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Placing coordination inside or outside nursing: The professional self-concept of inter-organisational coordination among frontline nurses and nurse leaders in Denmark

Author:

Anne Doessing

Via University College, Denmark, DK
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Abstract

Patients need better coordinated health services, and coordination has always been a part of what nurses do (1). Yet, professionally led development of coordination depends on whether this is regarded as a legitimate professional task. A central element of professional logic is to grant or deny legitimacy to actions based on the view of relevant professional problems and attached views of valid evidence (2). Thus, if coordination is not viewed as a legitimate part of nursing, no endogenous development and innovation of such tasks can be expected to take place.

Thus, the object of this paper is to provide empirical insight into the professional self-concept of inter-organisational coordination (IOC) based on a qualitative case study involving 44 Danish nurses and nurse leaders from hospitals, municipal institutions and general practices. Empirical material included field observations and five focus groups.

In exceptional cases, nurses interpret IOC as ‘outside nursing’ due to the administrative character of the work and because it did not match the nurses’ general understanding of nursing.

Ambivalence towards IOC was the dominating picture reflected in numerous accounts related to the demarcation of the nursing job, awareness of IOC tasks, the nursing education, the office location and finally the distribution of IOC tasks among staff members. E.g., one the one hand, the nurses themselves feel unable to explain this work to outsiders. On the other hand, the nurses criticise ‘the healthcare system’ for not recognising the IOC they perform.

Understanding ‘IOC as inside nursing’ is also a rare interpretation, but some nurses express a functional based self-understanding: Since IOC is a comprehensive part of nursing work; it also becomes a natural part of what nursing is. Furthermore, the nurse leaders have a fairly clear stand on this, as they link IOC directly to nursing and even to the professional core concept of caring.

Consequently, the professional self-concept of IOC can be characterised as a non-homogeneous inter-mixture of rejection, profound ambivalence and inclusion. The findings implies that an explicit link between coordination and the concept of caring can promote legitimacy.

These findings do not rule out the existence of alternative interpretations of the relationship between IOC and nursing among other categories of nursing professionals (e.g. academics or educators). The Findings do imply, however, that such potential ideas have not been spread to clinical professionals at the front line of healthcare.

How then can nursing be evolved to meet the patients’ needs for coordinated health services?  At the very least, it seems relevant to make the existing knowledge of operative coordination within nursing more visible, so that nursing students may benefit, and coordination theory from organisational science should be included in the nursing curriculum.

 

1. Postma J, Oldenhof L, Putters K. Organized professionalism in healthcare: articulation work by neighbourhood nurses. J Prof Organ. 2015;(2):61–77.

2. Suddaby R, Viale T. Professionals and field-level change: Institutional work and the professional project. Curr Sociol. 2011;59(4):423–42.

 

 

How to Cite: Doessing A. Placing coordination inside or outside nursing: The professional self-concept of inter-organisational coordination among frontline nurses and nurse leaders in Denmark. International Journal of Integrated Care. 2022;22(S3):400. DOI: http://doi.org/10.5334/ijic.ICIC22369
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Published on 04 Nov 2022.

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