Institutional Ethnography (IE), Nursing Work and Hospital Reform: IE's Cautionary Analysis

Abstract

Hospitals in Canada have been subject to intensive reorganization in the past few decades as the public health care system absorbs and adapts to a neoliberal government agenda that promotes more "efficient and effective" use of public funds and increased involvement on the part of the private sector. A massive infusion of public money for health information technology and health services research has created the capacity to generate objectified knowledge and to use it to reform the health care system—both its organization and, increasingly, its therapeutics—with the promise of making it all work better. The research reported here is on the engagement of professional nurses in their everyday/night work in restructured hospitals and on how nursing practice is being reshaped in consequence. Our research approach, institutional ethnography, focuses on the social organization of health knowledge from the standpoint of those involved in and subordinated to its managerial uses, in this case, the nurses. We argue that a new form of ruling is being deployed. Nurses play an active part in the subordination of their own professional judgment to the objectified knowledge and knowledge-based practices that externalize decision making and reposition authoritative knowing. The paper describes and discusses the conduct of an institutional ethnographic inquiry (RANKIN & CAMPBELL, 2006) and illustrates some of its distinctive features using examples from our research. URN: urn:nbn:de:0114-fqs090287