How do nurses fill the gaps in the organization?
Reassessing nursing's social contribution by highlighting the invisible aspects of nurses' work.

In this book, author Davina Allen argues that nurses play a vital role in organizing health care, and she substantiates this claim with data from observational studies of nurses' daily work.
By synthesizing insights from practice-based approaches, actor-network theory, and neo-institutionalism, we attempt to explain healthcare organizations and (re)conceptualize how nursing fills the gaps in these organizations.

This book, which reveals the invisible work of nurses, moves beyond the traditional understanding of nursing as a caregiving identity and focuses on the crucial and valuable work nurses do in large organizations like hospitals: bringing diverse actors into networks and balancing the needs of patients and the organization while maintaining a holistic view.
This may pose a challenge to traditional understandings of the health care system and the role of nurses, and may have important implications for improving services, training nurses, and structuring the nursing workforce.
The primary goal of this book is to highlight the previously neglected functions of nursing, the knowledge and skills that support them, and the characteristics of the healthcare system that makes them possible.
Through this, we aim to provide an integrated understanding of real-world nursing practice and, based on this, provide a new perspective on nurse education, workforce planning, and healthcare service management.

Celia Davis likened the "professional predicament" nurses face to polo mint.
Polo mints are a type of candy with a hole in the center, and Davis argues that the healthcare system distracts nurses from their core work with patients by demanding all the support they need to do their jobs.
The healthcare system is responsible for the loss of nurses' core function of caring for patients.
_ Pages 25-26 / Chapter 1: Swapping the Foreground and Background

On the other side of the spectrum, the Specialist Nurse Practitioners (SNPs) complain that there are problems with the patient care system at night and that when they arrive on the ward, nurses greet them with the words, “You’re not my patient.”
They lament the fact that there is no one person in charge of the ward as a whole.
The nurses only handed over their patients to each other, and there was no overall coordinator.
…Patient Access Nurses said they prefer to work on wards with a coordinator, and that it is frustrating when they ask someone a question and only hear, “Sorry, that’s not my patient.”
Pages 84-85 / Chapter 2: Creating Business Knowledge Using Treatment Trajectory Narratives

“Everyone was kind to me, but they didn’t really do anything for me.
Several medical staff said, 'You'll get better if you get an antibiotic injection,' but no one actually gave you one.
What I'm trying to say is that everyone was doing their own thing, but I kept slipping through the cracks.” According to Julie, it wasn't that the medical staff was indifferent to her.
Julie's treatment slipped through the cracks of the system.
These 'gaps' and the day-to-day tasks of managing them are the focus of this chapter.
_ Page 100 / Chapter 3 Coordinating the Treatment Trajectory

When trying to discharge a patient from the emergency room and they told me they didn't have their house keys, the coordinator would 'make some phone calls and contact his wife' to resolve the issue.
When doctors forgot to prescribe laxatives when a patient was being discharged, the attending nurse consulted with the pharmacist to ensure that discharge was not delayed because of this.
When Mrs. Green's discharge was delayed because she needed blister packs (divided pill bottles for each day of the week - translator's note), the nurse took the temporary measure of arranging for a local pharmacist to provide her with the medication.
Because hospital work is unpredictable and complex, it's natural to work flexibly to cope.
_ Page 126 / Chapter 3 Coordinating the Treatment Trajectory

Coordinator: “There was a huge argument yesterday about a patient in the hospital room.
[···] The doctor wanted to send the patient to a transitional care unit (a special facility within the hospital or operated in a separate building where patients who have completed acute treatment can receive additional treatment, rehabilitation, or social support before being discharged - translator's note), but that too was full.
So we were working on another safe discharge plan.
The patient's ultimate goal is to return home, but the doctor says, "No, you can't.
I need to go to the transition room.
“If the patient likes it there, they can go there,” he said.
I know we need to give patients all the options.
However, since the patient is currently in an acute care hospital bed, he or she may continue to be exposed to the risk of infection.
[···] Anyway, what the discharge nurse was trying to do was blocked by the doctor.
[···] The doctor focused on the patient and argued that a transitional care unit bed was needed.
It's all good, but the problem is that it's full.
We live in the real world.
There are patients in the emergency room hallway and patients from other departments in the surgical ward, so we can't keep these patients lying in acute care beds.
We need to find an alternative.
“Doctors only think about their patients, but we consider the entire system.” _ Pages 164-165 / Chapter 4 Matching Patients to Beds

Once all the paperwork was completed, the ward nurse notified the operating room electronically, and the operating room staff received the patient with little or no interaction with the ward nurses.
At this time, a checklist that acts as a translator mediating contact between departments and allows for efficient processing of a large amount of information without missing anything is used to cross boundaries and ensure safe surgery.
This process can be viewed as a technologically mediated patient transfer, made possible by pre-hospital work to assess the patient's suitability for surgery before admission and to develop carefully designed documentation to support patient flow on the day of surgery.
This is an example of black-boxing, as described in actor-network theory, where technology is taken for granted and the complex socio-material relationships that constitute it become invisible.
However, many healthcare encounters cannot be managed in this way, and successful boundary crossing relies on more complex conditions.
A good example is the transfer of a patient from the recovery room to the surgical ward.
_ Pages 193-194 / Chapter 5: Transitioning from Baton Passing to Patient Parsing

“This paperwork is just ridiculous,” the nurse said.
He said the ward was very busy and his feet were often on fire.
Excessive paperwork is making this situation worse and taking away time from patient care.
He also talked about the various forms and brochures used in different departments within the hospital, and the time it takes to copy and transfer information from one format to another.
[…] He said, “As long as all the documents are the same, it’s fine.
It is okay to receive patients from the Green Ward using the same document.
“However, the surgical patient assessment room uses a pink form, and the internal medicine patient assessment room uses a large yellow form,” he said.
_ Page 214 / Chapter 5: Transitioning from Baton Passing to Patient Parsing

Throughout this book, I have argued that nurses are a necessary part of healthcare organizations.
A mandatory passing point is a functionally essential element in an actor network that all other actors must pass through.
Nurses are network builders and key mediators, connecting the various elements that make up the network, arranging treatment trajectories, and, when necessary, separating them.
In health care, there is little that goes on without a nurse.
However, to take this role of nurses seriously and to secure the legitimacy of the logic that underpins their organizing work, it is important to go beyond metaphors and analogies—lubricants, adhesives, and connective tissue.
And we need to develop a formal language to describe the mechanisms of that activity.
_ Pages 229-230 / Chapter 6: Revisiting the Organizational Work of Nurses

One of the objectives of this study is to identify the knowledge and skills that support organizational work.
Let's consider the issue of considering organizational work as something other than the official duties of nurses and explore ways to provide nurses with the necessary training and professional development for organizational work.
When studying practice with cultural technology, we should not seek knowledge that resides in the minds of participants, but rather knowledge that is actually used in activities, events, and procedures.
A closer look at the organizational work of nurses revealed that effective translational mobilization requires a combination of clinical and organizational knowledge.
…The synthesis of these two types of knowledge can be called the nurse’s unique professional vision.
Page 231 / Chapter 6: Revisiting the Organizational Work of Nurses

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