A discourse analysis of managerialism and trust amongst nursing professionals

McCabe, Thomas Joseph; Sambrook, Sally Anne

doi:10.2478/ijm-2018-0009

Abstract

This study explores the effects of New Public Management (NPM) on trust amongst nursing professionals, nurses and nurse ward managers within the British National Health Service (NHS). Thirty-nine nurses and nurse ward managers, recruited randomly, participated in semi-structured interviews. The original data, collected in 2000-2002, are re-analysed from a discourse analysis perspective. The findings support and extend contemporary research. They show that nurses have a strong professional identity and commitment and that increasing managerialism is eroding trust. Nurses both accommodate and resist managerialist discourses. They conceptualise trust in terms of their own ward environment, line-manager and colleagues. Trust is reciprocal and related to previous experiences and other factors. Trust is beneficial to healthcare organisations, healthcare professionals and their patients. Good communication and openness positively influence the development of trust. Nurse ward managers play a pivotal role in translating contested managerialist discourse into nursing practice to sustain trust and effect professional patient care.

References

Allen, D. (2004), ‘Re-reading nursing and rewriting practice: Towards an empirically based reformulation of the nursing mandate’. Nursing Inquiry 11: 4, 271-283.
Search in Google Scholar Back to article
Bennis, W., & Nanus, B. (1985). Leaders: The strategies for taking charge. New York: Harper & Row.
Search in Google Scholar Back to article
Bejerot, E. and Hasselbladh, H. (2011). ‘Professional autonomy and pastoral power: The transformation of quality registers in Swedish healthcare’. Public Administration 89: 4, 1604-1621.
Search in Google Scholar Back to article
Beresford P, Wallcraft J (1997). Psychiatric system survivors and emancipatory research: issues, overlaps and differences. In: Barnes C, Mercer G. Doing disability research. . Leeds, Disability Press.
Search in Google Scholar Back to article
Blomgren, M. (2003). ‘Ordering a profession: Swedish nurses encounter new public management reforms’. Financial Accountability & Management 19, 45-71.
Search in Google Scholar Back to article
Bresnen, M., Hodgson, D., Bailey, S., Hyde, P. and Hassard, J. (2017). ‘Mobilizing management knowledge in healthcare: Institutional imperatives and professional and organizational mediating effects’. Management Learning 48:5, 597-614.
Search in Google Scholar Back to article
Brown P., Alaszewski A., Pilgrim D. and Calnan M. (2011). ‘The quality of interaction between managers and clinicians: A question of trust’. Public Money and Management 31:1, 43-50.
Search in Google Scholar Back to article
Buchan, J., May, F. and Dussault, G. (2013). ‘Nursing workforce policy and the economic crisis: A global overview’. Journal of Nursing Scholarship, 45 3, 298-307.
Search in Google Scholar Back to article
Burgess, N. and Currie, G. (2013). ‘The knowledge brokering role of the hybrid middle level manager: The case of healthcare’. British Journal of Management 24, S132-S142.
Search in Google Scholar Back to article
Calnan, M. and Gabe J. (2001). ‘From consumerism to partnership?’ Britain’s National Health Services, 31: 1, 119-131.
Search in Google Scholar Back to article
Calnan, M. and Rowe, R. (2006). ‘Researching trust relations in health care: Conceptual and methodological challenges – an introduction.’ Journal of Health Organisation and Management, 20: 5, 349-358.
Search in Google Scholar Back to article
Carter, B. (2007). ‘Review: symposium on managing to nurse: Inside Canada’s health care reform. Reformatting nursing: The invidious effects of the growth of managerialism.’ Health, 11: 2, 268-272.
Search in Google Scholar Back to article
Carvalho, T. (2012). ‘Managerialism and professional strategies: A case from nurses in Portugal’. Journal of Health Organization and Management 26: 4, 524-541.
Search in Google Scholar Back to article
Clarke, S. (2006). ‘Research on nurse staffing and its outcomes: The challenges and risks of grasping at shadows’, in S. Nelso and S. Gordon (eds), The Complexities of Care, New York: Cornell University Press.
Search in Google Scholar Back to article
Connell, N.A.D. and Mannion, R. (2006). ‘Conceptualisations of trust in the organisational literature’. Journal of Health Organization and Management 20: 5, 417-433.
Search in Google Scholar Back to article
Cope, V., Jones, B. and Hendricks, J. (2016). ‘Resilience as resistance to the new managerialism: Portraits that reframe nursing through quotes from the field.’ Journal of Nursing Management, 24:1, 115-122.
Search in Google Scholar Back to article
Croft, C., Currie, G. and Lockett, A. (2015a). ‘Broken “two-way windows”? An exploration of professional hybrids.’ Public Administration 93: 2, 380-394.
Search in Google Scholar Back to article
Croft, C., Currie G. and Lockett, A. (2015b). ‘The impact of emotionally important social identities on the construction of a managerial leader identity: A challenge for nurses in the English National Health Service, Organization Studies 36:1, 113–131.
Search in Google Scholar Back to article
Crowe, M. (2005). ‘Methodological issues in nursing research, Discourse analysis: towards an understanding of its place in nursing’. Journal of Advanced Nursing, 51:1, 55-63.
Search in Google Scholar Back to article
Currie, G. and Lockett, A. (2007). ‘A critique of transformational leadership: Moral, professional and contingent dimensions of leadership within public services organizations. Human Relations 60, 341-370.
Search in Google Scholar Back to article
De Vries, M. and Nemec, J. (2013). ‘Public sector reform: An overview of recent literature and research on NMP and alternative paths’. International Journal of Public Sector Management 20:1, 4-16.
Search in Google Scholar Back to article
Fairclough N. and Wodak, R. (1997). ‘Critical discourse analysis: An overview’, in T. Van Dijk (ed.), Discourse and Interaction, London: Sage.
Search in Google Scholar Back to article
Felstead, A., Gallie, D., Green, F. and Inanc, H, (2013). Work Intensification in Britain: First Findings from the Skills and Employment Survey 2012 London: Institute of Education.
Search in Google Scholar Back to article
Ferlie, E., Fitzgerald, L., McGivern, G., Dopson, S. and Bennett, C. (2013), Making Wicked Problems Governable: The Case of Managed Networks in Health Care Oxford: Oxford University Press.
Search in Google Scholar Back to article
Fotaki, M. (2010). ‘Why do public policies fail so often? Exploring health policy-making as an imaginary and symbolic construction’. Organization 17, 703-720.
Search in Google Scholar Back to article
Freidson, E. (2001), Professionalism: The Third Logic Cambridge: Polity Press.
Search in Google Scholar Back to article
Gilbert, T.P. (2005), “Trust and managerialism: exploring discourses of care”, Journal of Advanced Nursing, 52 (4) 454-63.
Search in Google Scholar Back to article
Gilson, L. (2003). ‘Trust and the development of health care as a social institution’. Social Science and Medicine 56, 1453-68.
Search in Google Scholar Back to article
Gilson L., (2006). ‘Trust in health care: Theoretical perspectives and research needs’. Journal of Health Organization and Management, 20: 5, 359-375.
Search in Google Scholar Back to article
Granter, E., Wankhade, P., Mccann, L., Hyde, P. and Hassard, J. (2018). ‘Multiple dimensions of work intensity: Ambulance work as edgework’. Work, Employment & Society First published online: 19 March, 2018. http://journals.sagepub.com/doi/abs/10.1177/0950017018759207?journalCode=wesa[Accessed 03 November 2018].
Search in Google Scholar Back to article
Hallier, J. and Forbes, T. (2004). ‘In search of theory development in grounded investigations: Doctors’ experiences of managing as an example of fitted and prospective theorizing’. Journal of Management Studies 41: 8, 1379-410.
Search in Google Scholar Back to article
Hassard, J., Hyde, P., Cox, W.J., Granter, E. and McCann, L. (2017). ‘Exploring health work: A critical-action perspective’. Journal of Health Organization and Management, 31: 5, 567-580.
Search in Google Scholar Back to article
Hoyle L. (2014). ‘Nurses’ perception of senior managers at the front line: People working with clipboards’. Journal of Advanced Nursing 70: 11, 2528-2538.
Search in Google Scholar Back to article
Hunter, D.J. (2007). ‘Exploring managing for health’, in D.J. Hunter (ed.), Managing for Health Abingdon: Routledge.
Search in Google Scholar Back to article
Hyde, P., Granter, E., Hassard, J. and McCann, L. (2016), Deconstructing the Welfare State London:Routledge.
Search in Google Scholar Back to article
Ibarra, H. and Barbulescu, R. (2010). ‘Identity as narrative: Prevalence, effectiveness, and consequences of narrative identity work in macro role transitions’. Academy of Management Review 35: 1, 135-54.
Search in Google Scholar Back to article
Iedema, R., Degeling, P., Braithwaite, J. and White, L. (2004). ‘It’s an interesting conversation I’m hearing’: The doctor as manager. Organization Studies 25:1, 15-33.
Search in Google Scholar Back to article
Jefferson, T., Klass, D., Lord, L., Nowak, M. and Thomas, G. (2014). ‘Context and the leadership experiences and perceptions of professionals’. Journal of Health Organization and Management 28: 6, 811-829.
Search in Google Scholar Back to article
Kurunmaki, L. (2004). ‘A hybrid profession: The acquisition of management accounting expertise by medical professionals. Accounting Organizations and Society, 29:3/4, 327-347.
Search in Google Scholar Back to article
Kvale, S. (1996), Interviews: An Introduction to Qualitative Research Interviewing London: Sage.
Search in Google Scholar Back to article
Laschinger, H.K.S. and Finegan, J. (2005). ‘Using empowerment to build trust and respect in the workplace: A strategy for addressing the nursing shortage’. Nursing Economics January-February, 23: 1, 6 -13.
Search in Google Scholar Back to article
Latimer, J. (2000), The Conduct of Care: Understanding Nursing Practice Oxford: Blackwell Science.
Search in Google Scholar Back to article
Learmonth, M. (2017). ‘Making history critical: Recasting a history of the “management” of the British National Health Service’. Journal of Health Organization and Management 31: 5, 542-555.
Search in Google Scholar Back to article
Llewellyn, S. (2001), ‘“Two-way windows”: Clinicians as medical managers’. Organization Studies 22:4, 593-623.
Search in Google Scholar Back to article
MacDonald, K. (1995), The Sociology of the Professions Sage, London.
Search in Google Scholar Back to article
Marinetto, M. (2011). ‘A Lipskian analysis of child protection failures from Victoria Climbie to “Baby P”: A street-level re-evaluation of joined-up governance’. Public Administration 89: 3, 1164-81.
Search in Google Scholar Back to article
Martin, G. P. and Learmonth, M. (2012). ‘A critical account of the rise and spread of “leadership”: The case of UK healthcare’. Social Science & Medicine 74: 3, 281-288.
Search in Google Scholar Back to article
McCabe, T.J. and Garavan, T.N. (2008). ‘A study of the drivers of commitment amongst nurses, the salience of training and development and career issues’. Journal of European Industrial Training, 32: 7, 528-568.
Search in Google Scholar Back to article
McNamara, M. (2009). ‘Nursing academics’ languages of legitimation: A discourse analysis’. International Journal of Nursing Studies 46, 1566-1579.
Search in Google Scholar Back to article
Newell, S. and Swan, J. (2000). ‘Trust and inter-organizational networking’. Human Relations 53: 10, 1287-1328.
Search in Google Scholar Back to article
Newman, K., Maylor, U. and Chansarkar, B. (2002). ‘The nurse satisfaction, service quality and nurse retention chain: Implications for management of recruitment and retention’. Journal of Management in Medicine 16: 4, 271-291.
Search in Google Scholar Back to article
Nordgren, L. (2008). ‘The performity of the service management discourse: “Value creating customers” in health care’. Journal of Health Organisation and Management 22: 5, 510-528.
Search in Google Scholar Back to article
Noordegraaf, M. and De Wit, B.A.S. (2012). ‘Responses to managerialism: How management pressures affect managerial relations and loyalties in education’. Public Administration 90, 957-973.
Search in Google Scholar Back to article
O’Donohue, W. and Nelson, L. (2007). ‘Let’s be professional about this: Ideology and the psychological contracts of registered nurses’. Journal of Nursing Management, 15, 547-555.
Search in Google Scholar Back to article
O’Reilly, D. and Reed, M. (2010), ‘“Leaderism”: An evolution of managerialism in UK public service reform’. Public Administration 88: 4, 960-978.
Search in Google Scholar Back to article
Peter, E. and Morgan, K.P. (2001). ‘Explorations of a trust approach for nursing ethics’. Nursing Inquiry 8: 1, 3-10.
Search in Google Scholar Back to article
Petriglieri, G. and Stein, M. (2012). ‘The unwanted self: Projective identification in leaders’ identity work’. Organization Studies 33, 1217-1235.
Search in Google Scholar Back to article
Potter, J. and Wetherell, M. (1987). Discourse and Social Psychology: Beyond Attitudes and Behaviour London: Sage.
Search in Google Scholar Back to article
Pratt, M.G., Rockmann, K.W. and Kaufmann, J.B. (2006). ‘Constructing professional identity: The role of work and identity learning cycles in the customization of identity among medical residents’. Academy of Management Journal 49: 2, 235-62.
Search in Google Scholar Back to article
Reed, M. (2002). ‘New managerialism, professional power and organisational governance in UK universities: A review and assessment’, in A. Amaral, G. Jones and B. Karseth (eds), Governing Higher Education: National Perspectives on Institutional Governance, Dordrecht: Kluwer University Publishers.
Search in Google Scholar Back to article
Reed, M. and O’Reilly, D. (2011). ‘The grit in the oyster: Professionalism, managerialism and leaderism as discourses of UK public services modernization’. Organization Studies 32: 8, 1079-1101.
Search in Google Scholar Back to article
Reinders, H. (2008). ‘The transformation of human services’. Journal of Intellectual Disability Research, 52: 7, 564-572.
Search in Google Scholar Back to article
Rowe, R. and Calnan, M. (2006). ‘Trust relations in health care: Developing a theoretical framework for the “new” NHS’. Journal of Health Organization and Management, 20: 5, 376-396.
Search in Google Scholar Back to article
Rydenfält C., Johansson G., Larsson P.A., Akerman K. and Odenrick P. (2012). ‘Social structures in the operating theatre: How contradicting rationalities and trust affect work’. Journal of Advanced Nursing 68: 4, 783-795.
Search in Google Scholar Back to article
Sambrook, S. (2000). ‘Talking of HRD’. Human Resource Development International, 3: 2, 159-78.
Search in Google Scholar Back to article
Sambrook, S. (2001). ‘HRD as an emergent and negotiated evolution: An ethnographic case study in the British National Health Service’. Human Resource Development Quarterly 12: 2, 169-193.
Search in Google Scholar Back to article
Sambrook, S. (2006). ‘Management development in the NHS: Nurses and managers, discourses and identities’. Journal of European Industrial Training 30: 1, 48-64.
Search in Google Scholar Back to article
Scudder, L.E., Rheaume, A., Clement, L. and LeBel, N. (2011). Why new graduate nurses quit their first jobs’. International Journal of Nursing Studies, 48, 490-500.
Search in Google Scholar Back to article
Skinner, D., Saunders, M. and Duckett, H. (2004). ‘Policies, promises and trust: Improving working lives in the National Health Service’. International Journal of Public Sector Management 17: 7, 558-570.
Search in Google Scholar Back to article
Smircich, L., & Morgan, G. (1982). Leadership: The Management of Meaning. The Journal of Applied Behavioral Science, 18, 257-273.
Search in Google Scholar Back to article
Stewart, J. and Sambrook S. (2007). ‘HRD in health and social care: The emerging challenges’, in S. Sambrook and J. Stewart (eds), Human Resource Development in the Public Sector, London: Routledge.
Search in Google Scholar Back to article
Tallman, R. (2007). ‘Does trust matter?: Perceptions, trust and job satisfaction of hospital nurses’. International Journal of Business Research 7: 4, 200-211.
Search in Google Scholar Back to article
Townsend, K. and Wilkinson, A. (2010). ‘Managing under pressure: HRM in hospitals’. Human Resource Management Journal 20: 4, 332-338.
Search in Google Scholar Back to article
Traynor M. (1999). ‘Managerialism and Nursing: Beyond Profession and Pppression London: Routledge.
Search in Google Scholar Back to article
Tummers, L., Bekkers, V. and Steijn, B. (2009). ‘Policy alienation of public professionals: Application in a new public management context’. Public Management Review 11: 5, 685-706.
Search in Google Scholar Back to article
Tummers, L., Steijn, B. and Bekkers, V. (2012). ‘Explaining the willingness of public professionals to implement public policies: Content, context, and personality characteristics’. Public Administration 90: 3, 716-736.
Search in Google Scholar Back to article
Wallace, M. and Pocklington, K. (2002). Managing Complex Educational Change: Large Scale Reorganisation of Schools London: Routledge Falmer.
Search in Google Scholar Back to article
Williams, L.L. (2005). ‘Impact of nurses’ job satisfaction on organisational trust’. Health Care Management Review, 30; 3, 203-211.
Search in Google Scholar Back to article
Yu, K.H. and Levy, F. (2010). ‘Offshoring professional services: Institutions and professional control’. British Journal of Industrial Relations 48: 4, 758-783.
Search in Google Scholar Back to article

A discourse analysis of managerialism and trust amongst nursing professionals

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