July 8, 2020

Place and Structure in Nursing Community

In a previous post, I mentioned communal meaning making as an attractive force in my life. What is meaning making? What does it have to do with community? With nursing? I’d like to begin to explore the idea of communal meaning making through this blog. I know it’s such an enormously complex topic that the exploration can only unfold over time. In this post, I’ll begin to scratch the surface of the idea of community by considering the structure of community.

Community in its most basic sense is a social unit or group, the members of which have something in common. The factor in common can be practically anything, but one of the most readily recognizable is place. Place isn’t so precise as location, as in a geographic point. Instead, place generally carries the connotation of socially constructed boundaries, those determined with the aggregate action and understanding of community members. For example, people living in the suburbs of a major city often self-identify as residents of the major city proper, even if in some contexts they see themselves as residents of the suburbs.

Beside place there are limitless possible commonalities that unite communities. For example, identification with a particular sports team forms a community of fans with an interest in the success of the team. Art enthusiasts may frequent similar events and museums. Whether they know each other personally or not, the events or institutions they value exist in large part because of their collective interest.

With respect to nursing, many would note that the relevant place for community is obvious. After all, acute care services in healthcare are provided in a particular setting, commonly thought of as a hospital. On a smaller scale, various nursing units are housed in the institution in particular locations. Even the exceptions, such as wound care or central line placement teams, exist in place in a sense because they encounter patients throughout the hospital.

However, the identification of place as a primary factor in community may not be adequate for all considerations because there are so many aspects of community life that are in flux. Things change, yet the community remains. For example, assigned locations change. The general medical unit on which I work has undergone remarkable change during the past several years, as the unit onto which I was originally hired merged with a similar but smaller medical unit to allow the formation of a progressive care unit. Not only did the work location of many staff members change, but the staff compositions of the two pre-merger units changed as well due to the selection of personnel from each unit to staff the two resulting units.

The experience of the merger overall, from the anticipation to the honeymoon period to the new normal, has been an education in community for me. Of course, place is important. Also important are the composition of the community in terms of the individuals involved, the connections of the community to the outside world of other communities within the institution and beyond, and the values and beliefs present in the community.

Furthermore, communities are unique and evolving. No two nursing units are alike, and no nursing unit is exactly the same from day to day. Patient census and population characteristics change because patients come and go on the unit. During any given shift, there are different staff present. Staffing models affect composition in real time. Day shift differs from night shift for many reasons, some of which have to do with human personalities and the availability of resources, among other influences.

A close look at nursing unit-specific communities reveals a variety of subcommunities, small communities within the larger community. The features of community mentioned previously are interrelated in complex ways within the community itself and in relation to the world outside the community. Examples of these subcommunities include unit leadership, charge-eligible nurses, the shared governance and other committees, day shift staff, night shift staff, weekend option staff, licensed staff, unlicensed or technician staff, staff on orientation, and the patient population.

Again, this post is intended to scratch the surface of the idea of community in nursing by looking briefly at some structural features of community. There will be more to come on community in nursing. What structures of community do you notice in your nursing context?

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