Nurses at the nexus: a case study in structurational divergence

Hospital-based nurses are institutionally positioned at a nexus where numerous social structures interpenetrate, compelling the individual to simultaneously fulfill obligations from multiple rules systems. When these rules systems are incompatible, the individual's position is untenable. This article describes the phenomenon of structurational divergence (SD) identified in our previous research, wherein the intersection of incompatible rules systems manifests as unresolved conflict that sets off a negative spiral of communication. To explore and illustrate SD in the nursing role, we present herein a case study of a geriatric care unit where the phenomenon is clearly visible. Using qualitative interviews and observation, we first look simply to identify the negative spiral that is the hallmark of SD. Once the instances of the negative spiral are identified, we explore the issues surrounding them to discover the underlying structurational incompatibilities, using sets of incompatible rules identified in previous research as a guide. Finally, we address the extent to which the SD in this case is particular to this situation or might be linked to nurses' unique institutional positioning, and we discuss our future research agenda.