Martini Dieke, Noordegraaf Mirko, Schoonhoven Lisette, Spits Jet, Van Bokhorst Pauline, Lalleman Pieterbas
Research Group for Person-Centeredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Nurs Inq. 2025 Jan;32(1):e12696. doi: 10.1111/nin.12696.
Shared governance in hospitals promotes the inclusion of nurses' expertise, knowledge and skills in organisational processes, and nurses increasingly fulfil positions in organisational hierarchies. However, incorporating nursing expertise in strategic governance structures might be complicated, as these structures are primarily linked to managerial and biomedical expertise. Drawing on a Foucauldian perspective on knowledge and power, intertwined and embedded in everyday (inter)actions, we study how newly appointed directors of nursing challenge these dominant 'modes of knowing'. By focusing on a (Dutch) healthcare organisation, a large academic medical centre, we gained insight into how the history of director of nursing roles relates to how nursing expertise is valued. We gathered qualitative data (from multiple sources) to get close to the daily practices of these directors. In this way, we were able to highlight three tactics that enable directors to relate to new 'knowledge-power knots': (1) positioning, by creating more unity; (2) profiling, by showing significance and (3) powering, by being alert and intervening. With these tactics, the directors of nursing try to embed themselves and their expertise in hospital governance. This study contributes to an everyday understanding of power and the tactics that directors of nursing employ as an ongoing practice. This provides practical starting points for embedding nursing in governance and decision-making.
医院的共享治理促进了护士的专业知识、技能在组织流程中的融入，并且护士在组织层级中担任的职位越来越多。然而，将护理专业知识纳入战略治理结构可能会很复杂，因为这些结构主要与管理和生物医学专业知识相关。借鉴福柯关于知识与权力相互交织并嵌入日常（互动）行为的观点，我们研究新任命的护理主任如何挑战这些占主导地位的“认知模式”。通过聚焦于一家（荷兰的）医疗保健机构，一家大型学术医疗中心，我们深入了解了护理主任角色的历史与护理专业知识受重视程度之间的关系。我们收集了（来自多个来源的）定性数据，以贴近这些主任的日常实践。通过这种方式，我们能够突出三种使主任能够与新的“知识 - 权力节点”建立联系的策略：（1）定位，通过创造更多的统一性；（2）塑造形象，通过展现重要性；（3）赋能，通过保持警觉并进行干预。凭借这些策略，护理主任试图将自己及其专业知识融入医院治理。这项研究有助于从日常角度理解权力以及护理主任作为一种持续实践所采用的策略。这为将护理融入治理和决策提供了实际的切入点。
