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'Speaking up, being heard: an exploratory study on how emergent voice behavior of auxiliary nurses is received and responded to by colleagues and supervisors'


Karin Kee ,

VU University Amsterdam, NL
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Marieke van Wieringen,

VU University Amsterdam, NL
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Bianca Beersma

VU University Amsterdam, NL
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Due to the types of care they deliver, Dutch auxiliary nurses presumably spend more time in a client’s home than other care professionals. Consequently, auxiliary nurses play a vital role in furthering coordination and cooperation between clients and their informal caregivers and other auxiliary and registered nurses, which is important in light of recent changes in the Dutch home care sector. For long, however, auxiliary nurses have not been in a position where they could effectively convey their interests or express their professions’ worth, nor were they invited to do so (Poortvliet & Lameris, 2016).

Yet, the realization has grown that it is important that the role and voice of auxiliary nurses are recognized within care organizations as well as in the organization of the caregiving process. In fact, the Dutch Association for Registered and Auxiliary Nurses launched a development trajectory which aimed to support fourteen auxiliary nurses in the development of skills that should enable them to speak up and raise ideas, concerns, and suggestions for improvement or change within the organization, their team and caregiving more broadly. In the literature, such behavior has been defined as employee voice(Morrison, 2011). However, past research has not considered how employee voice emerges in a traditionally ‘’silent group’’, such as the professional group of auxiliary nurses, and how this type of emergent voice behavior is received and responded to. Therefore, we explore which characteristics of emergent voice behavior are integral to how it is received and responded to by referent audiences.

Based on in-depth interviews with the fourteen participants, their colleagues and supervisors, in which experiences regarding the emergent voice behavior of the participants were discussed, our preliminary analysis reveals that participants who engaged in positive, promotive voice behavior were able to inspire their colleagues and supervisors with their emergent voice. What furthermore characterized these participants was that they sought input from their colleagues and supervisors and were able to formulate a clear voice message. As a result, the participants received positive reactions to their emergent voice behavior and were able to promote the position of auxiliary nurses within their organization. In contrast, some other participants were less succesful in inspiring their colleagues. Supervisors and colleagues indicated that these participants mainly conveyed a rather negative type of voice message and tended to address the things that went wrong in the organization. These participants furthermore adopted an authoritarian stance towards their colleagues, which resulted in deteriorated cooperation among team members and in some cases led to conflicts.

We conclude that reactions to emergent voice behavior differ, depending on the ways in which the auxiliary nurses engaged in emergent voice behavior. Organizations that aim to stimulate the emergence of voice in traditionally ‘silent’ groups can use this knowledge to develop specific interventions to help employees to best communicate their voice message. An important direction for future research would be to examine how employees continue to engage in emergent voice behavior over time.

How to Cite: Kee K, van Wieringen M, Beersma B. 'Speaking up, being heard: an exploratory study on how emergent voice behavior of auxiliary nurses is received and responded to by colleagues and supervisors'. International Journal of Integrated Care. 2019;19(4):286. DOI:
Published on 08 Aug 2019.


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