The Nursing Process as a Strategy for a (De-)Professionalization In Nursing: A Critical Analysis of the Transformation of Nursing In Germany In the 1970s and 1980s

Abstract

In this study, I analyze a discourse that emerged during the 1970s and 1980s in German nursing. At that time, the German healthcare system underwent dramatic changes and economic reorganization, which can be understood as the emergence of the neoliberal rationale in Germany. The argument of cost explosion was used to restructure hospitals into enterprises that were to operate based on the logic of the market. At the same time, the nursing process was introduced into German nursing. The nursing process is a cybernetic, problem-solving cycle containing distinct steps of assessing the patient, planning nursing goals, executing and documenting nursing interventions, and evaluating performance. German nurses valued the nursing process as a central component of the professionalization of the nursing vocation. However, in neoliberalism, professions are seen as obstacles to free competition in marketized areas, and thus strategies such as accounting mechanisms were implemented to decrease their power. Using the historical approach of the history of the present, the perspective of governmentality and insights from critical accounting, this study analyzes the impact of the nursing process on the German nursing vocation. The nursing process needs to be understood as an accounting tool and hence, as a component of neoliberal strategies to make formerly intangible fields of work like nursing service calculable. As an accounting tool, the nursing process does not represent reality in a neutral manner but affects the areas to which it is applied in a constitutive way. As this study shows, the implementation of the nursing process led to reconstituting the nursing vocation into a calculable entity. And while German nurses valued the potential that the call for increased accountability and transparency in nursing care held for their professionalization, the findings suggest that a newly constituted accountable nursing vocation can instead be considered as de-professionalizing.