Sensemaking of change in the managed care era: a case of hospital‐based nurses

Abstract

This study explores how nurses working in a large, metropolitan hospital make sense of the managed care change. Findings from 24 nurse interviews suggest that nurse sensemaking has generated interpretations of managed care change that are grounded in the caregiving role. Study results show that nurses view managed care with ambiguity. Nurses understand managed care change as instrumental in encouraging collaboration and affecting patient care quality. Implications are drawn regarding the importance of identity construction to the sensemaking process and illustrate the paradox of change in the managed care era. Although nurses view collaboration and professional empowerment as positive outcomes of managed care, further analysis reveals that these values function ideologically, promoting managed care concerns over worker interests. Concertive control – a team‐based process which shifts organizational control from management to employees – is explored as a way that workers act in accordance with management decisions and uphold traditional power structures.

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