Keeping it secret: the costs and benefits of nursing's hidden work in discharging patients


Carol L McWilliam, Assistant Professor, Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario, Canada N6A 5C1


Workload analysts and nursing theorists alike continue their attempts to capture the hidden work of nursing, with varying degrees of success. An interpretative study of the process of discharging patients from hospital to care at home led to a new understanding of the context-related work which nurses do. Three components of context-related work were identified: working with the characteristics of bureaucracy; compensating for bureaucracy on behalf of the health care team; and providing leadership which ensured effective care from others. All constituted invaluable yet obscured and unrecognized components of nursing's indirect contribution to patient care. The costs to keeping this work ‘secret’ were readily apparent. The understanding derived from this research affords new insights into why nursing has kept this hidden work secret. These insights, in turn, help identify potential solutions for consideration by all concerned about nursing's professional role, status and identity.