August 8, 2020

Cultivation of Nursing Community: Stated vs. Shared Values

While reflecting on my recent posts, I’ve been thinking about several issues related to the enduring nature of nursing communities.  What does it mean to say that nursing communities last?  How do they last?  Can nursing communities be cultivated?  The answers to these questions are related to one of the most important issues I’ve raised: the curation and preservation of meaning.

In my most recent post, I highlighted the many crises of interpretation, so-called hermeneutic crises, faced by nurses in the course of both direct and indirect patient care.  The long-term resolution of these crises within a nursing community requires a clear vision of the community’s values as well as planning and implementation of various mechanisms of meaning making.  This post will begin to explore these in some detail.

Think about the values of your nursing community.  I suspect it’s easier to think of the stated values of your health care organization (HCO), as presented in corporate communications, than to think of specific shared values of the many individuals comprising the organization.  Corporate values statements, by their nature and the intention behind their formulation, serve as a means of synchronizing the values of the constituents with respect to their behavior within the organization.  On the other hand, corporate values statements apply to only a limited extent within the lives of individuals.

For many individuals, religion and spirituality provide the bases for the values by which they live.  Because of this, it should be no surprise that individuals in HCOs may not commit themselves to corporate values statements as thoroughly as might be hoped by management.  This is not to say that corporate values statements are unnecessary or at odds with personal values, although that remains a possibility in some cases.  Many individuals live quietly according to their own personal values rather than the organization’s, recognizing that their own values are more comprehensive and more firmly rooted in their religious and spiritual ground.  Such people find they can rest comfortably in the knowledge that as they live out their personal values, for the most part they are in no danger of violating corporate values.

However, there is no guarantee of compatibility between individual and corporate values. There is always the possibility that an individual within the organization will sense a dilemma calling for a choice between his or her personal values and those of the organization. HCOs may attempt to avoid the occurrence of such a dilemma by requiring formal assent to the stated corporate values and by reiterating those values through corporate communications. However, people change, and organizations drift from or reinterpret their stated values over time.

Across HCOs, stated corporate values may seem to be shared as constituents conduct their everyday affairs within the organization in a manner consistent with those values. Such values are reinforced by formal policies and procedures. In that sense, organizations take on a value-driven character in the marketplace.

On lower levels of organization, on levels not amenable to the assessment of aggregate behavior, there is much less homogeneity. With respect to specific values, individuals may disagree markedly with one another as to their interpretation or their application to behaviors within the organization. To the extent that this value incongruity can be minimized by adherence to stated corporate values, the organization can forestall disintegration.

However, there are many possible personal values that are not shared among the constituents of HCOs. Deeply held beliefs give rise to practical behaviors, some of which will be classified by some as matters of professional ethics. Hence, large HCOs may expect some degree of tension between stated corporate values and shared personal values.

Given the possibility that such tension may be endemic within nursing communities, it is important for leaders and managers of HCOs to embrace the complexity of their organizations and seek to cultivate communities of integrity within the organization. Such communities, many of them nursing communities, engage in much of the meaning making of the larger organization.

Upcoming posts will discuss various mechanisms of meaning making within nursing communities, with particular emphasis on the nursing unit level. In the meantime, what are your experiences with the tension between your personal values and those of your organization?

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