The Paradox of Socially Organized Nursing Care Work

As contemporary health care organizations struggle to control costs, yet deliver quality patient-centred care, the concept of care becomes socially transformed through the use of quality improvement models (i.e., Lean methodology) and quality assurance documentation. This research investigates how nurses’ care work is socially organized in a system that defines care through quality management practices. I use Dorothy E. Smith’s Institutional Ethnography as a feminist mode of inquiry and as a guiding framework for my interviews with nurse participants as I explore the complex social relations within the health care system from the vantage point of nurses undertaking care work. I argue that the social reorganization of care work has affected the emotional lives of nurses as they try to balance actual patient-centred care with their reporting obligations under quality management.MAS