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Making New Health Services Work: Nurse Leaders as Facilitators of Service Development in Rural Emergency Services

1
Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway
2
Department of Health Sciences in Gjøvik, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 2802 Gjøvik, Norway
*
Author to whom correspondence should be addressed.
Healthcare 2018, 6(4), 128; https://doi.org/10.3390/healthcare6040128
Received: 19 September 2018 / Revised: 22 October 2018 / Accepted: 25 October 2018 / Published: 27 October 2018
(This article belongs to the Special Issue Rural and Remote Nursing)
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PDF [231 KB, uploaded 27 October 2018]

Abstract

Nurse leaders in middle management positions in Norway and other Western countries perform additional new tasks due to high demands for quality and efficacy in healthcare services. These nurses are increasingly becoming responsible for service development and innovation in addition to their traditional leadership and management roles. This article analyses two Norwegian nurse leaders efforts in developing an emergency service in rural municipal healthcare. The analysis applies an ethnographic approach to the data collection by combining interviews with the nurse leaders with observations and interviews with six nurses in the emergency service. The primary theoretical concepts used to support the analysis include “organizing work” and “articulation work”. The results show that in the development of an existing emergency room service, the nurse leaders drew upon their experience as clinical nurses and leaders in various middle management positions in rural community healthcare. Due to their local knowledge and experience, the nurses were able to mobilize and facilitate cooperation among relevant actors in the community and negotiate for resources required for emergency medical equipment, professional development, and staffing to perform emergency care within the rural healthcare context. Due to their distinctive professional and organizational competency and experience, the nurse leaders were well equipped to play a key role in developing services. While mobilizing actors and negotiating for resources, the nurses creatively balanced these two aspects of nursing work to develop the service in accordance to their expectation of providing the highest quality of nursing care to their patients. The nurse leaders balanced their professional ambitions for the service with legal directives, economic incentives, and budgets. Throughout the development process, the nurses carefully combined value-based and goal-based management concerns. In contrast, other studies investigating nursing management and leadership have described that these orientations are in opposition to each other. This study shows that nurses leading the processes of change in rural communities manage the change process by combining the professional and organizational domains of the services. View Full-Text
Keywords: nurse leaders; rural nursing; organizational work; articulation work; qualitative research; service development; health policy; rural emergency clinic nurse leaders; rural nursing; organizational work; articulation work; qualitative research; service development; health policy; rural emergency clinic
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Kise Hjertstrøm, H.; Obstfelder, A.; Norbye, B. Making New Health Services Work: Nurse Leaders as Facilitators of Service Development in Rural Emergency Services. Healthcare 2018, 6, 128.

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