NURSiNg MANAgeRS betweeN “goveRNMeNtAlitY” ANd “goveRNANce”; leSSoNS fRoM the eNgliSh expeRieNce

Abstract

Through a reinterpretation of existing evidence, supplemented by interview material, this article seeks to move beyond the common academic conceptualisation of front-line hospital nursing managers in both France and England as “caught between a rock and a hard place”. Comparative analysis of the implementation of two care quality improvement initiatives, one in each country, highlights the particular ways in which these front-line managers, working within Pôles in France or the longer-established Clinical Directorates in England, meet the demands of managerial constraints and performance-measurement mechanisms. The room for manoeuvre created by the tension between “governmentality” and “governance” is appropriated differently by managers in each country, according to the opportunity structures established by their distinctive historical, organisational and professional contexts. From this analysis, it emerges that, while collective professional recognition constitutes a major challenge in the French case, involving an essential role for the Institut de Formation des Cadres de Santé, the key change-determining factor in the English case is the capacity for influence which managers are able to generate for themselves within each individual hospital, as illustrated by the transformation of formal structures during the implementation of the “Essence of Care” initiative. In the course of this process, the actors called upon to apply pre-established quality-related norms actually redefine them.