The Credibility of Nursing Evidence: Three Case Studies Demonstrating the Devaluing of Nursing Knowledge and Experience to Serve the Hegemonies of Power and New Public Management

Abstract

The voice of nursing has struggled to be heard in matters relating to patient safety, quality of care, and the health and wellbeing of patients and communities. In Aotearoa New Zealand we have entered a period of intense fiscal scrutiny and austerity, where nursing (as the largest healthcare workforce) is being expected to save money through budget cuts, freezing of positions, and limited career progression to advanced nursing roles. Using institutional ethnography as the approach to explicate how managerial practices are imposed and operate in the healthcare sector, we present three case studies of extant highly political issues, which directly affect patient safety: 1) Registered nurse safe staffing in hospitals; 2) The overdue transformation of primary healthcare; and 3) The education and training of nurse practitioners (NPs). Each case study highlights how nursing knowledge and evidence is being excluded from the frontline, the design of services, and from policy and budgeting tables. We identify how hegemonic discourses and practices (neoliberal, new public management and medicine) subordinate the credibility of nursing knowledge and relegate it to a lower position in knowledge hierarchies, in turn posing a risk to patient safety. The paper raises epistemological issues related to whose knowledge is valuable, who is considered to know best, and whose interests are served when certain epistemologies are valued over others. Te reo Māori translation Ngā Tapuhi Rēhita i roto i ngā Kaupapa Here: Te noho i waenga pū i te mahi whaiaro me te mahi kirimana Ngā Ariā Matua Kāore i tino rangona te reo o ngā tapuhi mō ngā āhuatanga e pā ana ki te haumaru tūroro, te kounga taurimatanga, te hauora me te toiora o ngā tūroro me ngā hapori. I Aotearoa nei, kua tomo tātou ki tētahi wā arotake, here whakapaunga nui, i roto i ngā tūmanako kia whakahekea ngā utu e ao tapuhi (ko te ao tapuhi te kāhui kaimahi hauora nui rawa), i roto i te hiahia kia whāomoomotia he moni mā te tapahi rārangi pūtea, te whakatoka i ngā tūranga, me te whakauaua i te pikinga ara mahi ki ngā tūranga tapuhi teitei. Nā te whakamahi i te mātauranga momo tangata ā-hinonga hei ara mō te whakamārama i ngā tikanga whakahaere i whakatauria, e whakamahia ana hoki i te rāngai hauora, tēnei mātou te tāpae atu nei i ētahi mātainga e toru o ētahi take tōrangapū rawa o te wā, ka pā tika nei ki te haumaru tūroro: 1) Ngā taumata kaimahi tapuhi i roto i ngā hōhipera; 2) Te whakaumutanga o te taurimatanga hauora taketake kua roa e tāria nei; me te 3) akoranga me te whakangungu mō ngā kaimahi tapuhi (ngā NP). Ka kitea i roto i ia tū āhua he pēhea ngā mātauranga me ngā taunakitanga tapuhi i wehea ai i te aroākapa o ngā mahi, te hoahoatanga o ngā ratonga, me ngā tēpu wānanga kaupapa here, whakatakoto pūtea hoki. Ka tautohu mātou he pēhea ngā kōrero angahao herekore i ētahi atu, me ngā mahi anō hoki (tuku noa i ngā mahi pakihi, ngā kaiwhakahaere hauora tūmatanui me te ao rongoā hou) e tāmi ai i te mōhiotanga o te ao tapuhi, e whakahokia ai ki tētahi taumata pāpaku i roto i ngā whakapaparanga mōhiotanga, me te puta mai o ētahi tūraru mō te haumaru tūroro. I tēnei pepa ka whakatairangatia ētahi take mātauranga e pā ana ki te pātai ko te tohunga whai mōhiotanga whai hua, ko wai kei te tino mōhio, ko wai hoki te hunga ka whiwhi painga, ki te whakapikia ētahi tikanga wehewehe mātauranga ki runga ake i ētahi. Ngā kupu matua Anga mātauranga; mātauranga momo tangata; nurse practitioners / mātanga tapuhi, mahi tapuhi, haumarutanga tūroro; kaupapa here; tōrangapū; taurimatanga hauora; taumata kaimahi haumaru