Shifting (com)positions on the subject of management : a critical feminist postmodern ethnography of critical care nursing

This ethnographic study investigated nurses’ experiences of managing nurses and being managed by nurses within the context of a critical care unit. The four specific aims of the study were to: valorise and make space from which nurses could speak of their management perceptions and experiences; investigate and interrogate the cultural practices and knowledges that comprised and reinscribed the discourses of nursing management; identify the marginal, contradictory or subjugated discourses in the form of alternate or oppositional knowledges and practices embedded in nurses’ experience; and reveal how participants were inscribed by or resisted the various discourses, including the multiple and mobile subject positions they adopted. The ethnography was theoretically informed by critical, feminist, and postmodern perspectives. Utilising the strategy of writing from the authorial position of occupying a mobile or nonunitary subjectivity, the research highlighted the methodological tensions so as to struggle for social justice whilst contesting the romance of knowledge as cure (Lather, 2000). Music was metaphorically appropriated to interrupt, subvert, and draw attention to the partial, interpretive, and intertextual nature of ethnographic representation and to represent the feminine other in a thesis normatively privileging written text. Conducted over a period of ten months, direct participant observation, individual interviews, and reflective field notes comprised the data. Eleven registered nurses, from all levels of the nursing hierarchy, participated in the study, in addition to the researcher. The findings of this research revealed nurses experienced feeling abnormal, lonely, angry, and rejected. Interprofessional relations reflected a lack of individual valuing and predominantly vertical violence. Shifting subject positions were primarily informed by dominant instrumental, patriarchal, managerialist, and modernistic discourses that homogenised the identity of nurses and defined the meaning of progress and normal. Management activities were deemed superior to the activities and being of a clinical nurse. Alternate and subjugated discourses included notions of teamwork, equality, mateship, and viewing management as superfluous and contemptuously. Patriarchal behaviours separating personal life from work life were contested, and behaviours often denigrated and stereotyped as female were valued. Valuing and sharing being human within ordinary nursing work, valuing work for the enjoyment of the work itself, and viewing power as with rather than over were further alternate discourses. The major implications from this study for nursing as a profession relate to nurses explicitly and foremost valuing their own practice and fostering a culture that genuinely permits individual diversity to alter the existing pre-scripted relations that constrain nurses’ ability to engage in more meaningful interpersonal relations. Questioning current discourses and practices that value specific economic and scientific knowledges, support patriarchal behaviours, and silence nurses is essential. The articulation of alternative discourses that value women and nursing is crucial for reconstructing a reality that does not result in women and nurses feeling abnormal, rejected, and alienated; particularly within the context of a nursing shortage.