Power Dynamics within Icelandic Nursing: Walking the Fine Line
Keywords:Health, Working Environment & Wellbeing
Like other Nordic nations, Iceland has a reputation of gender-equality, despite 98% of the country’s nursing profession being women. This paper examines power dynamics within the profession. Fifteen semi-structured interviews with nurses were analyzed with a thematic analysis. Our theoretical framework draws on an ecological perspective highlighting nurses’ vulnerability to power dynamics, and Allen’s work on organizational labor and the invisibility of nurses’ ‘glue work’. The findings reveal that the nurses experience power imbalances when their autonomy is restricted in cooperation with other professionals, demanding their time and disrespecting their professional workspace, and they miss support from their supervisors. They feel their professionalism is belittled, and that the gender imbalance hinders equality. For coping and meeting norms and expectations, the nurses use silencing, which with time pressure and unclear boundaries preserve and enhance stereotypical images. Attracting more male nurses could enhance equality, but additional effort at multiple levels is needed.
Allen, D. (2015). The invisible work of nurses: Hospitals, organisation and healthcare, London: Routledge.
Apesoa-Varano, E. C. (2007). Educated caring: The emergence of professional identity among nurses, Qualitative Sociology 30: 249–274. Doi: 10.1007/s11133-007-9069-6
Blair, P. L. (2013). Lateral violence in nursing. Journal of Emergency Nursing 39(5): 75-78. https://doi.org/10.1016/j.jen.2011.12.006
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology, Qualitative Research in Psychology 3(2): 77– 101. https://doi.org/10.1191/1478088706qp063oa
Brynjólfsdóttir, A. D. (2018). Efling í starfsumhverfi og starfsánægja hjúkrunarfræðinga á bráðasjúkrahúsi. [Empowering work environment and job satisfaction among nurses in acute care hospitals]. (Unpublished MS thesis), Reykjavik: University of Iceland. Available at: https://skemman.is/bitstream/1946/30654/3/Meistararitger%c 3%b0%20ADB%202018.pdf [Accessed 28 April 2021].
Burton, C. W. (2020). Paying the Caring Tax: The detrimental influences of gender expectations on the development of nursing education and science, Advances in Nursing Science 43(3): 266-277. Doi: 10.1097/ANS.0000000000000319
Carter, M. (2014). Vocation and altruism in nursing: The habits of practice, Nursing Ethics 21(6): 695-706. Doi: 10.1177/0969733013516159
Cingel, M. & Brouwer, J. (2021). What makes a nurse today? A debate on the nursing professional identity and its need for change, Nursing Philosophy 22(2): 1-7. Doi: 10.1111/nup.12343
Clegg, S. (1989). Radical revisions: Power, discipline and organisations. In Critical perspectives on organisation and management theory, eds. L. Smirich and M. Calais: 97– 11,. London: Dartmouth.
Connell, R. (1987). Gender and Power: Society, the Person and Sexual Politics, Cambridge: Polity Press.
Crotty, M. (1998). The Foundations of social research: Meaning and perspective in the research process, London: SAGE.
Curran, J. M. (2006). Visible and Invisible Care: An Anthropological Study of Nursing Assistants on a Psychiatric Ward in London. Phd Thesis, Goldsmiths College London University. Available at: https://research.gold.ac.uk/id/eprint/28851/1/ANT_thesis_CurranJ_2006.pdf
Davies, C. (1995). Gender and the professional predicament in nursing, Buckingham: Open University Press.
DeMarco R. (2002). Two theories/a sharper lens: the staff nurse in the workplace, Journal of Advanced Nursing 38(6): 549–556.
DiPalma, C. (2004). Power at Work: Navigating Hierarchies, Teamwork and Webs, Journal of Medical Humanities 25(4): 291-308. DOI: 10.1007/s10912-004-4834-y
Donnelly, T. (2014). Stress among nurses working in an acute hospital in Ireland, British Journal of Nursing 23(13): 746–750. Doi: 10.12968/bjon.2014.23.13.746
Eley, R., Eley, D., & Rogers-Clark, C. (2010). Reasons for entering and leaving nursing: An Australian regional study, Australian Journal of Advanced Nursing (Online) 28(1): 6-13. https://link.springer.com/article/10.1186/1472-6955-13-11
Fanon F. (1967). Black Skins, White Masks, New York: Grove Press.
Farrah, M. (2021). Stats and facts: UK nursing, social care and healthcare 2021. Available at: https://www.nurses.co.uk/blog/stats-and-facts-uk-nursing-social-care-and-healthcare-2021/ [Accessed 5 October 2021].
Gill, J. & Baker, C. (2019). The power of mass media and feminism in the evolution of nursing’s image: A critical review of the literature and implications for nursing practice, Journal of Medical Humanities 42(3): 371-386. Doi: 10.1007/s10912-019-09578-6
Girvin, J., Jackson, D. & Hutchinson, M. (2016). Contemporary public perceptions of nursing: A systematic review and narrative synthesis of the international research evidence, Journal of Nursing Management, 24(8): 994–1006. Doi: 10.1111/jonm.12413
Godsey, J. A., Houghton, D. M. & Hayes, T. (2020). Registered nurse perceptions of factors contributing to the inconsistent brand image of the nursing profession, Nursing Outlook 68(6): 808-821. Doi: 10.1016/j.outlook.2020.06.005
Green, B. (2012). Applying feminist ethics of care to nursing practice, Journal of Nursing and Care, 1(3): 1-4. Doi: 10.4172/2167-1168.1000111
Gupta, V., Agarwal, U. A. & Khatri, N. (2016). The relationships between perceived organizational support, affective commitment, psychological contract breach, organizational citizenship behaviour and work engagement, Journal of Advanced Nursing 72(9): 1-12.
Happell, B., Dwyer, T., Reid-Searl, K., Burke, K. J., Caperchione, C. M. & Gaskin, C. J. (2013). Nurses and stress: Recognizing causes and seeking solutions, Journal of Nursing Management 21(4): 638–647. Doi: 10.1111/jonm.12037
Hart, S. M. & Warren, A. M. (2015). Understanding nurses’ work: Exploring the links between changing work, labour relations, workload, stress, retention and recruitment, Economic and Industrial Democracy 36(2): 305–329. Doi: 10.1177/0143831X13505119
Hugman, R. (1998). Social work and de-professionalization. In P. Abbott & L. Meerabeau (eds.) The Sociology of the Caring Professions (2nd ed.): 178-198.
Hutchinson, M., Vickers, M. H., Jackson, D. & Wilkes, L. (2010). Bullying as circuits of power: An Australian nursing perspective, administrative theory & praxis 32(1): 25–47. Doi: 10.2753/ATP1084-1806320102
Hølge-Hazelton, B. & Berthelsen, C. B. (2021). Why nurses stay in departments with low turnover: A constructivist approach, Nordic Journal of Nursing Research 41(3): 158-165. Doi: 10.1177/2057158521991434
Icelandic Ministry of Health. (2020). Mönnun Hjúkrunarfræðinga [Nurse Staffing]. Available at: https://www.stjornarradid.is/library/02-Rit--skyrslur-og-skrar/Skyrsla_monnun_hjukrunarfr_21082020.pdf [Accessed 4 September 2021].
Iceland´s Directorate of Equality. (2021). C-19: Actions to prevent increased violence against women and children. Available at: https://www.jafnretti.is/en/moya/news/category/1/c-19-actions-to-prevent-increased-violence-against-women-and-children [Accessed 20 April 2021].
Johnson, S. L. (2011). An ecological model of workplace bullying: A guide for intervention and research, Nursing Forum 46(2): 55-63. https://doi.org/10.1111/j.1744-6198.2011.00213.x
Kenny, D. (2015). Vocation, caring and nurse identity. PhD Thesis, University of Central Lancashire, UK. Available at: https://e-space.mmu.ac.uk/582274/1/Deborah%20Kenny%20Vocation%20caring%20and%20nurse%20identity%20-%20Doctorate%20in%20Education%20June%202015.pdf [Accessed 20 April 2021].
Kristoffersen, M., Friberg, F. & Brinchmann, B. S. (2016). Experiences of moral challenges in everyday nursing practice: In light of healthcare professionals' self-understanding, Nordic Journal of Nursing Research 36(4): 177-183. Doi: 10.1177/2057158516633633
Kubsch, S., Tyczkowski, B. & Passel, C. (2021). Altruism and the difficult patient, Journal of Holistic Nursing 39(1): 43–55. Doi: 10.1177/0898010120933123
Lu, H., Zhao, Y. & While, A. (2019). Job satisfaction among hospital nurses: A literature review, International Journal of Nursing Studies 94: 21–31. Doi: 10.1016/j.ijnurstu.2019.01.011
Marc, M., Bartosiewicz, A., Burzynska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage - a prospect of global and local policies, International Nursing Review 66(1): 9-16. Doi: 10.1111/inr.12473
Marquis, B. L. & Huston, C. J. (2017). Leadership Roles and Management Functions in Nursing. Theory and application. (9th ed.), Philadelphia: Wolters Kluwer/Lippincott Williams & Sons. Available at: http://sbmu.ac.ir/uploads/marquis%20leadership%20roles%20and%20%20%20management%20functions%20in%20nursing%20theory%20and%20application%202017.pdf
Meadus, R.J. & Twomey, C. (2011). Men student nurses: The nursing education experience, Nursing Forum 6(4): 269 -279. Doi: 10.1111/j.1744-6198.2011.00239.x.
Pétursdóttir, G. M. (2009). Within the aura of gender equality: Icelandic work cultures, gender relations and family responsibility. A holistic approach. PhD Thesis, University of Iceland, Iceland, 2009.
Roberts, S. J., DeMarco, R., & Griffin, M. (2009). The effect of oppressed group behaviours on the culture of the nursing workplace: A review of the evidence and interventions for change, Journal of Nursing Management 17(3): 288–293. Doi: 10.1111/j.1365-2834.2008.00959.x
Salmi, I., Pietiläinen, V. & Syväjärvi, A. (2020). The experience qualities approach to leadership and employee wellbeing, Nordic Journal of Working Life Studies 11(2): 1-22. Doi: https://doi.org/10.18291/njwls.122593
Sasa, R. I. (2019). Male nurse: A concept analysis, Nursing Forum 54(4): 593–600. Doi: 10.1111/nuf.12374
Sedgwick, M. G. & Kellett, P. (2015). Exploring masculinity and marginalization of male undergraduate nursing students' experience of belonging during clinical experiences, Journal of Nursing Education 54(3): 121-129. Doi: 10.3928/01484834-20150218-15
Simard, K. & Parent Lamarche, A. (2021). Abusive leadership, psychological well being, and intention to quit during the COVID 19 pandemic: a moderated mediation analysis among Quebec’s healthcare system workers, International Archives of Occupational and Environmental Health 95: 437–450. https://doi.org/10.1007/s00420-021-01790-z
Skeggs, B. (1997). Formations of class and gender: Becoming respectable. (1st ed.), London: SAGE, 1997.
Slettmyr, A., Schandl, A. & Arman, M. (2017). The ambiguity of altruism in nursing: A qualitative study, Nursing Ethics 26(2): 368–377. Doi: 10.1177/0969733017709336
Smith, K. M. (2019). Facing history for the future of nursing, Journal of Clinical Nursing 29: 1429–1431. Doi: 10.1177/1468794110384447
Statistics Iceland. (2021). Health expenditure as a percentage of GDP below the OECD average. Available at: https://www.statice.is/publications/news-archive/public-finance/health-expenditure-in-iceland-1998-2019/ [Accessed 20 August 2021].
Statistics Norway. (2021). Employment, register-based. Available at: https://www.ssb.no/statbank/sq/10066990 [Accessed 20 April 2022].
Sund, B. (2015). Just an illusion of equality? The gender diversity paradox in Norway, Scandinavian Journal of Business Research 29(2): 157–183. Available at: https://www.idunn.no/file/pdf/66812083/just_an_illusion_of_equality_the_gender_diversity_paradox_.pdf
Taylor, J. (2011). The intimate insider: negotiating the ethics of friendship when doing insider research, Qualitative Research 11(1): 03–22. Doi: 10.1177/1468794110384447
Tesch-Römer, C., Motel-Klingebiel, A. & Tomasik, M. J. (2008). Gender differences in subjective well-being: Comparing societies with respect to gender equality, Social Indicators Research 85(2): 329–349. Doi: 10.1007/s11205-007-9133-3
The University of Akureyri. (2021a). Faculty of nursing. The studies. Available at:
https://www.unak.is/english/university/schools-and-faculties/school-of-health-sciences/faculty-of-nursing [Accessed 28 August 2021].
The University of Akureyri. (2021b). Karlar enn fámennir í hjúkrun. [Still few men in nursing], Available at: https://www.unak.is/is/samfelagid/frettasafn/frett/karlar-enn-famennir-i-hjukrun [Accessed 28 August 2021].
The University of Iceland. (2021). Faculty of nursing. Admission requirements 2021. Available at: https://www.hi.is/heilbrigdisvisindasvid_hjukrunarfraedideild/inntokuskilyrdi_i_bs_nam_i_hjukrunarfraedi [Accessed 28 August 2021].
Warming, K. (2013). Men who stop caring: The exit of men from caring occupations, Nordic Journal of Working Life Studies 3(4): 5-20. Doi: https://doi.org/10.19154/njwls.v3i4.3070
Wolfenden, J. (2011). Men in nursing, The Internet Journal of Allied Health Sciences and Practice 9(2): 1–6. Doi: 10.46743/1540-580X/2011.1347
Wood, H. & Skeggs, B. (2020). Clap for carers? From care gratitude to care justice, European Journal of Cultural Studies 23(4): 641–647. Doi: 10.1177/1367549420928362
World Economic Forum. (2021). Global Gender Gap Report 2021. Available at: https://www.weforum.org/reports/global-gender-gap-report-2021/digest [Accessed 20 April 2021].
Worringer, B., Genrich, M., Müller, A. & Gündel, H. (2020). Hospital medical and nursing managers’ perspective on the mental stressors of employees, International Journal of Environmental Research and Public Health 17: 2-36. C:Userskth75AppDataLocalTempijerph-17-05041-v2-1.pdf Doi: 10.3390/ijerph17145041
Zhang, W., & Liu, Y. L. (2016). Demonstration of caring by males in clinical practice: A literature review, International Journal of Nursing Sciences 3(3): 323– 327. Doi: 10.1016/J.IJNSS.2016.07.006
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