Organizational predicaments: ethical conditions for nursing research

Aim. This paper highlights the sometimes problematic matter of access to the field in clinical ethnographic research by discussing a hypothetical scenario of an instance of change in the terms of access. Background. A review of the methodological literature about research access revealed that there was little in the nursing literature about this issue, although anecdotally many nurse researchers reveal that access is not unproblematic and requires active maintenance to ensure smooth operation of a project. However, in returning to literature in sociology and anthropology, where gaining access for fieldwork is not considered so routine, we found much in the literature about dilemmas, predicaments and conflicts over access, confidentiality and anonymity that were not mentioned in nursing research about access to clinical areas. We returned also to the ethical and legal framework guiding access practices so as to explore the issues in fieldwork situations. Discussion. In exploring the problems arising from maintaining confidentiality, safety of participants and researchers, it is clear that the much-vaunted insider status is both a boon and a burden. Intimate and inquisitive research using ethnographic techniques has the potential to unsettle organizations and workers through the very processes used to undertake the research. Conclusion. Ethical comportment is not enough to protect a study. A more overt and less naive approach to access for fieldwork is required to better inform future nurse researchers how to maintain access to the field and the requirement of constant negotiation and adjustment.