The Credibility of Nursing Evidence: Three Case Studies Demonstrating the Devaluing of Nursing Knowledge and Experience to Serve the Hegemonies of Power and New Public Management

Abstract

The voice of nursing has struggled to be heard in matters relating to patient safety, quality of care, and the health and wellbeing of patients and communities. In Aotearoa New Zealand we have entered a period of intense fiscal scrutiny and austerity, where nursing (as the largest healthcare workforce) is being expected to save money through budget cuts, freezing of positions, and limited career progression to advanced nursing roles. Using institutional ethnography as the approach to explicate how managerial practices are imposed and operate in the healthcare sector, we present three case studies of extant highly political issues, which directly affect patient safety: 1) Registered nurse safe staffing in hospitals; 2) The overdue transformation of primary healthcare; and 3) The education and training of nurse practitioners (NPs). Each case study highlights how nursing knowledge and evidence is being excluded from the frontline, the design of services, and from policy and budgeting tables. We identify how hegemonic discourses and practices (neoliberal, new public management and medicine) subordinate the credibility of nursing knowledge and relegate it to a lower position in knowledge hierarchies, in turn posing a risk to patient safety. The paper raises epistemological issues related to whose knowledge is valuable, who is considered to know best, and whose interests are served when certain epistemologies are valued over others.Te reo Māori translation