Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-20T13:18:37.384Z Has data issue: false hasContentIssue false
  • English
  • Français

‘I mean, obviously you're using your discretion’: Nurses Use of Discretion in Policy Implementation

Published online by Cambridge University Press:  22 July 2013

Louise Hoyle
Louise Hoyle*
Affiliation:
School of Nursing, Midwifery & Social Care, Edinburgh Napier University E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article explores the application of Lipsky's (1980) notion of street-level bureaucracy for nursing staff. This article aims to demonstrate the importance of discretion within the day-to-day work of front-line nursing staff, which is similar to that of other public-sector workers. The findings are from an exploratory case study based within a Scottish inner-city hospital. It specifically focuses on how nurses can be seen to be street-level bureaucrats and how front-line nursing staff interpret policy. Discretion can be seen to be a significant feature within the front-line practice of nursing staff and this may have implications for the implementation of health policy.

Keywords

Discretionhealth policyLipskynursingpolicy implementationstreet-level bureaucracy
Type
Articles
Information
Social Policy and Society , Volume 13 , Issue 2 , April 2014 , pp. 189 - 202
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atkinson, P., Delamont, S. and Hammersley, M. (1988) ‘Qualitative research traditions: a British response to Jacob’, Review of Educational Research, 58, 2, 231–50.CrossRefGoogle Scholar
Baldwin, M. (2000) Care Management and Community Care: Social Work Discretion and the Construction of Policy, Aldershot: Ashgate.Google Scholar
Baldwin, M. (2004) ‘Critical reflection: opportunities and threats to professional learning and service development’, in Gould, N. and Baldwin, M. (eds.), Social Work, Critical Reflection and the Learning Organisation, Aldershot: Ashgate.Google Scholar
Bergen, A. and While, A. (2005) ‘Implementation deficit and street-level bureaucracy: policy, practice and change in the development of community nursing issues’, Health and Social Care in the Community, 13, 1, 1–10.CrossRefGoogle ScholarPubMed
Bolton, S. C. (2000) ‘Nurses as managers: between a professional rock and an HRM hard place?’, Human Resource Development International, 3, 2, 229–34.CrossRefGoogle Scholar
Bolton, S. C. (2003) ‘Multiple roles? Nurses as managers in the NHS’, The International Journal of Public Sector Management, 16, 2, 122–30.Google Scholar
Brunnetto, Y. (2002) ‘The impact of growing managerialism amongst professionals in Australia: a comparative study of university academics and hospital nurses’, Research and Practice in Human Resource Management, 10, 1, 5–21.Google Scholar
Buchan, J. and Seecombe, I. (2012) RCN Labour Market Review: Overstretched, Under Resourced – the UK Nursing Labour Market Review 2012, London: Royal College of Nursing.Google Scholar
Cheetham, J. (1993) ‘Social work and community care in the 1990's: pitfalls and potential’, in Page, R. and Baldock, J. (eds.), Social Policy Review, 5, Canterbury: Social Policy Association.Google Scholar
Cresswell, J. (1998) Qualitative Inquiry and Research Design: Choosing among Five Traditions, London: Sage.Google Scholar
Crotty, M. (2005) The Foundations of Social Research, London: Sage.Google Scholar
Denzin, N. K. and Lincoln, Y. S. (2000) ‘The discipline and practice of qualitative research’, in Denzin, N. K. and Lincoln, Y. S. (eds.), Handbook of Qualitative Research, 2nd edition, London: Sage.Google Scholar
Durose, C. (2011) ‘Revisiting Lipsky: front-line work in UK local governance’, Political Studies, 59, 4, 978–95.CrossRefGoogle Scholar
Ellis, K., Davis, A. and Rummery, K. (1999) ‘Needs assessment, street-level bureaucracy and the new community care’, Social Policy and Administration, 33, 3, 262–80.Google Scholar
Evans, T. (2009) ‘Managing to be professional? Team managers and practitioners in modernised social work’, in Harris, J. and White, V. (eds.), Modernising Social Work: Critical Considerations, Bristol: Polity Press, pp. 145–64.Google Scholar
Evans, T. (2010) Professional Discretion in Welfare Services: Beyond Street-Level Bureaucracy, Aldershot: Ashgate Publishing.Google Scholar
Evans, T. and Harris, J. (2004) ‘Street-level bureaucracy, social work and the (exaggerated) death of discretion’, British Journal of Social Work, 34, 6, 871–95.Google Scholar
Evans, T. and Harris, J. (2007) ‘A case of mistaken identity? Debating the dilemmas of street-level bureaucracy with Musil et al.’, European Journal of Social Work, 9, 4, 445–59.Google Scholar
Exworthy, M. and Halford, S. (1999) ‘Professionals and managers in a changing public sector: conflict, compromise and collaboration?’, in Exworthy, M. and Halford, S. (eds.), Professionals and the New Managerialism in the Public Sector, Buckingham: Open University Press, pp. 1–17.Google Scholar
Fletcher, D. R. (2011) ‘Welfare reform, jobcentre plus and the street-level bureaucracy: towards inconsistent and discriminatory welfare for severely disadvantaged groups?’, Social Policy and Society, 10, 4, 445–58.CrossRefGoogle Scholar
Frenkel, S. J., Tam, M., Korczynski, M. and Shire, K. (1998) “Beyond bureaucracy?” Work organisation in call centres’, The International Journal of Human Resource Management, 9, 6, 957–79.CrossRefGoogle Scholar
Gorini, A., Miglioretti, M. and Pravettoni, G. (2012) ‘A new perspective on blame culture: an experimental study’, Journal of Evaluation in Clinical Practice, 18, 3, 671–5.Google Scholar
Grant, A. (2013) ‘Welfare reform, increased conditionality and discretion: Jobcentre Plus advisors’ experiences of targets and sanctions’, Journal of Poverty and Social Justice, 21, 2, 151–62.Google Scholar
Greener, I. (2009) Healthcare in the UK: Understanding Continuity and Change, Bristol: Polity Press.Google Scholar
Ham, C. (2009) Health Policy in Britain, 6th edition, Hampshire: Palgrave Macmillan.Google Scholar
Harris, J. (1998) ‘Scientific management, bureau-professionalism, new managerialism: the labour process of state social work’, British Journal of Social Work, 28, 6, 839–62.CrossRefGoogle Scholar
Harvey, D. (2005) A Brief History of Neoliberalism, Oxford: Oxford University Press.Google Scholar
Hill, M. (1997) The Policy Process: A Reader, 2nd edition, London: Pearson/Prentice Hall.Google Scholar
Hoyle, L. P. (2011) ‘New public management and nursing relationships in the NHS’, Ph.D. thesis, University of Stirling, Stirling.Google Scholar
Howe, D. (1991) ‘Knowledge, power and the shape of social work practice’, in Davies, M. (ed.), The Sociology of Social Work, London: Routledge, pp. 202–20.Google Scholar
Treasury, HM (2010) Budget 2010, London: The Stationery Office.Google Scholar
Hudson, B. (1997) ‘Michael Lipsky and street level bureaucracy: a neglected perspective’, in Hill, M. (ed.), The Policy Process: A Reader, 2nd edition, London: Pearson/Prentice Hall, pp. 393–403.Google Scholar
Hunter, D. J. (2007) ‘Exploring managing for health’, in Hunter, D. J. (ed.), Managing for Health, Abingdon: Routledge, pp. 54–79.Google Scholar
Hutchison, S. and Purcell, J. (2010) ‘Managing ward managers for roles in HRM in the NHS: overworked and under-resourced’, HR Management Journal, 20, 4, 357–74.Google Scholar
Johansson, S. (2011) ‘Who runs the mill? The distribution of power in Swedish social service agencies’, European Journal of Social Work, 15, 5, 679–95.CrossRefGoogle Scholar
Jones, C. (1999) ‘Social work: regulations and managerialism’, in Exworthy, M. and Halford, S. (eds.), Professionals and the New Managerialism in the Public Sector, Buckingham: Open University Press.Google Scholar
Jones, C. (2001) ‘Voice from the front-line: state social works and New Labour’, British Journal of Social Work, 31, 4, 547–62.Google Scholar
Khatri, N., Brown, G. D. and Hicks, L. L. (2009) ‘From a blame culture to a just culture in health care’, Health Care Management Review, 34, 4, 312–22.Google Scholar
Kinnie, N., Hutchinson, S. and Purcell, J. (2000) ‘“Fun and surveillance”: the paradox of high commitment management in call centres’, International Journal of Human Resource Management, 11, 5, 967–85.Google Scholar
Kirkpatrick, I., Dent, M. and Kragh Jespersen, P. (2011) ‘The contested terrain of hospital management: professional projects and healthcare reforms in Denmark’, Current Sociology, 59, 4, 489–506.Google Scholar
Lapsley, I. (1994) ‘Market mechanisms and the management of healthcare: the UK model and experience’,International Journal of Public Sector Management, 7, 6, 15–25.CrossRefGoogle Scholar
Lewis, J. and Glennerster, H. (1996) Implementing the New Community Care, Buckingham: Open University Press.Google Scholar
Lipsky, M. (1980) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services, New York: Russell Sage.Google Scholar
Lipsky, M. (2010) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services, 30th anniversary expanded edition, New York: Russell Sage.Google Scholar
Loyens, K. and Maesschalck, J. (2010) ‘Towards a theoretical framework for ethical decision making of street-level bureaucracy: existing models reconsidered’, Administration and Society, 42, 1, 66–100.Google Scholar
Maddock, S. and Morgan, G. (1998) ‘Barriers to transformation: beyond bureaucracy and the market conditions for collaboration in health and social care’, International Journal of Public Sector Management, 11, 4, 234–51.Google Scholar
Maynard-Moody, S. and Musheno, M. (2000) ‘State agent or citizen agent: two narratives of discretion’, Journal of Public Administration, 10, 2, 329–58.Google Scholar
Maynard-Moody, S. and Musheno, M. (2003) Cops, Teachers and Counsellors: Stories from the Front-Line of Public Service, Ann Arbor, MI: University of Michigan Press.CrossRefGoogle Scholar
McCall, V. (2009) ‘Social policy and cultural services: a study of Scottish border museums as implementers of social inclusion’, Social Policy and Society, 8, 3, 319–31.Google Scholar
McMahon, A. (1998) ‘Developing practice through research’, in Roe, B. and Webb, C. (eds.), Research and Development in Clinical Nursing Practice, London: Whurr Publishers, pp. 219–46.Google Scholar
Meyers, M. K. and Vorsanger, S. (2007), ‘Street-level bureaucrats and the implementation of public policy’, in Peters, B. G. and Pierre, J. (eds.), Handbook of Public Administration, London: Sage, pp. 153–64.Google Scholar
Mulgan, R. (2000) ‘Accountability: an ever expanding concept?’, Public Administration, 78, 3, 555–73.CrossRefGoogle Scholar
Mulholland, K. (2004) ‘Workplace resistance in an Irish call centre: slammin’, scammin’ smokin’ an’ leavin’’, Work, Employment and Society, 18, 4, 709–24.Google Scholar
Newman, J. and Clarke, J. (1994) ‘Going about our business? The managerialization of public services’, in Clark, A., Cochrane, A. and McLaughlin, E. (eds.), Managing Social Policy, London: Sage.Google Scholar
Noordegraaf, M. (2011) ‘Remaking professionals? How associations and professional education connect professionalism and organizations’, Current Sociology, 5, 4, 465–88.Google Scholar
Oxford English Dictionary (2006) Concise Oxford English Dictionary, Oxford: Oxford University Press.Google Scholar
O'Sullivan, T. (2011) Decision Making in Social Work, 2nd edition, Basingstoke: Macmillan.Google Scholar
Pope, C., Royen, P. and Baker, R. (2002) ‘Qualitative methods in research on healthcare quality’, Quality and Safety in Health Care, 11, 2, 148–52.Google Scholar
Ritchie, J., Spencer, L., and O'Conner, W. (2008) ‘Carrying out qualitative analysis’, in Ritchie, J. and Lewis, J. (eds.), Qualitative Research Practice: A Guide for Social Science Students and Researchers, London: Sage, pp. 219–62.Google Scholar
Robson, C. (2002) Real World Research, 2nd edition, Oxford: Blackwell.Google Scholar
Rowe, M. (2012) ‘Going back to the street: revisiting Lipsky's street-level bureaucracy’, Teaching Public Administration, 30, 1, 10–18.Google Scholar
Scottish Government (2010) NHS Scotland Quality Strategy – Putting People at the Heart of our NHS, Edinburgh: The Scottish Government.Google Scholar
Scott, P. (1997) ‘Assessing determinants of bureaucratic discretion: an experiment in street-level decision making’, Journal of Public Administration Research and Theory, 7, 1, 35–57.Google Scholar
Som, C. V. (2009) ‘“Quantity” versus “quality” dilemma of health staff in NHS UK’, Clinical Governance: An International Journal, 14, 4, 301–14.Google Scholar
Taylor, I. and Kelly, J. (2006) ‘Professionals, discretion and public sector reform in the UK: re-visiting Lipsky’, International Journal of Public Sector Management, 19, 7, 629–42.Google Scholar
Townsend, K. and Wilkinson, A. (2010) ‘Managing under pressure: HRM in hospitals’, HR Management Journal, 20, 4, 332–8.Google Scholar
Tummers, L. and Bekkers, V. (2012) Discretion and Its Effects: Analysing the Experiences of Street-Level Bureaucrats during Policy Implementation, http://repub.eur.nl/res/pub/34967/ (accessed 13 November 2012).Google Scholar
Tummers, L., Vermeeren, B., Steijn, B. and Bekkers, V. (2012) ‘Public professionals and policy implementation’, Public Management Review, 14, 2, 1041–59.Google Scholar
Van Berkel, R. and Van der Aa, P. (2012) ‘Activation work: policy programme administration or professional provision?’, Journal of Social Policy, 41, 3, 493–510.CrossRefGoogle Scholar
Van den Broek, D. (2004) ‘“We have the values”: customers, control and corporate ideology in call centre operations’, New Technology, Work and Employment, 19, 1, 2–13.Google Scholar
Warren, J. and Harris, M. (1998) ‘Extinguishing the lamp: the crisis in nursing’, in Anderson, D. (ed.), Come Back Miss Nightingale: Trends in Professions Today, London: The Social Affairs Unit, pp. 11–36.Google Scholar
Wells, J. S. G. (1997) ‘Priorities, “street level bureaucracy” and the Community Mental Health Team’, Health and Social Care in the Community, 5, 5, 333–42.Google Scholar
Wong, W. H. (2004) ‘Caring holistically within new managerialism’, Nursing Inquiry, 11, 1, 2–13.Google Scholar
Wright, S. (2003) ‘The street-level implementation of unemployment policy’, in Millar, J. (ed.), Understanding Social Security, Bristol: The Policy Press, pp. 235–54.Google Scholar
Yin, R. (1994) Case Study Research: Design and Methods, 2nd edition, Thousand Oaks, CA: Sage.Google Scholar