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This article considers data from a qualitative study of discipline and misconduct in nursing. It outlines the ways in which the study can inform our understanding of changes in the control of nursing work. Specifically it considers evidence for work intensification in nursing and contrasts this with policy pronouncements, which have proclaimed that nurses have been empowered by recent changes. The study found that empowerment often implied increased responsibility accompanied by tightened control. Some nurses described their managers as ‘seagull’ managers and the article elaborates what was meant by that term. The four key features of seagull management were: distance, distrust, destructive criticism, and a defensive culture.
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Seagull management and the control of
nursing work
Hannah Cooke
University Of Manchester
ABSTRACT
This article considers data from a qualitative study of discipline and misconduct in
nursing. It outlines the ways in which the study can inform our understanding of
changes in the control of nursing work. Specifically it considers evidence for work
intensification in nursing and contrasts this with policy pronouncements, which have
proclaimed that nurses have been empowered by recent changes.The study found
that empowerment often implied increased responsibility accompanied by tight-
ened control. Some nurses described their managers as ‘seagull’ managers and the
article elaborates what was meant by that term. The four key features of seagull
management were: distance, distrust, destructive criticism, and a defensive culture.
KEY WORDS
empowerment / NHS management / nursing work / work intensification / work-
place control
‘We have seagull managers here, they fly in from a great height, make a lot of noise,
drop a lot of crap, then they fly off again.’
Introduction
his article considers data from a study of the discipline and management
of the problem nurse (Cooke, 2000, 2002). It outlines the ways in which
the study can inform our understanding of the control of nursing work.
The data collection for the study took place in during 1999–2001 in a period
223
Work, employment and society
Copyright © 2006
BSA Publications Ltd®
Volume 20(2): 223–243
[DOI: 10.1177/0950017006064112]
SAGE Publications
London,Thousand Oaks,
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T
of rapid change in the English National Health Service (NHS) as New Labour
instituted a series of modernizing reforms designed, they claimed, to produce a
New NHS (Department of Health, 1997). Among these reforms, the New
Labour government has instituted a number of managerial and regulatory
changes designed to tighten control of the health professions. Ostensibly these
reforms have been designed to improve public protection and empower the con-
sumer of health services.
At the same time the government has claimed that it will empower health
workers with new opportunities and responsibilities. Nurses in particular have
been offered liberation in the New NHS (Beecham, 2000). What this article
contends is that it is more fruitful to understand these changes in the context of
wider changes in workplace control, specifically through an understanding of
recent conflicts over the effort bargain in health work. Changes in workplace
control have largely reflected a flexibility offensive designed to get more for less
from the nursing workforce. Although this flexibility offensive has been accom-
panied by a narrative that has emphasized the empowering nature of these
changes, the evidence for empowerment remains equivocal.
This combination of empowerment and work intensification has been noted
by other authors (Foster and Hoggett, 1999) and is characteristic of a manage-
ment approach often described as new public management (Hoggett, 1996).
A number of authors have pointed out the inherent contradictions in recent
managerial reforms of the public sector. Clarke and Newman (1997) have sug-
gested that recent social policy has been driven by the contradictory discourses
of neo-liberalism and neo-conservatism articulated around competing concep-
tions of freedom and discipline. Advocates of new public management articu-
lated these contradictory discourses in a variety of wish lists for public sector
reform, most influentially in the work of Osborne and Gaebler (1992).
Essentially Osborne and Gaebler wanted to disaggregate public sector organi-
zations and use the disciplines of the market as a substitute for bureaucratic
rules and procedures. They damned bureaucracies as rigid, unresponsive to the
consumer and unable to cope with change.
Yet public sector reform has embodied contradictory trends: centralization
versus decentralization; empowerment versus tighter control; hierarchy versus
competition. New public management has produced hybrid organizations regu-
lated through ‘quasi-markets’ and ‘managed competition’. The resultant orga-
nizational form is one in which hierarchy is strengthened and yet markets and
competition are valorized. A number of recent authors have highlighted these
contradictions of new public management (Du Gay, 2000; Hoggett, 1996;
Hood, 1998; Pollitt and Bouckaert, 2000). Pollitt and Bouckaert offer a num-
ber of relevant ‘candidate contradictions’. A simplified scheme based on their
list of contradictions is presented below:
Increase political control but free managers to manage;
Save money but raise standards;
Motivate and empower staff but intensify work and downsize;
224 Work, employment and society Volume 20
Number 2
June 2006
Reduce bureaucracy but increase audit, measurement and juridification;
Decentralize responsibility but centralize control.
Such tensions and contradictions will arguably play themselves out in the
everyday lives of public sector workers. My study was of discipline and mis-
conduct in nursing. The management of troubles, the imposition of discipline
and acts of blame pinning all reflect the strains and tensions of organizational
life and thus tensions between nurses and their managers rapidly became appar-
ent and are the subject of this article.
Within the study nurses described the development of an inconsistent and
contradictory management style among those who managed them. Some
referred to this style as ‘seagull’ management. The term seagull management
nicely captured the tensions inherent in recent changes in public sector man-
agement. Before considering this data I will outline the ways in which the com-
peting discourses of new public management have been reflected in recent
literature on nursing policy and practice.
‘Modernization’ and change in nursing
Getting more for less
Recent commentary on changes in nursing work has reflected wider debates
about changes in workplace control. Following labour process theory,
(Braverman, 1974) authors have detected routinization, deskilling, work inten-
sification and the imposition of Taylorist controls over nurses (Brannon, 1994).
Efforts to get ‘more for less’ from the nursing workforce date back to the
beginnings of Thatcher’s neo-liberal reforms of the 1980s designed to ‘roll
back’ the welfare state. Since the 1980s the NHS has been subject to successive
waves of cutbacks and this search for cost savings has continued under New
Labour: targets for 2003–2006 include a 2 percent improvement in ‘value for
money’ (Department of Health, 2002a). Generally this has increased through-
put of patients while reducing capacity; NHS inpatient capacity has halved
since the 1980s. At the same time acute activity has increased; ‘finished con-
sultant episodes’ rising by 38 percent between 1990 and 1998 (Buchan and
Edwards, 2000). The effect on nurses of faster throughput combined with
higher rates of bed occupancy has been heavier workloads as nurses care for
larger numbers of more dependent patients (Ackroyd and Bolton, 1999;
Adams et al., 2000).
Qualitative studies (Wigens, 1997; Woon Hau, 2004) have found that
nurses wish to give ‘holistic’ individual care to patients. These aspirations reflect
cherished professional values but nurses feel thwarted by Taylorist management
practices, which force them to conform to a production line style of care giving.
These findings echo Taylor and Bain’s research on call centres in which they
describe call centre operators as having an ‘assembly line in the head ‘ – always
225Seagull management Cooke
feeling under pressure and ‘constantly aware that the completion of one task is
immediately followed by another’ (Taylor and Bain, 1999).
In 1991 The Audit Commission report on the nursing resource accelerated
attempts to extract ‘efficiency gains’ from nurses through increased labour flex-
ibility. Throughout the 1990s increased contract flexibility was pursued
through the use of part-time, temporary and bank staff (Buchan, 1994).
Managers experimented with strategies to reduce the ‘slack’ in the nursing
workforce, imposing time flexibility through eliminating shift overlaps and
implementing more ‘flexible’ forms of rostering such as 12-hour shifts and
annualized hours.
These drives to achieve time and contract flexibility offered managers some
scope for cost savings, but the biggest savings would come from restructuring
the nursing workforce. Pressure for grade dilution followed the introduction of
the healthcare assistant (HCA) grade in the 1980s. Some NHS managers dur-
ing the 1990s argued that a largely trained nursing workforce was a luxury that
the NHS could no longer afford (Caines, 1993). Training places for nurses were
cut savagely during this period. In 1984 England had 75,000 student and pupil
nurses but by 1994 this figure had halved (Buchan and Edwards, 2000).
Both Grimshaw (1999) and Thornley (1996) have demonstrated that the
introduction of the HCA was used as a mechanism to lower the pay floor in
nursing. A high proportion of HCAs had been employed on local pay and con-
ditions, part time and below the national rates for the nursing auxiliaries that
they replaced. Their findings lend some support to the fears expressed by some
nursing writers (see, for example, McKeown, 1995) that nursing was being
restructured along the lines of Atkinson’s (1984) ‘flexible firm’ with a ‘core’ of
relatively secure and functionally flexible workers and a ‘periphery’ of insecure,
low paid workers. The latter would carry out the care work once regarded as
the core of nursing. For example, in one much-publicized incident a Trust laid
off all of its junior staff nurses (D grades) subsequently offering them care assis-
tant posts at grade B (McKenna, 1998). Thornley concluded that the introduc-
tion of the HCA grade had led to greater ‘segmentation and inequality’ in the
nursing workforce.
It follows from Atkinson’s model that there will be pressure on the ‘core’
nursing workforce to become more functionally flexible. Thus, nurses have
been under pressure to take on more routine managerial and medical work. The
introduction of general management (Griffiths, 1983) had led to the disman-
tling of nurse management hierarchies in most Trusts. Further cutbacks in nurs-
ing management were facilitated by the clinical grading structure introduced in
1988. This created a nine point grading structure for nurses from A to I giving
ward sisters at point G 24-hour responsibility for their wards. This led to sub-
stantial shedding of night support staff. Ward sisters have been widely re-titled
‘ward managers’ taking on a wide range of management functions, formerly
performed by middle managers. As well as undertaking more routine adminis-
tration and paperwork during office hours, ward nurses now provide most on-
site and out of hours management cover (Willmott, 1998).
226 Work, employment and society Volume 20
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In addition to these extra managerial responsibilities, the ‘New Deal’ for
junior doctors (National Health Service Management Executive, 1991) reduced
junior doctor hours and created a need for a substitute. Nurses were required
to take on much of their routine work such as inserting intravenous cannulae
and certifying expected deaths. There was little consideration of the effect on
nurses’ workloads. Role extension was presented as a positive opportunity for
nurses to enhance their status (United Kingdom Central Council for Nursing
Midwifery and Health Visiting, 1992). In most cases roles were extended with-
out any increase in nursing establishments, inevitably increasing nurses’ work-
loads (Calpin-Davies and Akehurst, 1999).
Throughout the 1990s nursing writers expressed their concerns about the
downsizing of the registered nursing workforce. In 1998 The UK nursing regis-
ter showed its largest decline in nurse numbers as both recruitment and reten-
tion plummeted. Successive surveys portrayed an occupation experiencing
declining morale and rising levels of stress (Borrill et al., 1998; Smith and
Seccombe, 1998). For example a survey in 1999 found that 59 percent of nurses
had worked for more than their contracted hours in the previous week. In addi-
tion, the number of nurses reporting that they felt under ‘too much pressure’ at
work had remained constant at around 50 percent over the previous five years
(Robinson et al., 1999). Almost one-third of nurses stated that they would leave
the profession if they could.
Hart (1994) has suggested that the nursing profession has throughout it
history been characterized by ‘cycles of discontent’. The erosion of nurses’ pay
and working conditions leads to periodic crises over nursing shortages; a short-
term fix improves nurses’ pay and conditions and temporarily increases nursing
numbers – then the whole cycle begins again. By the end of the century it was
clear that nursing was facing yet another crisis over shortages of staff. It
remains to be seen whether New Labour’s reforms will break the cycle of dis-
content or offer yet another short-term fix.
Liberating nurses’ talents?
There has thus been a growing body of evidence suggesting that the pressure
on nurses to become more functionally flexible has greatly increased nurses’
workloads and put nurses under intense pressure. It has, however, been pre-
sented to nurses as empowerment. Secretary of State for Health, John Reid said
he wished to encourage a new generation of entrepreneurial nurses
(Department of Health, 2004). For New Labour, new roles and responsibilities
offer a ‘challenging future’, but a ‘future full of opportunities’ (Department of
Health, 1999).
New Labour’s strategy for nursing was laid out in the Making a Difference
document (Department of Health, 1999). Making a Difference promised the
recruitment of 20,000 more nurses, the expansion of training places, improved
working lives and a modern career framework. In return, nurses were to ‘sup-
port new roles and new ways of working’, which would ‘release the untapped
227Seagull management Cooke
potential’ of nurses. Resources would only be released in return for moderniza-
tion – it had to be, according to the Secretary of State, a something for some-
thing arrangement (Hart, 2004).
A similar bargain was suggested in the human resource (HR) strategy for
the NHS (Department of Health, 2002b). Architectural metaphors have
become a favourite rhetorical device in Department of Health policy and the
HR strategy has four pillars: making the NHS a model employer; ensuring
the NHS provides a model career; improving staff morale; and, building
people management skills. It also has as its centrepiece a ‘skills escalator’
described thus:
This offers more opportunity for progression and describes a career as a succession
of stages, each with its own pay band and learning requirements. Staff are encour-
aged and assisted to constantly renew and extend their knowledge enabling them to
move up
the escalator. Meanwhile roles and workloads are delegated down
the esca-
lator generating efficiencies and skill mix benefits. (Department of Health, 2002b: 8)
The enterprising employee is offered the opportunity to rise up the esca-
lator but how much opportunity there will be to move upwar
ds when roles
to which individuals aspire pass them on their way down
the escalator
remains unclear. It is hard to avoid the image of nurses running uphill in
order to stand still.
The government’s promises as an employer were therefore: to reverse the
decline in staff numbers; to engage in commitment and trust building activities;
and to make a greater commitment to staff development. In return, greater flex-
ibility and productivity were to be expected from staff. This is a familiar bar-
gain in the contemporary workplace, but it is a bargain in which, according to
Thompson (2003), the employer is rarely able to keep to his side of the deal.
The creation of a virtuous circle between employers, employees and consumers
leading to enhanced knowledge and skills, greater productivity and greater
opportunity is too often merely the preserve of valedictory management litera-
ture. The reality is often, according to Thompson, unfulfilled or unsatisfactory
bargains and unequal workplace relations. For example, in a recent study of
four contemporary workplaces, Grimshaw et al. (2002) suggest that de-layering
and the creation of flattened hierarchies has created a polarized workforce.
Despite a rhetorical commitment among employers to lifelong learning and
skills acquisition, progression is only available to a very select few. Many
become resigned to a lack of employment prospects. For others who take
employers’ promises at face value the outcomes of attempts to progress are
often painful and unfulfilling.
Some evidence of unfulfilled or unsatisfactory bargains is beginning to
emerge in nursing. The government claims to have met its initial target of
increasing nurse numbers by 20,000. However, it has relied on a head-count fig-
ure rather than whole time equivalents (Finlayson et al., 2002a). This increased
head-count has largely been achieved by recruitment overseas with 40,000
overseas nurses registering in the UK in 2001–2004 representing 45 percent of
228 Work, employment and society Volume 20
Number 2
June 2006
new nurse registrations (Buchan and Seccombe, 2004). Numbers leaving the
nursing register have continued to rise and the continued reports of a high
vacancy factor, estimated by the RCN as 22,000, suggests that the nursing
shortage has yet to be solved (Buchan and Seccombe, 2004). Many NHS nurses
remain sceptical that nurse numbers have increased with only 30 percent
reporting an increase in their institution in a recent survey (Guardian, 2004).
More importantly it is unclear to what extent recent increases have matched
increased demand given the government’s commitment to increase the func-
tional flexibility of nurses (Finlayson et al., 2002a).
There have been a number of new roles for nurses such as nurse practi-
tioners, nurse consultants and modern matrons. However, numbers are small
and their impact on the opportunity structure in nursing is unclear. By 2002 the
NHS had recruited 500 nurse consultants in a workforce of over 300,000
nurses (Finlayson et al., 2002a, 2002b). It was not clear how many of these
were new posts as opposed to old senior nurse posts with new titles. The
creation of these new roles has to be set against the background of a steady
erosion of nursing grades since the introduction of clinical grading in 1988. For
example, the proportion of ward managers/sisters graded at G or above has
reduced from 64 to 48 percent since 1993, in spite of the fact that they have
acquired a wider range of responsibilities during this period. A significant pro-
portion of ward sisters (G) and senior staff nurses (E) have been on the same
grade for over 10 years and almost half of all nurses feel that their grade is not
appropriate to their responsibilities (Ball and Pike, 2003). Thus there is grow-
ing evidence that the polarized workforce identified by Grimshaw et al. (2002)
is developing in nursing.
Almost one-third of nurses continue to say that they would leave nursing if
they could and reports of poor working conditions and low morale remain high
in recent surveys (Aiken et al., 2001; Ball and Pike, 2003; MORI, 2004). Thus,
much recent literature supports the contention that the contradictions and ten-
sions inherent in recent public sector reform have had a marked and often detri-
mental impact on nurses.
Study, setting and selection of cases
The study involved organizational case studies of three Trusts in the north of
England. These Trusts were selected on the basis that they seemed, as far as
could be reasonably ascertained, to be typical district general hospitals in sub-
urban areas. One Trust which I have named Townend (TO) provided acute and
community services to its local population. By contrast, in the Hilltop district,
two Trusts existed which separately provided acute and community services:
(Hilltop Acute – HA and Hilltop Community – HC). Twenty-five wards
involved in the study organized into seven ‘clinical directorates’ across the three
Trusts (see Table 1).
229Seagull management Cooke
Fifty ward nurses were interviewed spread across the 25 wards. All of
the managers, human resources staff, quality assurance staff and risk man-
agement staff relating to these 25 wards were included in the study. The
numbers of interviews are shown in Table 2 below according to the grades of
staff interviewed.
In total 120 informants were interviewed in the three Trusts. Coverage of
informants was almost complete with only three refusals. In addition to the
directors of nursing interviewed in the three case study Trusts, directors of nurs-
ing in 12 further local Trusts were interviewed. Twelve other key informants
were interviewed at a regional and national level. The majority of ward nurses
interviewed were female (82%) and 78 percent had been qualified for over five
years. Five of the seven clinical directorates were managed by women. There
were negligible numbers of staff from minority ethnic groups employed as
nurses in these Trusts which recruited mainly from their local labour market.
230 Work, employment and society Volume 20
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June 2006
Table 1 Wards included in the study shown by clinical directorate
and Trust
Townend Trust
Medicine and care of the elderly 4
Care of the elderly mentally ill 2
Surgical specialities 2
Hilltop Acute Trust
Acute Medicine 5
Surgical specialities 2
Hilltop Community
Medicine for the elderly 7
Care of the elderly mentally ill 3
Table 2 Staff interviewed shown by grade
Ward sisters/charge nurses 25
Staff nurses/enrolled nurses 25
Clinical nurse specialists 7
Directorate managers 22
Quality assurance and risk managers 6
Patients’ representatives 3
Human resource managers 10
Board level managers 11
Union representatives 11
Methods
The main method of data collection was qualitative interviews, lasting approx-
imately one hour. Other data collected included Trust policies, local press cut-
tings, observations of Trust board meetings and observations of professional
conduct cases.
A semi-structured interview guide was used giving a prompt list of topics
to be covered during the interviews including: how staff were managed and dis-
ciplined; nursing workloads; and relationships between managers and nurses.
Accounts of 76 disciplinary cases were also collected and analysed. Due to the
sensitivity of the topic, informants were given the option to refuse tape record-
ing of the interview. This was at the insistence of the Local Research Ethics
Committee. Only one-third of informants agreed to the use of a tape recorder
and in the remainder of interviews verbatim notes were taken. This highlighted
the fears and insecurities of many of the staff interviewed and it may be that the
use of note taking was a factor in the remarkably free and frank responses given
by many informants.
Thematic and comparative analysis of the data was carried out by hand
using colour coding and marginal codes. Analysis of the data was an iterative
process in which I continually compared and contrasted accounts working back
and forth between different batches of data. In addition to comparing individ-
ual accounts of the same incidents given from different standpoints in the orga-
nization, I also constantly compared my data with official policy discourse on
the emerging issues. The data is presented using ‘thick description to convey its
richness’ (Geertz, 1973). In this article, I will be considering the data from these
interviews relating to workplace control in nursing.
Work intensification
There was overwhelming evidence that nurses’ workloads had increased enor-
mously. Changes have included increased throughput and patient dependency
(patients are going through the system ‘sicker and quicker’), grade dilution, and
expanded roles as nurses took on more ‘hands on’ management and ‘hands on’
medical care. ‘Hands on’ was a widely used term, which denoted routine, low
status work considered suitable for delegation to nurses.
Work intensification led to conflict over working hours, shift patterns and
pressures on staff to move frequently between wards to cover gaps in the ser-
vice. All nurses said that work intensification was the main factor affecting
standards of nursing care: there was ‘not enough time in the day’ to care ade-
quately for patients. Nurses complained frequently of stress, exhaustion and
low morale:
The morale problem was people were tired, exhausted, not enough staff, demor-
alised. It was workload, it was attitude, it was not feeling appreciated and not feel-
ing wanted. (Ward Sister/Manager HA)
231Seagull management Cooke
Many managers countered that nurses had always complained of low
morale and according to some ‘actual signs of clinical stress’ were not there.
(Although recent research contradicts this commonly held assumption [Borrill
et al., 1998]). Patient’s representatives corroborated the nurses’ complaints:
It was clear that staffing was out of control. People were doing double shifts, nurs-
ing staff were knackered. There was rising sick leave, the managers didn’t seem to
realise it needed to be dealt with. (Patients’ representative HC)
Many wards had a high vacancy factor. Most directors of nursing said that
nurse shortages reflected a national demographic problem and were out of their
control. Many nurses, however, said that their colleagues were leaving because
they were ‘unhappy and stressed’. They blamed this on heavy workloads and
an unsatisfactory management style:
I’ve never seen morale so low. You get little or no management support, you’re
expected to grin and bear it, get on with it, no one backs you up. They’re taking the
piss. You get no support, no backup. You ring up and say you’ve got no staff and
the response is ‘Tough, it’s the same everywhere’. (Staff Nurse HA)
Most ward nurses also said that despite increased workloads higher stan-
dards were expected of them. Both patients and managers had increased their
expectations. Several nurses said that politicians had raised public expectations
through consumerist reforms such as the Patients Charter. They felt that the
public had been encouraged to expect a service that they could not deliver with
the resources available to them. Nurses bore the brunt of patients’ resultant dis-
satisfaction and, if there was a complaint, were frequently blamed.
In addition, managers’ fears of litigation, complaints and adverse publicity
had created a defensive culture. This led to increased requirements for nurses to
provide paper trails charting every aspect of the patient care:
The paperwork is silly … on admission you have to have a front sheet, assessment
sheet, Waterlow assessment, manual handling assessment, nutritional assessment, a
different form for everything … you’ve got about 10 forms to fill in, you’ve got an
ill patient, and you can’t give care, because you’re too busy filling out forms. (Ward
Sister/Manager HC)
The increased preoccupation with defensive documentation was an impor-
tant cause of periodic ‘crackdowns’ by managers. Relationships between nurses
and their managers were strained in the majority of the study directorates and
work intensification was an important cause of conflict. I will now consider
these relationships in more depth.
Structural conflict:‘empowering’ ward nurses
Strained relationships between nurses and managers reflected the conflicting
pressures felt by both parties. Nurses felt torn between their responsibilities
to their patients and the demands of managers. Middle managers also felt the
conflicting pressures of their role intensely. They were at the sharp end of
232 Work, employment and society Volume 20
Number 2
June 2006
management, dealing with everyday operational problems, such as bed and
staffing shortages, yet it was they who were also expected to deliver on the
myriad strategic objectives ‘cascading’ down from the Department of Health.
Furthermore, the managerial culture was such that strategic management con-
ferred power and prestige whereas ‘hands-on’ or operational management was
of low status. Operational matters only came into prominence when some-
thing went wrong and therefore ‘hands-on’ management did not confer credit
– only blame. Thus, most middle managers expressed a preference for strate-
gic management. Many ‘talked up’ the strategic aspects of their role by stress-
ing their involvement in change management, marketing or shaping the
organizational ‘mission’.
In five of the seven study directorates there were explicit attempts to shed
‘hands-on’ management to a lower tier, usually ward sisters now often called
‘ward managers’. Middle managers had a mixture of motives. While the ratio-
nale for delegation of ‘hands-on’ management was usually said to be to
‘empower ward managers’, cutbacks of staff at middle management level were
an important factor especially outside of office hours. Managers hoped too that
devolving budgets to ‘ward managers’ would make them more financially
accountable and thus reduce spending:
The G grades now they’ve got their name on the top of the budget. They’re not part
of the budget setting process, but they certainly realise that they’ve now got their
name on the budget and they should be very careful about ordering things.
(Directorate Manager HA)
A wide range of extra management duties had been devolved to ward sis-
ters/managers including out of hours management cover, budget management,
attendance management, ordering stock and catering supplies and in-putting
data onto the hospital computer systems. Most of these were routine clerical
duties which managers had found dull and unrewarding.
Middle managers saw devolving hands-on management to ward staff as a
way of gaining control over their own careers. I noted earlier that strategic
work was highly valued by managers and seen as conferring status; thus, man-
agers saw shedding ‘hands-on’ management as an opportunity to enhance their
status and engage in more desirable activities. ‘Hands-on’ management was
relentless and inescapable – unless it could be passed on to someone else.
Several managers at directorate level remarked that they were trying to shed
‘the routine stuff’, because ‘that is not what I want to do’.
There was often considerable resistance from ward sisters to being
‘empowered’ with more routine managerial responsibilities. One directorate
manager commented: ‘we’re pushing it down – and they’re pushing it back up
again’. Many managers accused nurses’ of irrational resistance to change’.
Several strategies were used to overcome resistance and chivvy nurses into new
roles – disciplinary action was on occasions invoked. ‘Managerial incompe-
tence’ was an increasingly common cause of disciplinary cases.
233Seagull management Cooke
Directorate managers also said that empowerment meant not letting ward
nurses ‘hand problems’ to managers. Nurses should learn to find their own
solutions to problems. For example, several managers complained about nurses
‘waving the Code’ describing occasions when nurses invoked their Code of
Professional Conduct to complain about staffing shortages. They said that ward
nurses should not imagine that they could transfer accountability for staff
shortages at ward level to management:
What you get as well is people kind of waving the Code and saying: ‘I’ve got a prob-
lem and I’m using the Code of Conduct so what are you going to do about it?’ and
you answer: ‘Well what were you going to do about it?’ (Director of Nursing)
Many managers expressed impatience with nurses who resisted empower-
ment during interviews. Nurses they said: ‘wanted to be spoon fed’ or ‘wanted
someone to hold their hands’. They were ‘dull’, ‘apathetic’, ‘lacked dynamism’
and were ‘unwilling to change’. They were ‘dinosaurs’, ‘die-hards’, ‘sleepy
heads’ and ‘past their sell by date’. It is perhaps ironic that managers charac-
terized ward nurses in this way because of their resistance to taking on work
that managers had themselves described as unrewarding, dull and routine.
Nurses complained bitterly about the extra work which new management
responsibilities had brought them. Many ward nurses spoke of working con-
siderable amounts of unpaid overtime to complete management and paper-
work as their working hours were often spent entirely in caring for patients.
Nurses said that although their responsibilities had increased they had little
control. For example, although ward sisters/managers ‘had their name on top’
of the ward budget they could not choose how to spend it. One sister spoke
for most of her colleagues when she said: ‘I class myself as an impotent man-
ager of my budget’.
Thus, most ward sisters/managers said that they had little say over ward
staffing and were not consulted or informed about important changes affecting
their ward. Ward closure, staffing changes and relocation to a new site are
examples of changes made ‘above the heads’ of ward sisters/managers:
There’s been a sudden decision to close the ward this week, I haven’t had a full clear
explanation … at a strategic level, we don’t know a thing … you sometimes don’t
know what’s going on; you get a phone call saying ‘I’m your new staff nurse’ –
‘Pardon’ … she’s a good nurse, I’ve got no complaints, but I can sympathise with
the person who said we’re disempowered. (Ward Sister/Manager HC)
Thus, while managers claimed that they had empowered ward sisters/man-
agers, many countered that they had only the illusion of control; that they had
acquired responsibility without power. It was clear that as responsibilities
passed down to ward sisters they became more rigidly codified and the power
to choose how to exercise that responsibility diminished. A good example is
attendance management. Directorate managers retained considerable discretion
in dealing with staff sickness. However, ward sisters/managers who had
acquired this responsibility had to follow a protocol, which formally identified
234 Work, employment and society Volume 20
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triggers to particular actions; for example a standard warning letter may have
to be sent after a number of days of absence regardless of the reason for the
absence. They noted that the formalization of these responsibilities also entailed
an increase in paperwork:
There’s increased responsibility devolved to ward managers and there’s more docu-
mentation to prove to someone else that you accept that responsibility. (Ward
Sister/Manager HA)
In spite of much publicized initiatives to empower them most of the ward
sisters/managers in this study felt that they had acquired responsibility without
power. There was considerable evidence to support this view; as responsibilities
are passed down to front-line staff any element of discretion is removed. Thus
empowerment had come to imply increased responsibility accompanied by
tightening control.
Cracking down on ward nurses
Middle managers had something to gain from ‘empowering’ the ward sis-
ters/managers with operational management responsibilities but they also had
something to lose. Empowering ward sisters/managers gave them the opportu-
nity to engage in more desirable strategic management activities but there
remained the risk that problems at an operational level would come back to
haunt them. These managers faced considerable insecurity. Most were survivors
of several waves of redundancies. They had to meet tough financial targets yet
it was they who were held responsible for the low morale of front-line staff.
They saw themselves as the obvious scapegoats if something went wrong at
ward level. Thus, although middle managers were keen to devolve routine man-
agement to ward level, there remained a lurking anxiety that ward problems
might resurface to discredit them.
Middle managers had devised a number of informal strategies to resolve
this dilemma. They tried to informally ascertain what was ‘really going on’ at
ward level. Many stressed the amount of time that they spent ‘walking the job’
or doing ‘management by walking about’. This contrasted sharply with the
views of most ward nurses who described them as visiting rarely or ‘only if
there was trouble’. Managers described a number of problems that led them to
‘pull up’ nurses during ‘management by walking about’. What they saw as
problems confirmed the impression given by nurses that their visits were for the
most part fleeting.
Problems identified by managers were mainly to do with superficial appear-
ance and were things that could be noticed momentarily when passing through
the wards. The most common complaint from managers was of nurses ‘sitting
down’, ‘drinking tea’ or otherwise appearing to be having a break from work.
Managers also complained about the untidiness of wards, patients or nurses
and sometimes of nurses’ attitudes or demeanour:
235Seagull management Cooke
As regards personal appearance for example that’s a standard. We do that via man-
agement by walking about. Last night, when I was on the wards, I copped three
people with inappropriate jewellery on. (Directorate Manager TO)
Although managers were anxious to be seen to be involved in formal per-
formance measurement systems such as audit, few saw audits as a useful tool
for uncovering ward problems. Audit, they said, ‘tells us things we already
know’. Informal surveillance tools such as gossip or ‘the grapevine’ were valued
more highly. The ‘grapevine’ told managers of wards or individuals about
which they were ‘not happy’. The decision that managers were ‘not happy’ with
a nurse or ward area could trigger periods of intensive scrutiny. This increased
surveillance could involve spot checks of documentation, unscheduled ward
audits etc. Sometimes periods of scrutiny led to waves of disciplinary action.
These activities were similar to the informal control strategy described by
Fortado (1991) as ‘the microscope’. This scrutiny could lead on to informal
punishment or formal disciplinary action. Staff often described this process as
being ‘picked on’:
I’m lucky they don’t bully me like they bully some of the others. I feel confident to
stand up to them – others do get bullied. Once you fall into that pit it escalates –
they find fault with whatever you do. It’s a rolling programme of can’t do anything
right. The only way out is to leave … I have a feeling always as if I’m on the edge
of a precipice here and at any time I might fall over the edge. Here it’s whether it’s
your turn to be picked on or not. (Ward sister/Manager HC)
Thus, the structural conflict between ward staff and managers had cre-
ated a culture in which blame was endemic. This led ward nurses to give a
highly negative account of their relationship with their managers, which I will
outline next.
Seagull managers
I interviewed 25 ward sisters: only seven rated their managers as in any way
supportive. Managers alternated between remote control and periods of inten-
sive or microscopic control as described above. One group of community nurses
interviewed during the pilot phase of the study summed up this management
style by describing their managers as ‘seagull’ managers in the words quoted at
the head of this article.
Four main themes emerged from nurses’ descriptions of ‘seagull’ management:
Distance
As noted above, most ward nurses complained that their managers rarely or
never visited the wards. They were said to only visit ‘if there was trouble’; com-
ing ‘to find fault’ or ‘when something went wrong’. They were seen by the
236 Work, employment and society Volume 20
Number 2
June 2006
majority of nurses as distant figures uninterested in ward staff and their day-to-
day struggles to ‘cope’:
I feel strongly with management; managers should come on the ground floor; do
they heck. They should mix with you, eat with you. It doesn’t happen. They do
things by remote control. How do they know the feelings of the coalface worker?
(Ward Sister/Manager HA)
Trust Board managers were even more remote figures almost completely
unknown to even to senior ward nursing staff and were associated with cere-
monial visits such as ‘when the Bishop visited’ or ‘when they opened the
patient’s garden’:
I wouldn’t know the Director of Nursing if I fell over him in the car park. (Clinical
Nurse Specialist HA)
Distrust
Predictably, distance produced high levels of distrust between ward nurses and
their managers. Ward nurses identified three major reasons for this distrust:
lack of support, unsympathetic handling of staff sickness and a failure to
respect staff confidentiality. Lack of support was by far the most prominent
cause of distrust. There was an overwhelming sense among many ward nurses
that management ‘didn’t care’, ‘don’t listen’ and ‘don’t support us’:
I feel management don’t give a damn. They’ve forgotten what it’s like to be on the
ward, they’ve got further away from nursing. It’s very difficult – if the support was
there you wouldn’t mind making the effort. (Staff Nurse HA)
Linked to the above were frequent complaints that managers did not
understand or sympathize with workload pressures. They expect nurses to carry
on regardless of such pressures:
They don’t make any allowances for pressure … give us a break sometimes. You get
a thank you at Christmas; they don’t listen; it should be over twelve months. You
get bollocked if disclaimers are not filled in on every admission. You get shouted at;
told all the G grades are incompetent. (Ward Sister/Manager HC)
Destructive criticism
Destructive criticism was a prominent feature of the management style in
four out of the seven directorates studied. Baron (1988) has defined man-
agers’ destructive criticism as criticism accompanied by negative affect,
which blames poor performance on character failings intrinsic to the
employee. His research suggested that destructive criticism undermines
morale and task performance. Ward nurses complained of being shouted
at, belittled and criticized by their managers; they frequently spoke of
being ‘bollocked’:
237Seagull management Cooke
The managers come and do a stomp about and look for faults. I got a bollocking
in front of all the patients because there were 10 boxes of Weetabix in the store
cupboard. Well okay, it meant we weren’t going to order any next week. She went
away feeling happy; she’d done her job and left me feeling like a piece of shit. (Staff
Nurse HC)
There was no shortage of examples of punitive language in managers’ own
accounts during interviews; managers used expressions such as ‘a good slap’ or
an ‘ear bashing’ to describe the appropriate response to nurses who made mis-
takes or were insubordinate. Managers described themselves as acting in the
interests of patients or the service; the intent of these punitive behaviours was
said to be to ‘effect an improvement in performance’. Union representatives
often described these events as harassment:
Some managers reduce staff to shrivelling heaps. They seem to enjoy the power in
doing it. I had one case, the girl was very strong-minded, maybe too outspoken. By
God, by the time they’d finished with her she was off sick with stress and depres-
sion and in a terrible state. I don’t think nurses get much support. They’re fright-
ened of doing anything wrong because they’re suspended, disciplined or harassed to
bloody death. (Union Representative TO)
One manager at Trust Board level had noted the negative impact that
destructive criticism could have on nurses’ morale:
It’s the fleeting moments when they don’t listen to staff or destroy the morale of our
good and experienced practitioners. I try to model good behaviour, I don’t shout at
them (pause) but sometimes I just want to get out a gun and shoot them. (Director
of nursing)
Defensive culture
Fears of complaints, litigation and adverse publicity were high among both
managers and ward staff. Annandale (1996) suggested the creation of a risk
culture in the NHS and this study similarly found that ‘covering your back’
was a major preoccupation. Managers saw the development of risk manage-
ment systems as a high priority. These focused heavily on improving docu-
mentation in order to protect the Trust from litigation. Nurses bore a very
large share of the burden of producing these new paper trails. Most had been
taught the dictum: ‘If you haven’t written it, you haven’t done it’.
Documentation was an important focus for the waves of disciplinary action
that occurred. Ward nurses frequently complained about the burden of paper-
work saying that managers were ‘form mad’ and ‘it’s a wonder they haven’t
got a form for going to the toilet’. Ward nurses, however, felt the need to use
documentation to protect themselves from blame and sometimes tried to
insure themselves by documenting their concerns about issues such as poor
staffing. However, the use of documentation by nurses as individual rather
than institutional self-protection led to conflict, these were matters that their
managers did not want to see written down:
238 Work, employment and society Volume 20
Number 2
June 2006
There was an incident today and the managers wanted me to justify why I left the
ward with only two trained staff on duty. What do you do? We were stuck without
the staff. Now, if I’m left short I ask the managers ‘What do you want me to do?’
I’ve learnt to cover myself. You have to justify yourself. What am I supposed to do
next week when I haven’t got the staff again? You’re pushed to do your best. If it
goes wrong you’re to blame but they don’t want you to write it down. Now I phone
over if the numbers are low. That’s my insurance. You have to make do, it’s nurs-
ing. (Ward Sister/Charge Nurse HA)
It was the cumulative effect of incidents such as this that led nurses to
describe themselves as powerless and unsupported and to describe their man-
agers as ‘seagulls’.
Conclusion
It’s about a lot of people who work too hard for too little reward and are constantly
pressured when they get things wrong and too infrequently rewarded when they get
things right. (Clinical Manager HC)
The study corroborated other recent accounts of work intensification in nurs-
ing such as Buchanan and Considine (2002). Furthermore, it confirmed recent
policy literature which has highlighted the contradictions of new public man-
agement. Nurses were subject to contradictory expectations and pressures – but
so too were their managers. Out of these tensions arose the management style
which some nurses described as ‘seagull’ management. Key contradictions were
processes of delegation of responsibility, which were said to empower staff,
coinciding with a tightening of bureaucratic control mechanisms; arbitrary,
239Seagull management Cooke
Table 3 Management styles
Market/Enterprise and Regulatory bureaucracy and
empowerment Seagull Management Neo-Taylorism
Delegation Mock Bureaucracy Targets
Flat Structures Mock empowerment Procedures
Empowerment On/off controls Audit
Flexibility Decentralized responsibility Juridification
and centralized control
Portfolio working Work intensification/Doing
Decentralized blame and more with less
Consumerism centralized credit
Quality Remote control alternating
with microscopic control
on/off systems of surveillance and control; and a management style which con-
fused elements of both high trust and low trust in an instable hybrid. So-called
seagull management emerged from the contradictions of a hybrid organiza-
tional form, which combined authoritarian bureaucracy with an ostensible
commitment to enterprise and empowerment. I have summarized these contra-
dictions in Table 3.
Perhaps the most profoundly felt of these contradictions was that between
rhetoric and reality; it was nurses’ own ironic commentary on the gulf between
rhetoric and reality that shaped the concept of ‘seagull management’.
Acknowledgements
This study was made possible by a research scholarship from the United Kingdom
Central Council for Nursing, Midwifery and Health Visiting. I am grateful to Huw
Beynon for his guidance and support.
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Hannah Cooke
Hannah Cooke is a lecturer in the School of Nursing Midwifery and Social Work at
the University of Manchester. She has a broad interest in research into nurses’ working
lives. She has also written a book on care of the dying and has written extensively on
sociology for nurses.This research was funded by the United Kingdom Central Council
for Nursing Midwifery and Health Visiting (now the Nursing and Midwifery Council).
242 Work, employment and society Volume 20
Number 2
June 2006
Address: Dr Hannah Cooke BSc, MSc, PhD, RGN, School of Nursing Midwifery and
Social Work, University of Manchester, Coupland 3 Building, Coupland St, Manchester
M13 9PL, UK.
E-mail: hannah.cooke@man.ac.uk
Date submitted
Date accepted
243Seagull management Cooke
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In this chapter, Goldberg and Davidson’s notion of critical and transformative interdisciplinarity is introduced and their model of interdisciplinarity as an escape from disciplinary reductionism explained. The importance of multifaceted/mixed methods is noted. Two samples of journal articles (N = 172) are interrogated in order to characterize interdisciplinary research in the field of workplace bullying. Comparative analysis of these samples is undertaken to determine the necessary conditions for critical and transformative interdisciplinarity. Overall estimates of the degree of interdisciplinarity present in the samples are followed by analysis which assigns articles to four categories: health-focused, organization-focused, culture-focused and subordination-focused interdisciplinarity. The samples are found to be unevenly distributed across these categories, and some categories show more critical and transformative potential than others. This potential is reduced where the ontologies and epistemologies of contributing disciplines are closely aligned, as they were in one of the samples. The two samples are also assigned to categories depending on the methods they use, and again there is evidence of differences, particularly in the balance of quantitative and qualitative methods. Little or no use was made of multifaceted methodologies in the more quantitative sample. The other had more potential to contribute to critical and transformative interdisciplinarity by using multifaceted methods. The reasons for the differences in interdisciplinarity between the two samples are sought in institutional analysis, particularly in the way interdisciplinarity is limited where researchers share ontological and epistemological assumptions with employers.
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In this chapter an attempt is made to focus on the ideological and practical implications of the new people-oriented forms of healthcare management variously described as strategic human resource management, high-performance management, human capital management, or high commitment management. The chapter details the managerial and academic claims concerning the management of human resources and goes on to emphasize the impact that the literature of Human Resource Management (HRM) has had on healthcare employees and healthcare organizations. The restrictions of the applied research approaches are also highlighted and the author argues that the managerial and post-structural literature is limited in that its conceptualization of HRM and changing performances is incomplete. Also considered is a range of literature that has been used to study individual and organizational change with a labour process perspective and explains why an approach based upon the study of the disparity between the “HRM rhetoric” and the day-to-day practice, as well as how people experience and respond to that disparity within a wider frame of social, political, and economic relations, is to be preferred. As a basis for further contextualization, the powerful and privileged positions of healthcare professionals and the distinctive character of their employment relationship are considered. The chapter concludes that a more critical analysis is necessary to challenge the way in which the concept of HRM is examined by healthcare management academics and practitioners.
Chapter
In this chapter an attempt is made to focus on the ideological and practical implications of the new people-oriented forms of healthcare management variously described as strategic human resource management, high-performance management, human capital management, or high commitment management. The chapter details the managerial and academic claims concerning the management of human resources and goes on to emphasize the impact that the literature of Human Resource Management (HRM) has had on healthcare employees and healthcare organizations. The restrictions of the applied research approaches are also highlighted and the author argues that the managerial and post-structural literature is limited in that its conceptualization of HRM and changing performances is incomplete. Also considered is a range of literature that has been used to study individual and organizational change with a labour process perspective and explains why an approach based upon the study of the disparity between the “HRM rhetoric” and the day-to-day practice, as well as how people experience and respond to that disparity within a wider frame of social, political, and economic relations, is to be preferred. As a basis for further contextualization, the powerful and privileged positions of healthcare professionals and the distinctive character of their employment relationship are considered. The chapter concludes that a more critical analysis is necessary to challenge the way in which the concept of HRM is examined by healthcare management academics and practitioners.
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Using case study evidence from an investigation of 'quality' initiatives and working practices in three offices within a District of the Benefits Agency (BA), this article examines the contradictory role of new public management on employees. Decentralised management, performance related pay, teamwork philosophies and the promotion of a 'customer' culture reflect a move away from a traditional civil service bureaucratic form of organisation. However, the implementation of change within local settings has brought about variations in local management approaches, work organisation and staff perceptions. The consequences of these are explored and we consider whether the BA's attempts to empower staff have been thwarted by a progressive intensification of workloads. Our research, by illustrating the importance of variations in local settings, warns of the dangers of evaluating institutional and employment change in the public sector as if it were the result of a coherent and consistent neo-liberal re-structuring strategy. Moreover, it examines reasons why some change initiatives have been unsuccessful. Finally, we identify a recent shift in emphasis within the BA which presages a move away from service quality to economy and draw some initial conclusions about the future impact on employment in this sector.
Article
Full-text available
Using case study evidence from an investigation of `quality' initiatives and working practices in three offices within a District of the Benefits Agency (BA), this article examines the contradictory role of new public management on employees. Decentralised management, performance related pay, teamwork philosophies and the promotion of a `customer' culture reflect a move away from a traditional civil service bureaucratic form of organisation. However, the implementation of change within local settings has brought about variations in local management approaches, work organisation and staff perceptions. The consequences of these are explored and we consider whether the BA's attempts to empower staff have been thwarted by a progressive intensification of workloads. Our research, by illustrating the importance of variations in local settings, warns of the dangers of evaluating institutional and employment change in the public sector as if it were the result of a coherent and consistent neo-liberal re-structuring strategy. Moreover, it examines reasons why some change initiatives have been unsuccessful. Finally, we identify a recent shift in emphasis within the BA which presages a move away from service quality to economy and draw some initial conclusions about the future impact on employment in this sector.
Article
The development of a managed National Health Service (NHS) has been a central element of government policy for a substantial part of the last two decades. Within months of taking office in 1979, the first Thatcher administration repudiated the idea of a centrally planned and administered NHS in favour of a declared policy of managed localism (Klein 1995: 124–26; Pollitt 1993: 68–9). However, a somewhat more considered process of policy formation was soon set in train with the commissioning of the Griffiths enquiry and, following the acceptance of its conclusions in 1983, with the introduction of what was called ‘general management’. Since the middle of the 1980s, the management which Griffiths recommended (which allocates considerable decision-making independence to managers within a framework of prescribed budgets) has been consolidated and developed.
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This article examines the reorganization of nursing work during the cost containment era. In recent decades, the division of labor on hospital wards has been reversed through task reunification, a process promoted by nursing leaders as professional upgrading. The article argues that this change overcomes prior work difficulties yet contradicts theories of professionalization and serves managerial interests. Observations on hospital wards reveal that, although RNs are not “technically proletarianized,” reunified tasks and unmediated relations with patients intensify work, forcing RNs to limit an overextended work jurisdiction at the same time that the flattening of the nursing hierarchy increases their accountability.