Where we are and how we got here : an institutional ethnography of the Nurse Safe Staffing Project in New Zealand : a thesis in fulfilment of the requirements for Doctor of Philosophy, Massey University, School of Nursing, College of Health, Manawatu, New Zealand

Abstract

Frontline nurses in New Zealand hospitals still work on short-staffed shifts 18 years after they began to express concerns about unsafe staffing and threats to patient safety. The Nurse Safe Staffing Project and its strategies (Escalation planning and the Care Capacity Demand Management Programme) were designed to address the incidence and risks of short-staffing. After a decade, these strategies are yet to yield tangible improvements to frontline nursing numbers. Using institutional ethnography, I have charted a detailed description and analysis of how aspects of the strategies of the Nurse Safe Staffing Project actually work in everyday hospital settings. Competing institutional knowledge and priorities organise what is happening on short-staffed shifts, and nurses are caught in the crossfire. The central argument throughout this thesis is that nurses’ vital situated knowledge and work are being organised by and overridden in this competitive institutional milieu. I show how what actually happens is consequential for nurses, patient care, and staffing strategies. This analytical exploration contributes knowledge about nurses’ situated and intelligent compensatory work on short-staffed shifts, how this knowledge is displaced by abstracted institutional knowledge, and the competing social relations present in environments where nurse-staffing strategies are negotiated.