Working on the Front-Line: Risk Culture and Nursing in the New NHS

Nursing and midwifery are increasingly marked by risk and uncertainty under the dual impact of patient consumerism and organisational accountability. The omnipresent character of risk in health work means that it is particularly difficult to manage. Since the practice decisions of today may only be known as problems in the future, risk can never really be forestalled. This means that it is very difficult to close-off risk, but nonetheless imperative to try. Drawing on research conducted in two hospital trusts, this paper explores the strategies that nurses and midwives use in an attempt to colonise the future and protect themselves in the risk culture of the new NHS. It will suggest that although the self-protective strategies that emerge may enhance quality of patient care, they can also generate defensive practices which are in the interests of neither nurses and midwives nor patients.