Cocooning Nurse Autonomy in Türkiye: Navigating a Path to Professionalism That Does Not Challenge Medical Dominance

Area of Science:

• Healthcare Management
• Nursing Studies
• Sociology of Health

Background:

• Managerialism and professionalism discourses influence nursing work in Western countries.
• New Public Management (NPM) reforms shifted power dynamics, impacting nursing roles and professionalism.
• Limited research exists on NPM's influence on nurse management and professionalism globally.

Purpose of the Study:

• To examine the impact of NPM-type reforms on hospital nursing in Türkiye.
• To understand the evolving professionalization of Turkish nurses post-NPM reforms.
• To explore how nurses navigate medical dominance within reformed healthcare structures.

Main Methods:

• Qualitative study utilizing 40 in-depth interviews with hospital nurses in Türkiye.
• Data collected in 2021-2022.
• Analysis focused on the impact of NPM reforms on nursing practice and professionalism.

Main Results:

• NPM reforms had an uneven impact on medicine and nursing in Türkiye.
• Medical dominance persists, with nurses developing a professionalizing project that avoids direct confrontation.
• Nurses emphasized continuing education, guideline development, and limited teamwork away from physicians.
• Greatest nursing autonomy was observed in specialized wards, ICUs, and emergency departments.

Conclusions:

• Turkish hospital nursing is adapting to NPM reforms through professional development and strategic autonomy.
• Nurses are enhancing their professional standing by focusing on education and guidelines, while maintaining distance from direct medical oversight.
• The study highlights a unique model of professionalization within a context of enduring medical dominance.