Supporting interprofessional collaboration: The boundary work carried out by nurse managers in public hospitals
Abstract
While interprofessional collaboration is essential to the quality of care, nurse managers tasked with fostering it are increasingly overwhelmed by their role in managing resources, particularly human resources. Indeed, the situation regarding absenteeism and shortages of paramedical staff has worsened in recent years, leading nurse managers to devote most of their time to addressing the shortage of paramedical staff using management tools. This research seeks to understand how the support provided by nurse managers for interprofessional collaboration—which involves working across professional boundaries within the public hospital—can be compatible with their role in workforce management. Using a case study conducted in a French university hospital, we demonstrate that nurse managers’ management of absenteeism leads to two forms of boundary work (crossing professional boundaries between physicians, paramedical staff, and administrative staff on the one hand; and reinforcing the professional boundaries of nurse managers on the other). This boundary work influences interprofessional collaboration at two levels. While the work of crossing professional boundaries between different hospital groups supports interprofessional collaboration in terms of decision-making, the work of reinforcing the professional boundaries of nurse managers, by contrast, allows them to bypass the need for collaboration in order to make decisions autonomously. It is the implementation of these decisions that subsequently leads physicians, paramedical staff, and administrative staff to collaborate on their execution.