INFORMATION SYSTEMS AND MANAGEMENT OF HOSPITAL NURSING: A STUDY IN SOCIAL ORGANIZATION OF KNOWLEDGE

The use of information systems in effecting greater management control over hospital nursing is analysed in a study which builds in the standpoint of nurses. When documentary management methods integrate cost-control with control over execution of nursing work, nurses implement fiscal restraint against their professional judgment. Decision-making about practice is transferred from individual nurses into document-based "accounting" processes; a new capacity for achieving centrally-developed policy displaces local professional control. The nursing profession is linked to this development by its official sponsorship of documentary accountability. Used for cost-saving, management control over the nursing labour process reorganizes not just the technical but the social relations of nursing. The new relations have analogous organization and are experienced similarly to "class" relations arising within capitalist production.;Analysis of information as management technology is analysis of ideology (Smith, 1974a and b), generated to facilitate professionally sanctioned control over a work process. Management of nursing practice seeks demonstrable improvements in "efficiency" or "quality assurance", concepts which become discrete and measurable only as information. To accomplish its accounting ends, the information technology detaches concepts from their material base in nursing. Documentary demonstrations of "improvements" do not reflect accurately the working knowledge of nurses who accomplish them in managed settings; success of managed outcomes is more appropriately measured by their usefulness in corporate management of nursing. Making a professionally-trained labour force more tractible has incapacitating hidden costs to nurses whose judgment and skill must still be relied on to maintain patient care.;Documentary features of management activities and effects on nurses' work are the focus of organizational analysis conducted in a public general hospital. Formal organization is understood to be constituted in organizational activities, following Bittner, 1965. The nursing labour process is "held" in the documents; nursing activities are defined, evaluated and shaped in documents. Nurses, entering their knowledge of nursing into the information systems, participate in the exercise of management control over their practice. The information-generating process transforms nurses' knowledge in determinate ways. The research problematic is this exercise of control taking place in objective documentary processes. Mapped as courses of organizational action, documents connect a nurse's work (decisions) to policy decision originating elsewhere, in a government bureau, for instance.