ETUI-ETUC conference 2016 Panel 11 Rebecca Selberg

1. A Nightingale Speed‐Up?
Gender perspectives on work
intensification in nursing
Rebecca Selberg, PhD, Department of Gender Studies

2. September 2014:
Midwife: Unsafe for patients
February 2015:
Chaos in the ER: ’We cry
during shifts’
May 2016:
Hospitals sound the alarm: Healthcare in
total crisis
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3. The notion of crisis
• News about crisis – crisis in the industrial
sectors, crisis in the public sector – have made
headlines in Swedish media during the last 20
years
• However: in public healthcare new types of
interventions from health professionals
– Working conditions now pose a potential risk to
the lives and health of patients and employees

4. The actual crisis
• 585 Lex Maria‐cases: 35 deaths, 24 injuries
partly or fully related to lack of resources
(hospital beds)
• SWEA: assistant nurses and nurses report
more work‐related illnesses than other
occupations, mostly due to stress and high
workloads

5. Research on the healthcare crisis
• Increasing consensus among scholars studying
healthcare that privatization, subcontracting,
resource depletion have had negative impacts on
Swedish healthcare
• Increasing consensus among scholars that NPM
and other neoliberal policy‐ and management
regimes lead to work intensification and
decreasing job satisfaction, including work‐
related ill‐health among employees

6. Why – How?

7. Labor speed‐ups: the costs on
individual workers
• Staff nurse: [I cried] right before my vacation… It was stress. I
couldn’t manage. More and more we cry. We are overwhelmed
because we don’t know how to prioritize. You always have to
prioritize but sometimes it’s impossible because everything is
equally important. That’s when it comes, the tears. The patient
must be cared for.
• Nurse manager: We have minimal staffing. It’s not good. It’s
horrible, in fact, because the workload was extreme already, and
now we’ve had even further cutbacks… When someone calls in sick,
we’re not able to call in extra people. Maybe we’ll take in someone
on an hourly basis, but not much. So the staffing issue is a major
concern. And just quality‐ and competence‐wise it’s a disaster. We
have very good routines but we won’t be able to maintain them.
• Staff nurse: Hospital management told us… that ‘it’s not about
running fast; it’s about running smart’.

8. Contradictory processes
following NPM
• Ward nurses:
– Work intensification
– Job degradation
• Nurse managers:
– Expanded responsibilities
– Professionalization
• Historical link between nursing and notions of ”good women”
– Good nurse = ”reinforcing proper habits and attitudes, a sense of
responsibility, attention to detail and obedience to the rules and
regulations” (Bessant 1992: 159)
– This is a performance culture that is highly regarded under NPM
• New career paths and stronger standing
• More intense, both high touch, high tech, emotional labor:
– Dirty, Dangerous, Demeaning

9. Emotional labor speed‐up?
• Nurses’ work is increasingly performed front‐
stage; nurses are required to perform emotional
labor that is time‐flexible
– Nurses are given the responsibility to embody quality,
accessibility, and service at the hospital
• Employees “most likely to be required to provide
emotional labor in an organization are women,”
• ”Female public servants are expected and
required to engage in emotion work to a greater
degree than men” (Meier et al. 2006)

10. The need for intersectional analysis
• Nursing and work intensification: wealth of research
available – effects on workers and patients
• Labor speed‐ups for nurses ”bolstered by the impact of
work intensification on other groups working alongside
nurses, be they doctors … or cleaners” (Willis 2005)
• However: less focus on the increasing differentiation within
occupational groups
• Ethnographic research illustrates growing divides within the
nursing collective
– Some nurses are able to rise through ranks
– Some nurses are badly affected by speed‐ups and ”degradation”
– Who wins – who loses? Gender/ethnicity/social capital
• Unions – who do they speak/work for?

11. Differentiation / individualization –
exit?
• ”A new Nightingale spirit”?
– Nurses prone to protest – focus on salary
– But also compliant, notions of a ”calling” – performing
normative femininity
– Solidarity trap – covering for the organization for the sake of
patients and professional pride
– Creative altruism – micro‐power
• Strikes ineffective and costly
• Best strategy: exit?
• Researchers as well as unions, employers and policy makers
need to adopt an intersectional perspective in analyzing
work intensification in care work
• Including a focus on emotional labor and expectations on
women to ”cover” for the organization in times of austerity

12. Thank you!
• Presentation based on the book Femininity at
Work – Gender, Labour, and New Relations of
Power in a Swedish Hospital (Arkiv, 2012)
• References available upon request
• Rebecca Selberg, Department of Gender
Studies, Lund University
• rebecca.selberg@genus.lu.se