The social construction of competence and "incompetence" : problematics of hospital nursing work in the era of restructuring
This is an institutional ethnography of front-line nurses and their work in hospitals in Vancouver and the Lower Mainland during the turmoil and change of health care restructuring. "Restructuring", then, is a contextual theme overshadowing the working lives of the nurses in this study. Another contextual theme is job segregation on the basis of gender and racialized ethnicity, seen when comparing the demographic compositions of nursing working groups on different levels of care (for example,
... re nurses from formerly colonized countries work in lower prestige areas like extended care). The intensification of nursing work, routinization, and an increasing division between conceptual and physical tasks have characterized hospital nursing work in the last decade. Nurses' anxiety about being "competent" in this new environment sometimes culminates in dysfunctional processes of negotiating "competent/incompetent" identities. This process (identified in the study as "anxious competence" and "projection of incompetence on the other"), is parallel to the phenomenon of "targeting" or workplace bullying at other worksites, and is usually directed by a few nurses toward an individual nurse who is new to the floor or who is somehow "different". This kind of targeting demarcates for some nurses the boundaries between what is competence and what is incompetence, and helps to maintain the reputation and prestige of their working group as "high functioning". Nurses have developed tactics of solidarity and resistance to targeting and negative effects of restructuring. The conceptual framework is informed by social constructionism, labour process theory, and feminist critical social theory. Fieldwork consisted of participant observation on three floors (corresponding to critical, acute, and extended levels of care) for one year in two hospitals in the Lower Mainland; and interviews with 25 front-line nurses and four nursing managers. Suggested policy changes could improve the working and interactional environments of nurses.