Climbing up the Ladder. the Changing Role of Nurse Managers within the German Hospital Management.

While there is evidence that medical directors or physicians that become clinical directors face tensions between medical professionalism and managerial control (Kitchener 2000, Witman et al. 2010, Correia 2013) and thus have to manage institutional complexity (Blomgren/Waks 2015), relatively little is known about the orientations of nurse managers in hospitals. Based on in-depth interviews with nurse managers in German hospitals we analyzed their perspectives and symbolic constructions. Different to medical directors they don’t perceive themselves in the dilemma between managerialism and professionalism (nurses) perspectives. As their aim is the well-functioning organization, their social orientation is more familiar with the managing director than the medical director. Furthermore nurse managers use parts of the nurse logic (e.g. the skills of organizing processes) to legitimize their manager’s position and distance themselves from the so called “particularistic” behavior of physicians.

We use different theoretical approaches to make sense of the coherence of these instructive inner conceptions and the embeddedness in the hospital management. From an institutional-logics perspective (Thornton et al. 2012) nurse managers use the nurse perspective to stabilize their manager’s position. Although they got socialized as nurses they distance themselves from their former domain and use the nurses semantic in an instrumental sense. From a field-level perspective (Fligstein/McAdam 2012) the organization could be understood as power struggles between different groups. Nurses are subordinated to physicians (e.g. their work is dependent from doctor’s instructions) and the introduction of hospital’s managers lead to a loss of power for physicians. From that angle, the growing identification of nurse managers with the general hospital management enables them to take influence not only in organizational but also in medical decisions.