Navigating the System of Regulation and Practice in the UK: Towards a Posthuman Institutional Ethnography of Nursing

To explore how regulatory frameworks, material constraints, and systemic conditions influence nursing practice, focusing on the Nursing and Midwifery Council (UK) Code, emotional labour, gendered expectations, and healthcare technology.

This qualitative study employed a Posthuman Institutional Ethnography (PIE) approach to understand the material and social dynamics that shape nursing practice.

A renal ward in a large acute National Health Service (NHS) hospital in the UK.

The sample consisted of 10 practising nurses, aged from their mid-20s to 50s, with varying lengths of service from 3 to over 30 years, offering diverse perspectives on nursing practice.

Data were collected from October 2018 to April 2019 through documentary analysis, participatory ethnography, multimedia diaries, and semi-structured interviews. Thematic analysis, guided by posthuman and new materialist frameworks, examined how human and non-human actors interact in the production of nurse work.

The Code's emphasis on individual accountability often clashes with systemic barriers such as staffing shortages, outdated healthcare technology, and limited resources, leading to distress and burnout among nurses. Gendered expectations further exacerbate the burden on nurses, contributing to feelings of inadequacy, exhaustion, and emotional strain. Inefficient electronic health records (EHRs) were identified as significant barriers to effective nursing practice.

Addressing systemic barriers is crucial to creating a supportive environment for nurses. Shifting from a model of individual accountability to one of systemic responsibility is vital for enhancing nurse well-being and improving patient care quality. Policy changes must acknowledge systemic factors such as staffing, technology, and resource availability to create a sustainable and effective healthcare system that supports nursing practice.

The study design includes participatory methods where participants create the framing and context of the data included. However, this study did not include patient or public involvement in its design, conduct, or reporting.