The Exercise of Discretion in the Work of Nursing
Written by Wilsie Bishop
Sunday, 03 September 1989 19:00
Nurses' Perceptions of Their Approach to Work
This DPA Dissertation is presented in searchable PDF format and is downloadable as 3 PDF files:
Part1 - 4.4MB (125 pages),
Part2 - 4.3MB (129 pages), and
Part3 - 2.7MB (78 pages) in size respectively .
Dissertation: 1989, DPA, University of Southern California, California, United States
"The purpose of this study was to explore the required and preferred approaches to work and the corresponding levels of capacity that nurses report in relation to their work experience. Rather than looking at what nurses do, this study considered how nurses deal with the complex and uncertain world of nursing practice...
...the nurse who is educated to perform as a sophisticated health care provider is laced into a system that requires so much routine work that these higher level functions cannot be consistently exercised. As a result, nurses become disillusioned and drop out or change careers. In addition, individuals with higher level capability are no longer being attracted to a profession that will not allow them to work toward achieving their maximum potential...
...It is this researcher's hypothesis that nurses with differing educational levels use differing approaches to work and function at differing levels of complexity when carrying out similar tasks...
...some nurses have the capacity to perform work at levels higher than those expected in a staff nurse position. The lack of an obvious career path and the resulting compression of career expectations and job functioning leads to a discontinuity between the nurse's capability and level of work.
This discontinuity can lead to job dissatisfaction and exit from the profession. It may also prompt the nurse to seek additional education in order to qualify for teaching and administrative positions. Some nurses presumably are content to live with the discontinuity and find other means (special projects, community volunteerism, offices in professional organizations) to exercise their capability.
If the above observation is true, it is imperative that the level of work of the jobs that nurses do be clearly identified so that individual capacity and work level can be better matched to avoid nursing drop outs.
Better matching of capacity and level of work will also lead to more effective recruitment of individuals into the profession and more effective delivery of nursing care. As a result, society would benefit from a concomitant improvement in the health care delivery system.
Jaques' Stratified Systems Theory offers a framework for gaining a new perspective of the work of nursing and potentially could provide the framework for restructuring nursing education and practice. The findings of this study also have wider implications for testing some of the tenets of Stratified Systems Theory within the context of public administration and education for professional levels of employment. "
Part 1 - Bishopw Dpa 1989-1 (4.32 MB)
Part 2 - Bishopw Dpa 1989-2 (4.16 MB)
Part 3 - Bishopw Dpa 1989-3 (2.66 MB)