Practicing flexible care: Nurses’ dual strategizing for power in nurse-doctor collaboration

Reform strategies aimed at improving the efficiency of hospital services, through more flexible care provisioning, target the collaborative dynamics of care and professional boundaries by attempting to increase nurses' autonomy. However, in practice, nurses still struggle to assert influence and power within their interprofessional collaborations with doctors. This article advances research at the intersection of studies on power dynamics in interprofessional collaboration and studies on the work of strategy realization by frontline employees. This is achieved through an ethnographic case study of the materialization of a flexible care strategy in an acute care department. The study draws on observations, interviews, and documents to examine how the operationalization of the reform is infused with power dynamics in nurse–doctor collaboration. The article advances a relational perspective on strategic action, informed by the sociology of Pierre Bourdieu. Our findings show that the nurses navigate the field's power structures differently depending on which group of doctors they collaborate with – junior doctors in training or consultants. We demonstrate what we term “nurses' dual strategizing,” which consists of (1) “overt domination” with junior doctors by mobilizing their practical knowledge and experience capital, and (2) “subordination and subtle influence” with consultants by seeking to mobilize their self-acclaimed patient communication capital and acute care concept expertise. However, both strategies yield limited success. The article contributes novel insights into power dynamics in inter-professional collaboration and their unanticipated consequences in strategy non-realization. We demonstrate how applications of Bourdieu's power-focused sociology can provide new insights into the complexities of changing interprofessional collaboration through healthcare reform in the context of institutionalized hierarchies, power dynamics, boundary contestations, and local organizational priorities.