How does the contemporary restructuring of health care affect nursing practice? Increasingly since the 1970s, and more intensively under recent reforms, Canadian health care is the focus of information-supported, professionally based management. In Managing to Nurse, Janet M. Rankin and Marie L. Campbell probe the operation of this new form of hospital and its effect management on nurses and nursing. Written from the nurse's perspective, this institutional ethnography discovers a major transformation in the nature of nursing and associated patient care: the work is now organized according to an accounting logic that embeds a cost-orientation into care-related activities. Rankin and Campbell illustrate how nurses adapt to this new reality just as they, themselves, perpetuate it - how they learn to recognize their adaptations as professionally correct and as an adequate basis for nursing judgement. Although Managing to Nurse may contradict contemporary beliefs about health care reform, the insiders' account that it provides is undeniable evidence that nurses' caring work is being undermined and patient care is being eroded, sometimes dangerously, by current health care agendas.
This is a book about a distinctive methodological approach inspired by one of Canada's most respected scholars, Dorothy Smith. Institutional ethnography aims to answer questions about how everyday life is organized. What is conventionally understood as "the relationship of micro to macro processes" is, in institutional ethnography, conceptualized and explored in terms of ruling relations.The authors suggest that institutional ethnographers must adopt a particular research stance, one that recognizes that people's own knowledge and ways of knowing are crucial elements of social action and thus of social analysis. Specific attention to text analysis is integral to the approach as is a sensitive to gender relations. Institutional ethnography is remarkably well suited to the human service curriculum and the training of professionals and activists. Its strategy for learning how to understand problems existing in everyday life appeals to many researchers who are looking for guidance on how to take practical action. At the same time, the highly elaborated theoretical foundation of institutional ethnography is difficult to deal with in the brief time most students are in the classroom. The authors successfully tackle the issue of teaching and applying institutional ethnography. Campbell and Gregor have been testing out instructional methods and materials for many years. MAPPING SOCIAL RELATIONS is the product of that effort.
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