Hospital Bureaucracy and Nurses: A Qualitative Study in Yazd, Iran

Introduction: Nowadays given the widespread bureaucratic systems in all social domains, and also the possibility of dominating through laws, norms, power relations, etc, one will increasingly witness these systems' negative consequences on individuals or employees. Thus, the present study investigated the contexts and consequences of expanding hospital bureaucratic processes on nurses' performance in Yazd, Iran. Methods: This qualitative research used a grounded theory(GT) method. The target population was nurses in public hospitals in Yazd, and through a theoretical and purposeful sampling, twenty of them were selected and in-depth interviews were conducted. The theoretical sampling was continued until the data saturation stage. Data were analyzed using open, axial, and selective coding. Results: The findings included seventeen main categories (including nurses' lack of leisure time, malfunctions of non-meritocracy, control and exile of nurses, phobia of blood-money petitions, comparisons of failure, and conflicting social policies), and one core category (construction of dissociation bureaucracy), which were presented as the paradigmatic model, and theoretical schema. Conclusions: The results showed that the dissociation bureaucracy is constructed as a result of widespread domination of the scaled bureaucracy, which is manifested in micro, middle, and macro scales within the hospitals. Encountering the domination of the scaled bureaucracy, nurses generally adopt a variety of strategies, including intentional transfer to other medical units, work dynamism, striving for a promotion, and long-term compatibility with the job. Nurses' reactions and resistance to the domination of the scaled bureaucracy, which are presented through various strategies, ultimately lead to consequences, including disruption in friendly social relations and material reflection in nursing.