Organizational Agents as Epistemic Agents: Re-examining Nurse Executives' Agency in Homecare Organizations

Abstract

This research presents a critical analysis and original theoretical approach to a complex phenomenon that addresses current gaps in our understanding of the experiences of nurse executives and their organizational positioning in homecare organizations. It reveals how nurse executives experience paradoxical identities of executive and nurse. The competitiveness of homecare as a business and the status of homecare among other healthcare sectors is problematic and exacerbates the tension between those two identities. This qualitative research aims to explore NEs' epistemic and discursive organizational positioning in HCOs. This research also explores how nurse executives enact their moral, socio-professional, political and epistemic agency in homecare organizations in Ontario. The research questions guiding this study were: 1) How do nurse executives enact their agency, identity, values, and means in their organization? 2) What are the daily transactions and negotiations with organizational and systemic entities with which nurse executives engage in their organization? 3) How do nurse executives navigate such complexities to fulfil their organizational responsibilities and enact influence in their organizations? This research emphasized the importance of dominant discourses and practices in homecare organizations, shaping distinct epistemic landscapes that foster specific ways of thinking, speaking, and acting across those organizations and within the healthcare system. Fairclough's Critical Discourse Analysis was used to analyze interviews with nurse executives and selected policy and guidance documents. A theoretical framework combining Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance was used to highlight the complexity of nurse executive power within the context of social structures. This study exposed the relationships and the circulation of knowledge and non-knowledge (i.e., ignorance) and the ability to exercise power within homecare organizations. Findings can contribute to scholarly knowledge about practice, education, policy, theory, and future research perspectives. This research has implications for scholarship about nursing leadership across healthcare and management disciplines by better understanding the power, knowledge, and ignorance dynamics within homecare organizations and the healthcare system.