Since at least the 1970s in Canada, there have been calls for health system reforms based on innovative roles and expanded scopes of practice for nurses. Professional regulatory organizations, through legislation, define the standards and parameters of professional nursing practice. Nursing regulators emphasize public protection over the advancement of nursing; regulatory processes and decisions tend to be conservative and risk‐averse. This study explored the impact that regulatory processes have on innovation in nursing roles. Nurses in a range of unique practice (...) situations were interviewed, including nurses in non‐traditional roles and/or settings, those with cross‐jurisdictional career histories, and those working in interdisciplinary practices and educational settings. For these nurses, nursing practice was viewed through a traditional clinical lens, which did not fit for them. They experienced hassle, delay, and inconsistencies in regulatory practices. They felt mistreated and fearful of the regulator and lamented the ways in which ambitious, creative, capable nurses were stymied in attempting new applications for nursing knowledge. Nursing is constraining its own mandate to contribute to health care through stringent licensing processes. Healthcare reform provides an opportunity for nursing regulators to rethink their processes and provide the latitude for nurse‐driven change. (shrink)

Nursing codes of ethics and conduct are features of professional practice across the world, and in the UK, the regulator has recently consulted on and published a new code. Initially part of a professionalising agenda, nursing codes have recently come to represent a managerialist and disciplinary agenda and nursing can no longer be regarded as a self‐regulating profession. This paper argues that codes of ethics and codes of conduct are significantly different in form and function similar to the difference between (...) ethics and law in everyday life. Some codes successfully integrate these two functions within the same document, while others, principally the UK Code, conflate them resulting in an ambiguous document unable to fulfil its functions effectively. The paper analyses the differences between ethical‐codes and conduct‐codes by discussing titles, authorship, level, scope for disagreement, consequences of transgression, language and finally and possibly most importantly agent‐centeredness. It is argued that conduct‐codes cannot require nurses to be compassionate because compassion involves an emotional response. The concept of kindness provides a plausible alternative for conduct‐codes as it is possible to understand it solely in terms of acts. But if kindness is required in conduct‐codes, investigation and possible censure follows from its absence. Using examples it is argued that there are at last five possible accounts of the absence of kindness. As well as being potentially problematic for disciplinary panels, difficulty in understanding the features of blameworthy absence of kindness may challenge UK nurses who, following a recently introduced revalidation procedure, are required to reflect on their practice in relation to The Code. It is concluded that closer attention to metaethical concerns by code writers will better support the functions of their issuing organisations. (shrink)

Background: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. Discussion: Some researchers suggest that a closer examination of how socio-political structures influence healthcare (...) delivery will move moral distress from being seen as located in the individual to an experience that is also located in broader healthcare structures. Informed by new thinking in relational ethics, we draw on research findings from neuroscience and attachment literature to examine the reciprocal relationship between structures and agents and frame the experience of moral distress. Conclusion: We posit moral distress as a form of relational trauma and subsequently point to the need to better understand how nurses as moral agents are influenced by—and influence—the complex socio-political structures they inhabit. In so doing, we identify this reciprocity as a framework for interventions. (shrink)

Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much‐needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision‐making of nurses through the impact of health institution management models on clinical practice. Based on Foucault's ethical theory, a qualitative study was conducted through a discourse analysis of the nursing records in (...) a hospital unit. The results revealed that the health institution standardises health care practice, which has an impact on professional and patient autonomy as it pertains to decision‐making. The results of this research indicate that resistance strategies in the internal structures of health organisations can replace the normalisation and instrumentalisation of professional practice aimed at promoting patient self‐determination. (shrink)

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time (...) dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge. (shrink)

Nursing professionalization is both ongoing and global, being significant not only for the nursing workforce but also for patients and healthcare systems. For this reason, it is important to have an in‐depth understanding of this process and the factors that could affect it. This literature review utilizes a welfare state approach to examine macrolevel structural determinants of nursing professionalization, addressing a previously identified gap in this literature, and synthesizes research on the relevance of studying nursing professionalization. The use of a (...) welfare state framework facilitates the understanding that the wider social, economic, and political system exercises significant power over the distribution of resources in a society, providing a glimpse into the complex politics of health and health care. The findings shed light on structural factors outside of nursing, such as country‐level education, health, labor market, and gender policies that could impact the process of professionalization and thus could be utilized to strengthen nursing through facilitating increased professionalization levels. Addressing gender inequalities and other structural determinants of nursing professionalization could contribute to achieving health equity and could benefit health systems through enhanced availability, skill‐level, and sustainability of nursing human resources, improved and efficient access to care, improved patient outcomes, and cost savings. (shrink)

Drawing upon selected literature from the United Kingdom, Denmark, and Canada we examine how Foucault's concepts of ‘episteme’, ‘rupture’ ‘parrhesia’ ‘care of the self’, and ‘problemitization’ have been applied to particular contexts of leadership development, pedagogy, nursing knowledge, and the relationship between caring and politics. Our aims are threefold: to give examples of how selected Foucauldian concepts have been taken up in practice; to clarify how we are positioned today as nurses; and to invite more nurses to engage critically with (...) historical inquiry and to engage in deep philosophical reflection about their relationship with nursing. We begin by examining the conditions and circumstances of Foucault's life, and conclude by posing the question in our subtitle to stimulate debate about the philosophical relevance of Foucauldian scholarship to nursing. (shrink)