A simple matter of control? NHS hospital nurses and new management

Over the past two decades the National Health Hospital Service has been subjected to considerable changes in is organization. 'New' public sector management (NPM) has been given the task of changing hospital culture and making service provision more efficient. Nurses, as the largest occupational group within the National Health Service (NHS), have attracted considerable management attention and there are two distinct accounts concerning how NPM has supposedly gained control of the nursing labour process. Firstly, it is proposed that the physical division of labour of health care professionals is now firmly in the hands of hospital management through the use of Tayloristic techniques. Secondly, alternative accounts suggest that public sector organization cultures have been successfully orientated toward a customer service ethos, and that the convincing discourse of 'quality' is achieving some success as a normative control device. This paper investigates the responses of nurses to NPM, whichever form this may take, and presents data collected as part of a longitudinal study carried out in an NHS Trust hospital. It charts the changes which have occurred in the nursing labour process over a six year period, but especially draws upon more recent data to show how nurses, over a period of time, develop their own ways of reinterpreting management's desires. It argues that management is more likely to continue to rely on nurses' traditional autonomy in the delivery of health care in recognition that nurses may resist some but accommodate many of the demands made of them.