Janet Rankin Biography

J RankinJanet Rankin has been a member of the Faculty of Nursing at the University of Calgary since January 2008. She has been involved in nursing work since 1975. Her direct practice background is in adult hospital care.  She taught undergraduates on Vancouver Island for 19 years and has a keen interest in nursing education. Her research focuses on the impacts of hospital restructuring and health care reforms on nurses and patients. Her book (co-authored with Marie Campbell in 2006) “Managing to Nurse: Inside Canada’s Health Care Reform” chronicles the “managerial turn” in the organization of nursing services since the 1970s. Using Dorothy Smith’s (1987, 2005) institutional ethnography (IE), and drawing on its feminist origins, Rankin is currently formulating a new book that extends the analysis through the years 2000 exploring how gendered forms of knowledge feature in contemporary nursing. The research focuses on nursing and health reform with a particular focus on nurses’ work within the developments of the electronic health record and other technologically generated modes of knowledge.

Janet has supervised eight PhD students and numerous MN students and is currently on secondment to the University of Calgary in Qatar.

To visit Janet Rankin's webpage, CLICK HERE


Abstract

The “conceptual” patient: An escalating technological design for professional nursing

My thinking about the question ‘what ideas lie behind nursing actions?’ is informed by sociological research designed to ‘explicate’ the organization of nurses’ knowledgeable activity. In this talk I examine the ideas embedded in integrated health information technologies that, in the hospitals studied, are the orienting structure of nurses’ work. In all sectors, not only in healthcare, computerized capacity to process and manipulate exceedingly large numbers of variables has resulted in an extraordinary capability to abstract, track and predict causal relationships – as in models to forecast weather. Confidence in the predictive capabilities of computer algorithms is central to the adoption of digital systems by large organizations. My research empirically examines a facet of the ruling, digitalized practices unfolding in hospitals. The talk, a snapshot of current research being conducted in collaboration with Marie Campbell, develops an account of a model of nursing care. It shows how techniques of digitalized abstraction and work fragmentation aligns nurses’ ideas and actions with interests that are not those of patients and patients’ care.

Field observations in hospitals drew ethnographic attention to CoAct – a model of nursing being innovated in Alberta. In the urban adult medical/surgical units where data were collected, aides conduct hourly “comfort rounds” and generate the bulk of the 1:1 personal care. Nurses and aides are expected to participate in two-hourly “huddles” for the purpose of gleaning information from one another. Doctors’ orders are computerized. When orders are entered onto the computer, they automatically populate multiple computer fields for nurses’ attention.

Within these coordinated routines, almost all of nurses’ time is devoted to carrying out and accounting for the medical plan, as it arises digitally in their work. They coordinate the plan among the extensive team of aides and health professionals. Everyone’s work is to be focused on the medically predicted ‘anticipated date of discharge’ (the ADOD).

In the past, nurses were relied on for their honed assessment and noticing skills through which they gathered information for decision-making and action. In contemporary practice, nurses’ knowledge about what is happening is progressively abstracted and fractured. The digital organization aligns nurses’ work with pre-formulated categorical constructs; it shepherds a new knowledge regime for nurses. Carried on prior assumptions that nursing is a planful activity (i.e. ‘the nursing process’), digitalized platforms and their companion models of care organize nurses to act “as if” they know what is happening. As nurses’ thinking and actions are changed, their commitment to patients is reformulated as an entirely conceptual practice. It is no longer grounded in actual bodily knowledge and experience.

 

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