Writing ourselves into a web of obedience: A nursing policy analysis

Background: Nursing work is governed by a web of overarching documents from professional bodies, registration bodies, and individual health care organisations. The focus for these documents is to maintain high standards and protect patients and organisations from unnecessary risk. The presentation of the nurse within these documents has important implications for the ability of nurses to function as autonomous professionals. Objectives: How the role of the nurse is situated in hospital procedural policy, and more specifically how these presentations of the nurse define, limit, and enable nursing practice is the focus of this paper. Design: A combination of random and purposive sampling of the nursing policies of one tertiary level hospital was utilised to collect policy documents for thematic content analysis. Setting: The study was completed in a tertiary level health institution, in one Australian jurisdiction with a population of approximately 500,000 people. This health institution employs over 4000 people and admitted 49,000 patients in the 2004-2005 financial year. Methods: An inductive approach, which utilised theoretical and contextual comprehension of the nursing policies, informed the collation of coded data which determined the themes of the study. Findings: Analysis consisted of coding of particular words, textual structure and theory content. Practice was presented in the nursing procedural policies in two themes, called 'lingering tradition' and 'bureaucratic template'. Conclusions: The discourse of hospital procedural policy situates the nurse as obedient to organisational requirements by limiting practice to a performance of actions without explicit recognition of professional autonomy. This sets up a puzzling contradiction between performance expectations from the employing organisation and the nursing profession. Writing hospital policy in the discourse of procedural directives reduces nurses' ability to act as autonomous, critically thinking professionals, with implications for patient safety, nurse autonomy and the professional status of nursing. (C) 2009 Elsevier Ltd. All rights reserved.