"Time Enough! or Not Enough Time!" an Oral History Investigation of Some British and Australian Community Nurses' Responses to Demands for "Efficiency" in Health Care, 1960-2000

By Hallett, Christine E.; Madsen, Wendy et al. | Nursing History Review, January 1, 2012 | Go to article overview

"Time Enough! or Not Enough Time!" an Oral History Investigation of Some British and Australian Community Nurses' Responses to Demands for "Efficiency" in Health Care, 1960-2000


Hallett, Christine E., Madsen, Wendy, Pateman, Brian, Bradshaw, Julie, Nursing History Review


Abstract. Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

The history of district nursing throughout the developed nations of the world underwent an extraordinary trajectory during the 20th century. From a nascent field largely built on the notion of the nurse as "sanitary missioner," the role of the district nurse underwent significant change, becoming enmeshed with the burgeoning of scientific medicine and technological change.1 This article argues that, during the last decades of the century, district nursing practice underwent a rapid and dramatic shift as nurses relinquished their focus on holistic nursing care of vulnerable members of the population and shifted to "high-tech" emphasis on acute care.

After an initial consideration of district nursing in the 20th century, we turn to a close focus on a series of oral history interviews conducted in two very distinct regions: Lancashire, in the deprived North West of England (7 participants), and Central Queensland, Australia (12 participants).2 Following this exposition of the views and perspectives of 19 British and Australian community nurses, we consider the possible reasons for-and consequences of-significant changes in nursing practice, the importance of increased economic costs of nursing care, a push from within the profession for professional and disciplinary recognition, and the drive for deinstitutionalization that characterized health care in the late 20th century.

The changes in nursing care are analyzed, in part, from the perspective of the way time is perceived. We suggest that from the sense of autonomy and freedom that enabled them to practice in a broad-ranging sense of " experiential time," nurses underwent a profound shift in their perspectives of how their practice fitted into "measured" or "clock" time, governed by schedules and bounded by fixed perceptions of tasks and narrowly defined duties.3

These shifts in perspectives on time and its use corresponded with dramatic changes in the nature of community nursing practice. Regardless whether these changes were seen as progressive or regressive, it is evident that community nurses did not instigate them but were responding to external forces. Examination of community nursing work during the later decades of the 20th century raises several questions: How did community nursing change, and how did nurses themselves perceive these changes? What factors influenced the changes? Are there "lessons" the profession can take from these experiences? To explore these questions, we considered the development of community nursing in the broader social, economic, and political contexts of Lancashire and Queensland.

Background: British and Australian Community Nursing in the Mid-20th Century

During the 20th century, nursing throughout the developed world was heavily influenced by notions of efficiency. This was an era when scientific management was the dominant discourse in western societies, and nursing was not immune to this trend. …

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