Inside ‘bed management’: ethnographic insights from the vantage point of UK hospital nurses

In the face of unprecedented financial and demographic challenges, optimising acute bed utilisation by the proactive management of ‘patient flows’ is a pressing policy concern in high income countries. Despite a growing literature on this topic, bed management has received scant sociological attention. Drawing on practice-based approaches, this paper deploys ethnographic data to examine bed management from the perspective of UK hospital nurses. While the nursing contribution to bed management is recognised formally in their widespread employment in patient access and discharge liaison roles, nurses at all levels in the study site were enrolled in this organisational priority. Rather than the rational, centrally-controlled processes promulgated by policy-makers, bed management emerges as a predominantly distributed activity, described here as match-making. An example of micro-level rationing, for the most part, match-making was not informed by explicit criteria nor did it hinge on clearly identifiable decisions to grant or deny access, rather it was embedded in the everyday practices and situated rationalities through which nurses accomplished the accommodations necessary to balance demand with resources