Dilemmas of responsibility for nurses in independent practice: knowledge, learning and innovation
Despite a loss of permanent nursing positions and a casualization of the nursing workforce (Armstrong and Armstrong 2003 ; Grinspun 2003 ; Laschinger et al . 2001 ), most nurses still work as front-line employees, mainly in hospitals (Canadian Institute for Health Information 2010 ). Nurses who turn to selfemployment as a career option are especially fascinating because they represent the few who have opted for a dramatic departure from nurses’ traditional organizational circumstances in an effort to enhance their professional potential. Selfemployed nurses work in diverse settings, clinically, geographically, and interpersonally, dramatically altering the nature of nursing practice. Yet, there has been virtually no academic investigation into this form and fi eld of nursing work. This ethnographic study explored nursing self-employment to illuminate the emerging issues in non-traditional nursing practice. Taking a practice-based perspective and considering the sociomaterial aspects of nursing entrepreneurship, this chapter delves into the unique working conditions and demands placed upon self-employed nurses, and addresses the following questions: What knowledge and ethics do these nurses draw upon in the enactment of their non-traditional practices? What confl icts do they face between notions of ‘care’ and ‘market’? What are the tensions between conservative regulatory standards and dynamic professional knowledge that allows for innovation and creativity in professional practice? What possibilities fl ow from these nurses’ innovative professional activities? Ultimately, the ways in which the nurses in this study negotiated these issues offers an example of how shifts in professional knowledge, responsibilities, and learning can be turbulent but also how they can present important possibilities when reconsidered.