ABSTRACT
In this chapter, I will be considering the uses of blame in contemporary healthcare organisations looking at changes in United Kingdom (UK) nursing and health policy discourse as a case study. Some similar changes have taken place in other countries although the trajectory of change in the UK has been striking in its rapidity. I will look in particular at changes in the distribution of blame as they affect nurses. I will also consider the ways in which changes in the distribution of blame have been instrumental in effecting changes in the boundaries of the nursing profession, as well as justifying increased managerial control of health care professionals. Different explanations of trouble place blame in different places and these narratives have played a central role in effecting changes in frontiers of control in healthcare. Firstly, I will look at the different explanations which have been used at different times to explain poor care. I will argue that these changing narratives reflect wider changes in the power structures of healthcare organisations. I will then consider how this change of narrative has influenced changes in the professional regulation of the health professions as well as changes in the control and disciplining of nurses. I will then consider the work of Mary Douglas on risk perception and blame. I will outline the ways in which her ideas can be applied to the distribution of blame in nursing to help us to understand what blame tells us about changing patterns of control and responsibility in healthcare.
