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

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.

Municipal Acute Units as Part of the Clinical Pathway for Older Patients

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Associations between nurse managers’ leadership styles, team culture and competence planning in Norwegian municipal in‐patient acute care services: A cross‐sectional study

“…However, one fifth of the managers scored in the lower third on both leadership styles. One explanation may be that the nurse managers’ heavy administrative workload and resource scarcity overburden them; restrict their freedom of action; and divert their attention from being a clear and visible leader [ 8 , 21 ].…”

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Nurses' assessments of horizontal collaboration in municipal health and care services for older adults: A cross‐sectional study

“…Allen's (2019) concept of “organizing work” refers to the “everyday elements of nursing practice concerned with the coordination and organization of patient care” in the health and social care system. Several studies underpin that nurses in both the hospital and municipal setting play key roles in facilitating collaboration and coordination of care among different (interdependent) actors in the healthcare services (Allen, 2014, 2019; Kise Hjertstrøm et al, 2018; Melby et al, 2018).…”