Managerialism, governmentality and the evolving regulatory climate

The special edition of Nursing Inquiry sets out to explore the interactions between managerial styles, intensification of regulatory processes under the aegis of professionalism and the potential for constraints on some aspects of nursing practice such as advocacy for patients, clients or even nursing staff. These changes are not new but have been happening since the 1980s when public services came under attack by economic rationalism such as neoconservative Thatcherism in the UK and Reaganomics in the USA. Moreover, these approaches to government were taken up globally. With each downturn in economies induced by cyclical crises in the capitalist industrialised world, these forms of governmental rationalities have come to be taken for granted or even ‘commonsense’ approaches to governmental budgets in the public sector. Much of the managerialist agenda is well rehearsed, couched in terms of much needed efficiencies and effective management of budgetary constraints (Rose and Miller 2008). In the face of the global financial crisis (GFC) – now termed ‘the Great Recession’ – governments throughout the world have had to put in place austerity programmes which almost always meant the reduction in healthcare and welfare services, moving care to less expensive locations with lower paid staff, setting limits to care through moving elective surgery to private care, rationing such operations in the public settings with increased waiting lists, and reduction in nursing numbers or actual bed numbers available for public health-care. Particular groups who are already vulnerable felt these constraints more – the older adult group, indigenous peoples in settler societies and recent refugees or migrants to the west, as well those displaced from their normal location and, in the recession, the people who found themselves unemployed or in insecure employment. While there has been some improvement of this situation recently, changes in Europe suggest that these upturns in countries’ economic conditions are fragile. Austerity is not over yet. Nurses in many locations do not see this global aspect of what is affecting their conditions of work. This political economy of health during the GFC is heightened by the intensification of capitalism within health industries where overcapitalisation of hospitals and acute care loses the necessary focus on prevention and harm reduction in health. There is often an emphasis on private/public partnerships to provide health-care and support by equities products to finance clinics leading to indebtedness in the future. As capitalism seeks out profitable enterprises, increasingly it looks to health, education and welfare (including disability services) as sources of profit (Moody 2011; Nealon 2012). With debt socialised to support threatened private financial companies during the GFC, the resulting Great Recession led to austerity programmes across the public sector. Choice, consumerism and individualism (Bauman 2010) become privileged in support of these moves from health as a public good – away from ‘health for all’ to health as a commodity. Nurses struggle with poor managerial support, either financial or in their working conditions, constraints on budgets and work intensification, as well as heightened calls for responsibility under the conditions of work insecurity or inappropriate conditions for professional safety (Rudge 2011; Moody 2012). Moreover, as Latimer (2014) suggests in her exploration of the effects on nurses and nursing, the marketisation of health and managerialist approaches have caused a focus on ‘the bottom line’ rather than the healthcare provided. In an increasingly privatised healthcare industry with lean production methods, the value of nurses’ work to the system is hidden through commodification of healthcare (Moody 2011; Allen 2015). Moreover, managerial, regulatory and professional groups that could speak to nurses’ difficulties in the public domain have unfortunately had disparate agendas and, often contradictory objectives as to nursing's future or present for that matter. Under the audit cultures currently dominating government of nurses’ work, nurses are required to steward the healthcare services’ resources. Constrained as they are by overzealous managerialism and regulation masquerading as professionalism, nurses lack the ability to raise their collective voice to point out the immorality of reductions in healthcare budgets. Hence, nurses require advocacy on their own behalf, rather than simply on behalf of their clients. They need to understand and act on their own discomfort with the contemporary ethos in health-care, recognising current conditions as robust grounds for ethical and political action (Perron, Rudge and Gagnon 2014). This edition of Nursing Inquiry seeks to animate this conversation. Through bringing together the operations of managerialism, governmentality and the changing regulatory climate, it invites nurses to explore their situation as participants in healthcare workplaces where their work to organise this system has been increasingly rendered invisible in the broader agenda towards commodification of health.