History, Organization and the Changing Culture of Care: A Historical Analysis of the Frontier Nursing Service

Aim: The aim of this study was to examine the organizational shift at the Frontier Nursing Service from all female, nurse run and community-people focused to the corporate-consumer focus adopted everywhere else and the accompanying work environment issues this shift brought to the organization. Background: Though it is not possible to isolate a single causative factor nursing’s history of cyclic ‘shortages’ as the problem is complex and interrelated, and there is no simple description in the available literature, there is agreement that the problem is having a negative impact on the current nursing practice environment, the retention of nurses, the profession’s ability to recruit nurses, and that the problem is global in scope and heading for crisis if not abated. Methods: Historical analysis of the Frontier Nursing Service located in Eastern Appalachia of the United States and oral history analysis of former Frontier and non-Frontier nurses was conducted using a culture theory framework. Data were collected from 2003-2007, and literature on the Frontier Nursing Service as well as local, world, medical, nursing, sociological and political history was reviewed from 1900s- 1970s. Findings: Findings defy conventional dissatisfaction causes while the Service was nurse-run, decentralized and interference-free. In the 1960s the organization moved to the corporate/business model of health care delivery being used elsewhere. Non-Frontier nurses in practice today mirrored the dissatisfaction experienced by former Frontier Nurses within this organizational culture after 1960 reflecting how deeply imbedded within health care institutions the prevailing culture has become. Conclusion: The empowerment inherent within an international professional community created by nurse leaders, who value and perpetuate their “professional identity” within institutional cultures, can advance the discipline’s ability to push for sustained positive change within these environments