Rhetoric and rationality: a deconstruction of managerial and nursing discourse in the new NHS

Traynor, Michael (1996) Rhetoric and rationality: a deconstruction of managerial and nursing discourse in the new NHS. PhD thesis, University of Nottingham.

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In 1991, the United Kingdom (UK) government introduced reforms of the National Health Service (NHS), the most recent in a series of successive rationalisations aimed at increasing accountability and containing the service's costs. These rationalisations featured the strengthening of managerial control over the traditional professions, among them medicine and nursing, a system of contracting between purchasers and providers of healthcare and an unprecedented emphasis on the control and measurement of inputs particularly in terms of workers' activities.

This thesis grew out of concerns arising from the author's involvement in a study conducted by the Royal College of Nursing (RCN) into nursing morale and managerial strategy in the wake of these reforms. The study took place in initially four and later three first wave NHS Trusts working in the community sector and ran over three years.

Influenced by postmodern philosophy, deconstructive literary theory and discourse analysis, this work places the language and argumentation of managers and many of nursing's leaders within a philosophical context of modernity. Modernity, in this context, is characterised by an appeal to impersonal criteria and procedures, a search for objective, context-free knowledge, and a turning away from the authority of tradition and revelation toward an autonomous use of reason and particular forms of rationality.

Postmodern writers argue that reason and rationality have come to be defined in terms that support the values and interests of particular groups and through their globalising claims marginalise other groups and delegitimise their claims to knowledge. In this study managers tended to characterise, at least sections of, their nursing workforce as irrational, fearful and traditional. Nurses described themselves in terms of moral agency and self-sacrifice in the face of exploitation by their managers.

This philosophical critique, effected through literary approaches, is offered as a theoretical framework within which to mount offensives on totalising regimes.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Robinson, J.
Keywords: Managerial strategy, Morale of nurses, Nurses and managers, Health services administration
Subjects: W Medicine and related subjects (NLM Classification) > WY Nursing
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
Item ID: 11178
Depositing User: EP, Services
Date Deposited: 12 Mar 2010 12:48
Last Modified: 19 Oct 2017 11:43
URI: https://eprints.nottingham.ac.uk/id/eprint/11178

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