If a bed is just a bed, what does that make the nurse? Nurses' negotiation of identity in a contested discursive terrain - an institutional ethnography.

A person-centred approach in healthcare has garnered increasing global attention and is promoted in research and by the WHO as an approach that holds potential for improving the quality of healthcare, patient safety, and nurses’ work environment. This, in turn, supports the recruitment and retention of nurses.
This institutional ethnography is situated on a Danish University hospital where a person-centred approach is central to the hospitals’ visions, goals, and strategy in nursing practice. We explore the connections between institutional discourses and nurses’ negotiations of meaning and identity and the implications for a person-centred approach. These connections often remain invisible until they are subjected to analysis.
The study is based on participant observation, interviews with nurses and nurse managers and scrutiny of the fields’ documents. Additionally, we conducted a series of co-creation workshops with nurses as co-researchers to facilitate critical reflection through joint analysis. The empirical material is analysed by the authors by using mapping and Bakhtin’s concept of voice.
This study sheds light on the multiple ways in which policy and institutional discourses constitute ruling relations which activate, mediate, and coordinate nursing practice as institutional logics infuse nurses’ person-centred, holistic voice. Thus, the study provides perspectives on how neoliberal efficiency discourses contribute to a cross-pressure affecting nurses’ work environment, shaping their ability to engage in person-centred care and communication.