Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing home

Abstract

By most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing's value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing's quest for professional status in the face of medicine's hegemony over health-care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict--and by aides' resistance to nurses' domination.

An Integrative Review of the Structures and Processes Related to Nurse Supervisory Performance in Long‐Term Care

“…as being important for an effective nurse supervisor in LTC included having a genuine admiration and affinity toward working with older adults (Cooper & Mitchell, 2006;Jervis, 2002;Moyle et al, 2003) as well as empathy, compassion, and sense of humor (Cooper & Mitchell, 2006;Dellefield, 2008). In the quantitative study, increased nurse age and personal attributes (e.g., financial, job-related physical and emotional health change) were associated with the effectiveness of a nurse supervisor.…”

Dysfunctional Health Service Conflict

“…Others have noted that the nursing profession is itself rigid, authoritarian, punitive, strict, rule-bound, and highly selfprotective-traits that might not only be considered masculine, but that also block power sharing with other female-dominated groups such as nurse aides in nursing homes (perhaps because closer ties to the aides may compromise the nurse's status and professional identity, which is already threatened by working in the historically stigmatized setting). 5,[123][124][125] Jameson 126 complicates things further by contemplating that conflict principle of collusion explains how both doctors and nurses play expected, if grating, roles that are consistent with the mythos of historic doctornurse relationships: the domineering male versus the compliant female. Both expect, subconsciously, to be treated in certain ways: doctors expect deference, whereas nurses assume the mantle of a resentful and disrespected servant.…”

Experiences of Racism by Female Minority and Immigrant Nursing Assistants

“…Their job is still considered unskilled and menial by society, despite its significance in supporting the well-being of vulnerable individuals. CNAs have little to no status in the health care community, receive little respect, and have no autonomy on the job (Crickmer, 2005;Jervis, 2002). Their average earnings are less than $10 an hour with minimal benefits, and many of them have incomes that are below the poverty line in spite of their full-time and often overloaded work schedules (Potter, Churilla, & Smith, 2006).…”

“…They are at the bottom of the health care hierarchy, in terms of status, salary, and privileges, while white middle-class women occupy higher-level managerial and supervisory positions (Dodson & Zincavage, 2007;Glenn, 1992;Jervis, 2002).…”