External change and its impact on nurse management: a case study

This paper sets out to identify major changes in the tasks and responsibilities of the nurse manager at a small postgraduate unit in central London as it and its parent hospital group became subject to major changes in the policy and financial environment. What happened to the nurse manager's function could well make transparent some of the important changes still affecting nurse management more generally today.

The article adds to the somewhat meagre academic literature which considers the middle management role in nursing.

The paper is based on a single yet detailed case study and the data were gathered by one of the authors over the period of change. The pros and cons of the dual researcher/participant role need to be considered along with the possibly wider significance of the case study.

The overriding conclusion is that nurse management in the specialist unit is evolving from a classic bureaucratic mode in which managerial authority, information and decision making were highly centralized to a much more devolved set of arrangements. Clearly a host of factors--e.g. the culture and history of the organization, and the personality types of the key players--could affect such change. However, this article concentrates on showing how the earlier, more centralized style was increasingly problematic in the rapidly changing circumstances faced by the unit.

In understanding the wider significance of this particular case study, it seems important to understand the strengths and weaknesses of the methodology. If such changes in nurse management are widespread, they represent a new era for nursing in action and one perhaps more consonant with a profession whose status is being enhanced by developments such as diploma and graduate education and the development of specialist roles.