Who to turn to? 'Knowing the ropes' in an underbounded health care system
Elizabeth McInnes
SV & MHS ACU Nursing Research Institute and School of Nursing, Australian Catholic University, Sydney NSW
Mary Chiarella
Modelling of Care Project, School of Nursing, University of Sydney, Sydney NSW
PP: 010 - 020
Abstract
This paper explores the impact of restructuring, conducted under the auspices of new public sector management, on the delivery of hospital based nursing care. Alderfer's model of 'overbounded' and 'underbounded' systems is used to analyse the way in which the organisation and delivery of nursing care has changed.
Nursing was traditionally organised in an overbounded system which nevertheless focussed clearly and primarily on the provision of excellence in patient care. Recent research and examples from case law illustrate how nursing has moved into an underbounded system, where lines of authority and accountability are crossed and blurred. This can lead to practices of 'responsible subversion' which leave nurses feeling dissatisfied, guilty and marginalised.
New management models are required to address the multiple and competing authority relations and imprecise, incomplete and overlapping role definitions.
Keywords
health management structures; nursing; lines of responsibility
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