Nursing practice in a contemporary health care corporation: Nurses' tensions and torment

Tensions exist between the ideology of caring as a nursing practice ideal, and the corporately managed health care settings in which nurses work. The objective of this critical feminist ethnography was to understand these tensions by grounding them in nurses' experiences and perceptions. Data was gathered through ethnographic interviewing and participant-observations of a nurse key informant and her co-workers in the pediatric unit of a corporately managed acute care hospital. The data were analyzed according to the coding procedures and comparative method described by Strauss and Corbin (1990). Four characteristics of the corporate health care culture that conflict with nurses' practice ideals were identified: The Corporate Productivity Motive; The Priority of a Medical Regime Over Nursing Care; The Tolerance of Risk to Patient Safety; and The Hospitality Perspective. A critique of the patriarchal value structure that influences the health care system and recommendations for nursing practice, education, and research is provided.