Guest editorial: Nursing, the politics of organisation and meanings of care

How should the ‘state of nursing’ be addressed in the light of seeing nurses take strike action, including midwives who have never done so before (Triggle, 2014)? In this editorial I want to suggest how this political action might be understood in the wider context of what has been happening to nursing, arising from disarray and dispute over the meanings of care and as a consequence of government agendas feeding and fuelling struggles and conflict in the ‘organisational politics’ of the NHS. In so doing I pick up on the link made in the Francis reports between a demoralisation of nursing and the preoccupation of the organisation with finance and targets to the detriment of the quality of patient care. My aim, however, is to suggest how any demoralisation also relates, first, to a fundamental downgrading of the status of nurses through changes to the organisational structure and the institutions within which they work, and second, to a devaluation of their work as a consequence of witting and unwitting manipulations in the meanings of care. What is striking is that this demoralisation and downgrading of status has happened over the same three or so decades in which the steering bodies representing nursing promised to raise its profile by ‘professionalising’ the profession. Indeed, far from the reforms in nursing education helping to equalise its standing (to say nothing of pay) with other health professions (doctors were always seen as the paradigm example), nurses continue to be positioned within class and gender social structures as a relatively oppressed group, with little power over either strategy or the distribution of resources. If lip service continues to be paid to nurses’ central contribution to the organisation of health services then the nurse