| Summary: | The research analyses the occupational governance of nursing, that is the ways in which nursing as an occupation is governed, and how this is influenced by health systems. Britain and Germany provide an interesting comparison: while nursing in both countries is confronted with the challenge of meeting increasing demands in a climate of cost containment the institutions of health care differ. The study challenges a generic understanding of occupations. It argues that the ways in which occupations are governed vary, reflecting the institutional context they are embedded in. The study begins by examining the occupational governance of nursing from a macro-perspective. It then reports on a micro-case study of the occupational governance of internal boundaries, which focuses on the interface between staff with different levels of training. The study draws on primary and secondary sources and interviews. The data for the case study was collected from two local providers of domiciliary care services in Britain and Germany. The macro-analysis identifies legalism, self-regulation and micro-politics as different though inter-related types of governance. The comparison across the two countries concludes that the occupational governance of nursing is more cohesive in Britain, while it is more fragmented in Germany. But at the same time, the micro-analysis of internal boundaries stresses the complexity and ambiguity of the occupational governance of nursing. It suggests that in the German case governance has strong legalistic elements, which makes it more centralised and standardised. By contrast, governance in its Britain counterpart is more localised. These institutional differences also influence the type and extent of involvement of individual actors. In summary, the multi-level analysis highlights the similarities and differences of the occupational governance of nursing in Britain and Germany.
|
|---|
