Slow death by policy manual

In an era of corporatized health care systems, increasingly overseen by strategic operations specialists and risk managers, nurses are struggling to maintain practice environments within which their nursing intelligence, applied the unique distinctive needs each patient situation, can be enacted. It has been well recognized that significant changes in complex forces shaping throughout second half 20th century have led a reduction tolerance for self-regulation widespread uptake expanded external controls. According McIntyre, Burton Holmes, as our organizations corporatized, with leadership interpreted oversight rather than professional management, augmented additional mechanistic influence electronic record keeping we “effectively erasing creativity, judgement indeed very humanity necessarily iteratively shaped construct nursing” (McIntyre et al., 2020, p. 7). is important understand these trends did not simply happen natural evolution growth development, but actually part grand design make delivery systems more efficient effective, reduce wastage error, benefit from what learned standardizing mechanisms processes demonstrably advantaged industrial sector. Systems such “lean management,” borrowed automobile manufacturing care, provide management philosophy includes powerful tools enforcing accountability structures help work relentlessly toward those goals (Kim 2006). Proponents lean explicitly seek dismantle they consider cultural practical barriers efficiency organization. On front, see “silo mentality” individual professions structural impediment; therefore strongly advocate break down favor interprofessional interchangeability across clinical programs organizational functions. recognize idea individualized (i.e., “each unique”) central ideological flaw requires vigilent surveillance emphatic disruption These kinds philosophies often described contributing “McDonaldization” (Ritzer, 1993) nursing, create conditions enforce standardized solutions workers do all settings, contexts, situations (Bradshaw, 2016; Norlyk 2017). Standardization makes much easier discipline control, thereby creating impression evidence-based accountability. That corporate most forcefully particular not, therefore, surprising. Not only constitute largest workforce, also notoriously resistant processes, given epistemological hardwiring patients individuals unmet needs. Further, significantly less likely other disciplines appropriate representation at senior governance tables (Prybil, 2013). Thus it inevitable will hardest-hit implementation modern practices (Rankin & Campbell, As many point-of-care noticed, obvious manifestation rapid proliferation standard protocols, guidelines, reporting requirements govern increasing array everyday activities. Their compliance policies protocols becomes driving focus managers who, increasingly, themselves may little understanding or sympathy perspective on constitutes good care. From perspective, adherence routines meeting Nurses feel disciplined controlled beyond point being able independent decisions behalf patients—to enact intelligence expertise profession stands for. Austin (2011) explained, this nature moral routinized activity. “Seeing suffering while unable respond true compassion, running around targets, delivering ‘very good' customer service leaves disoriented. They lose bearings self-identification ‘nurse' ceases meaning” (p. 164). Thus, she explains, operational incommensurate conceived practice. While COVID-19 demonstrated world value humane compassionate action, even extreme yet effectively mount argument serve populations better when supported exerting amount control over Within seems patently self-evident why empowered actively engaged strong astute leadership, improves likelihood safe effective (Murray 2018). [We know opposite true—that demoralized disempowered force poor 2016)]. However, must find ways pitch logic against managerial dedicated mission disarming dismantling us. Nursing Inquiry readers among inclined critically curious about unintended effects tightening circumscribing reducing inherent complexity profession's contribution captured task list. trend escalates, believe imperative offer countervailing “task fraternity” thoughtful critical conversations engage worlds theorizing, philosophizing, deconstruction. (Thorne 2012, 189) does seem if made progress perhaps slipped behind. I still community contains wisdom scholarly capacity sustain critique press change. pages journal, am confident continue support champion scholars who concern reflection global trends, remain persistently optimistic that, together, something turn tides. never just up declared defeat. And now time begin.