Date of Award


Degree Name

Doctor of Nursing Science


Ethnography, First-Line Nurse Managers, labor relations, management, nursing


The behaviors, beliefs and values that characterize everyday practice of first-line nurse managers role were analyzed. Ethnographic field research techniques were used including nine months of observation and in-depth interviews with practicing nurse managers. After reviewing historical events that shaped the role of the nurse manager, the role was then placed within the economic, social and health care context of the 1970's and 80's. Research and anecdotal descriptions of the manager role of the past twenty years were also explored. Research was conducted in two voluntary acute care, multi-service hospitals. One manager was observed intensively for two months to develop a semi structured open-ended interview guide. The guide was then used to conduct extensive ethnographic interviews with 16 inpatient managers. In addition, six nurse administrators were interviewed, institutional documents examined and a variety of techniques used to triangulate observations and theories that emerged and to examine issues of validity and reliability. Managers described their role as four processes: (1) social control, establishing, monitoring and maintaining standards; (2) "resourcing," the provision of emotional support, goods and services; (3) translating/ interpreting/negotiating among unit-based or related constituencies; and, (4) facilitating change. Administrators concurred with the managers' descriptions emphasizing social control. Managers described themselves as desiring control/power to make beneficial changes; being stimulated by a changing work environment and deriving satisfaction from staff development. They identified essential skills for role enactment as communication/interpersonal expertise, clinical knowledge, flexibility, a strong ego and political savvy. The study then examined how managers analyze the complexity of change, alter their management strategies accordingly and create a working culture that is maximally adaptable to an unstable health care environment. They identified ways to enhance success and avoid or respond to failure, using knowledge acquired primarily through experience. Finally, the study examined the common culture of nursing management within the context of its historical roots, particularly the necessity for a bicultural identity that incorporates beliefs and values of both manager/employee and professional clinician/nurse. Structured mentoring was explored as a bridging strategy to enhance enculturation and skill acquisition.

Document Type

Dissertation: Open Access



Included in

Nursing Commons