REGULATING HOSPITAL SOCIAL WORKERS AND NURSES

Abstract

<p>Canadian hospitals continue to adopt private sector strategies in an attempt to improve efficiency, accountability and quality. One such mandated efficiency is a computerized psychosocial assessment for mental health patients known as the Resident Assessment Instrument–Mental Health (RAI-MH). This thesis uses the RAI-MH as the gateway into exploring how neoliberal or private sector strategies are used to penetrate hospital care work resulting in the regulation and restructuring of work practices. The RAI-MH requires professionals to input specified, closed ended data about patients simplifying and narrowing their practice in an attempt to govern, measure and fund what is “value added” in the patient/professional encounter. This qualitative study uses interviews with social workers and nurses to examine the competing tensions experienced by professionals as they strive to provide client-centred care in a culture that promotes computer-centred care.</p> <p>My research findings reveal that the idealized portrayal of the 21^st century knowledge worker is in sharp contrast to the realities faced by many increasingly standardized and “leaned-out” health care professionals. Social workers and nurses report that standardization leads to increasing surveillance. A few professionals comply with the increasing standardization or regulation but most found ways to resist while striving to maintain professional autonomy. As certain areas of work become standardized some professionals find ways to increase autonomy in other areas of their work. The findings reveal differences between those who engaged in work tasks outside of paid work hours (boundary crossings) and those who did not (boundary refusals). <strong></strong></p> <p>Theoretically, this thesis contributes to the literature by illuminating the processes involved within the rapidly changing organization of hospital service delivery. Substantively, it adds to the literature on understanding the work of service providers and how they continue to find creative ways to resist the standardization process.</p>