Health Care System Reform and Senior Nurse Managers: Marginalisation as a Factor Contributing to the Nursing Crisis

By:
Dr. Marilyn Orrock,
Prof. Jocalyn Lawler
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The health care reform process in Australia, which gathered momentum during the decade of the nineties, was underpinned by rationalist ideology and managerialism. With a strong focus on the structural, financial and strategic aspects of health care, the traditional professional norms, values and attitudes were discarded for those that supported and strengthened corporatisation, restructuring and re-engineering along quasi private sector business management principles. This technical rational approach to health care was underpinned by a shift from a culture of care to a culture of getting the numbers right; the norms and values of a 'reformed' health care sector were inimical to nursing which, despite a long history of political invisibility and voicelessness in the discourse of public health care, found themselves further marginalised, yet expected to be the primary implementers of the reform agenda.

During the past decade there has been a surge of literature hailing the dawning of a new age of empowerment for senior nurse managers inherent in organisational restructuring and reform. In contrast, our research has demonstrated a progressive disempowering of senior nurse managers, which is part of a wider crisis in the health system's capacity to find a sustainable pattern for the nursing workforce.

In this paper we report on current research into the personal experiences of senior nurse managers in New South Wales Health (Orrock in progress). Throughout this study strong themes of oppression and marginalisation emerged as the participants related stories of betrayal, humiliation and disempowerment within a hostile and toxic health care management environment. Some described their experiences as akin to domestic violence. We will argue that the current nursing crisis is the consequence, in part, of marginalised nurse leaders, as well as a fundamental misunderstanding of nursing's value base and contribution to health care service provision.


Keywords: Health Care Reform, Senior Nurse managers, Marginalisation, Disempowerment, Oppression
Stream: Politics, Public Policy and Law
Presentation Type: Paper Presentation in English
Paper: Health Care System Reform and Senior Nurse Managers


Dr. Marilyn Orrock

Lecturer, Health Services Management., Faculty of Nursing and Midwifery, The University of Sydney
Sydney, New South Wales, Australia

Marilyn completed her nurse education in Broken Hill in 1970 and has extensive experience in nursing and health services management in both remote rural and tertiary referral hospitals, before joining the Faculty of Nursing and Midwifery. Her clinical background includes all critical care areas, operating theatres and labour wards. Her major area of clinical experience and preference is emergency and trauma nursing. She holds qualifications in nursing, midwifery, psychology, education and health services management. Her main research interests are leadership and health services management.

Prof. Jocalyn Lawler

Dean, Faculty of Nursing and Midwifery, The University of Sydney
Sydney, New South Wles, Australia

Jocalyn began her nursing career in Broken Hill in outback Australia, in 1967. She holds qualifications in nursing, social science and education and took Doctor of Philosophy from the University of New South Wales in 1989. Her research interests concern the experience of illness, methodologies for nursing research, nurses' social and interpersonal management of the body, and the reasons why nurses work is poorly understood and invisible.Jocalyn took up her position as Professor of Nursing at The University of Sydney in 1992; and she has been Dean of the Faculty of Nursing and Midwifery since 1999.

Ref: I06P0129