Changing nurses' dis-empowering relationship patterns.

Abstract

BACKGROUND: Nurses' inter- and intra-disciplinary relationships are frequently interpreted as oppressed group behaviours, contributing to their relatively dis-empowered status. In the context of restructuring in health care, this study examined the views of hospital staff nurses about their relationships with nursing colleagues and other health care professionals and their ideas for change. AIM: The aim of this paper is to report a study to add the views of staff nurses to the discourse on restructuring and to make visible the processes that contribute to their marginalization. DESIGN: The study was descriptive and exploratory. Staff nurses from various hospitals in a large Canadian city were selected by theoretical sampling. METHOD: Twenty volunteer staff nurses were interviewed between 1998 and 1999, using broad, open-ended questions and prompts to explore nurses' various relationships in the health care system. This approach allowed for multiple responses and expansions of ideas, without losing focus. The interviews were audio-taped and later transcribed. Thematic analysis was carried out. FINDINGS: Many participants were aware of inter-disciplinary hierarchies, particularly between nurses and physicians. Many also showed insights into their own intra-disciplinary hierarchies and mutual non-supportiveness. Both types of relationships were found to be inextricably linked, sustaining nurses' oppression through dis-empowering discourses. Nurses expressed many ideas about how to promote mutually supportive relationships. CONCLUSION: Change for the better needs to come from within the nursing profession. To develop effective strategies, bedside nurses have to be included in decision-making processes affecting them and their practice, about which they are the experts. Mutual respect, awareness-raising through education, development of caring nursing communities, mentorship and non-hierarchical leadership are key to stopping dis-empowering discourses and practices amongst nurses.