I mötet mellan modern management och professionell praktik : ny organisering möter sjuksköterskeprofessionen

Sammanfattning: The Swedish public sector is characterised by comprehensive organisational changes, often discussed in terms of New Public Management (NPM). NPM implies a transfer of management ideas from the private sector to the public sector, leading to new and changed principles for governance and organisation of the public sector. Within the health care sector this is illustrated by an emphasis on for example efficiency, accessibility and patient centred care. These changes are described in terms of a challenge of welfare sector professionals, as many of the characteristics traditionally having been linked to professional work are challenged by NPM. With departure in the above described, the aim of this dissertation is to discuss how changes in governance and organisation of Swedish health care influence the nursing profession.The dissertation is based on qualitative studies (interviews and text analysis) of two change processes in Swedish health care. The first study focuses an attempt to introduce process orientation at a hospital, and the second study an increased push for telephone advice services within a primary care organisation.In this dissertation, theories on organisation as well as professions are applied, as these complement each other in explaining the studied processes. In an attempt to understand why the changes studied are taking place right now, and whether they can be seen as expressions of NPM, institutional theory is applied. More specifically, the connection between organisational changes and the "package" of ideas regarding organisation of work that characterises the institutional environment is explained. The institutional theory also helps explain what happens when institutionalised ideas meet local practices. When it comes to how the nurses are affected by and experience the changes studied, theory on sociology of professions is applied. The relation between organisation and profession is in focus here, rather than the nursing profession as such. The result shows that the studied changes can be linked to NPM and lead to a challenge of the professional logic. The results point at a tension between organisation and profession. At the same time it becomes clear how the professionals still act based on their professional values; occupational professionalism. This illustrates the strength of the professional system.