysis in Institutional Ethnography: Guidance and Cautions. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917734472
Rankin J. M. (2015). The rhetoric of patient and family centred care: an institutional ethnography into what actually happens. Journal of advanced nursing, 71(3), 526–534. https://doi.org/10.1111/jan.12575
Reeves, S., Nelson, S. et Zwarenstein, M. (2008). The doctor-nurse game in the age of interprofessional care: a view from Canada. Nursing inquiry, 15(1), 1–2. https://doi.org/10.1111/j.1440-1800.2008.00396.x
Reverby, S. (1987). Ordered to Care: The Dilemma of American Nursing, 1850–1945. Cambridge University Press.
Rosenberg, C. E. (1987). The Care of Strangers: The Rise of America's Hospital System. Basic Books.
Shamian, J., Kerr, M. S., Laschinger, H. K. et Thomson, D. (2002). A hospital-level analysis of the work environment and workforce health indicators for registered nurses in Ontario's acute-care hospitals. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres, 33(4), 35–50.
Sharma, M. et Rawal, S. (2022). Women in Medicine: The Limits of Individualism in Academic Medicine. Academic medicine: journal of the Association of American Medical Colleges, 97(3), 346–350. https://doi.org/10.1097/ACM.0000000000004458
Smith, D. (2018). L’ethnographie institutionnelle. Une sociologie pour les gens. Economica.
Smith, D. E. (1987). The Everyday World As Problematic: A Feminist Sociology. Northeastern University Press.
Stake-Doucet, N. (2020). The Racist Lady with the Lamp. Nursing Clio. https://nursingclio.org/2020/11/05/the-racist-lady-with-the-lamp/
Stake-Doucet, N. (2021). Ethnographie institutionnelle du travail des infirmières soignantes en milieu hospitalier [thèse de doctorat, Université de Montréal]. Papyrus. https://hdl.handle.net/1866/26974
Stake-Doucet, N. (2023). White privilege and professionalization: a decolonial and critical feminist perspective on professional nursing. Witness: The Canadian Journal of Critical Nursing Discourse, 5(2), 26-38. https://doi.org/10.25071/2291-5796.153
Stein L. I. (1967). The doctor-nurse game. Archives of general psychiatry, 16(6), 699–703. https://doi.org/10.1001/archpsyc.1967.01730240055009
Teresa-Morales, C., Rodríguez-Pérez, M., Araujo-Hernández, M. et Feria-Ramírez, C. (2022). Current Stereotypes Associated with Nursing and Nursing Professionals: An Integrative Review. International journal of environmental research and public health, 19(13), 7640. https://doi.org/10.3390/ijerph19137640
Tsoukas, H. (2009). Craving for Generality and Small-N Studies: A Wittgensteinian Approach towards the Epistemology of the Particular in Organization and Management Studies. Dans D. Buchannan et A. Bryman (dir.), The SAGE Handbook of Organizational Research Methods. (p. 384-407). SAGE Publications Ltd.
World Health Organization (2019). Delivered by women, led by men: A gender and equity analysis of the global health and social workforce. Human Resources for Health Observer Series No. 24. Licence: CC BY-NC-SA 3.0 IGO. https://cdn.who.int/media/docs/default-source/health-workforce/delivered-by-women-led-by-men.pdf?sfvrsn=94be9959_2
Wytenbroek, L. et Vandenberg, H. (2017, July 3). Reconsidering nursing’s history during Canada 150. Canadian Nurse. https://community.cna-aiic.ca/blogs/cn-content/2017/07/03/reconsidering-nursings-history-during-canada-150