From Policy to Practice - an Analysis of a New Shift Distribution Policy for Hospital Nurses

This case study investigates the practical implementation of a policy on the distribution of irregular shifts among hospital nurses, known as Shared Irregular Shifts (SIS), and examines its implications for the nursing profession, healthcare organization, and gender dynamics. Prompted by a nursing shortage and the need for enhanced retention efforts, the Danish government established a National Commission on Healthcare Resilience in 2022. One of its recommendations was to distribute irregular shifts more evenly among nurses to promote work-life balance and workplace well-being. This study uses institutional ethnography as its primary methodology, focusing on how social institutions shape the daily experiences of nurses involved in this new policy.

Empirical data was collected through observations and interviews with 24 participants, including nurses from both inpatient and outpatient wards and first-line managers. The analysis employs Henry Mintzberg’s "Four Worlds" framework, which maps the trajectory of policy from formulation to implementation, to understand how SIS functions as a ruling relation within the healthcare system. Additionally, theories from Davina Allen on administrative invisibility, Celia Davies on gendered professional codes, and Eva Evetts on hybrid professionalism are used to critically analyze the policy’s impact.

Findings reveal that SIS is experienced differently across various organizational levels, with notable disjunctures between the intended policy outcomes and the actual experiences of nurses. SIS nurses reported feelings of insecurity, loneliness, and fear of compromising patient safety due to a lack of familiarity with the specialized tasks in inpatient settings. Inpatient ward nurses expressed concerns about increased responsibility and reduced flexibility, while outpatient nurses felt the policy threatened their work-life balance and undervalued their specialized roles. Managers highlighted the complexity of implementing the policy in terms of recruitment, role definition, and maintaining patient safety.