Sygeplejerske, hvem er jeg (vi)? En fænomenologisk interviewundersøgelse af indentitetsarbejdet i spændingsfeltet mellem omsorg og effektivitet

Abstract

Purpose – New Public Management, with its instrumental rationality, has brought a focus on efficiency through economic incentives and performance structures as a public governance paradigm, consequently pushing soft values into the background. This stands in stark contrast to their sense of vocation (calling) and the view of humanity that nurses are driven by, where providing care is a source of inner meaning. The purpose of this thesis is therefore to investigate how nurses experience the tension between care and efficiency, and how they create alignment between their self-perception and work situation.

Design, methodology and approach – The study is based on the qualitative research method and has been conducted abductively as a phenomenological interview study within the framework of elderly care in Sønderborg Kommune. Five semi-structured research interviews have been conducted with nurses who have a minimum of 10 years of experience. Four of these interviews have subsequently formed the empirical basis for the analysis, which has been achieved through the bricolage analysis strategy. The analysis is based on theories within work-life research, with a focus on identity, meaning, and motivation.

Findings – In the tension between care and efficiency, nurses feel pressured to disregard their professional judgment in order to meet the formal demands set by the efficiency frameworks of New Public Management. This creates a moral prioritization dilemma, leading to an identity crisis and putting nurses at risk of moral distress. To create better alignment between their self-perception and work situation, nurses engage in job crafting, attempting to adjust task boundaries and cognitive boundaries to reintroduce meaning into their work.

Discussion – It can be debated whether the job crafting performed by nurses is meaningful, as the moral dilemma they face creates a double-bind where the demands and frameworks of their work are contradictory in a way that makes it impossible for nurses to both follow their professional judgment and meet the requirements and procedures set by New Public Management.