Nurses' Experience of Leadership in Assisted Living

290 Pages·2016·4.38 MB·English

Antioch University
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Dissertations & Teses
2008
Nurses’ Experience of Leadership in Assisted
Living: A Situational Analysis
Carole H. Bergeron
Antioch University - PhD Program in Leadership and Change
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Bergeron, Carole H., "Nurses’ Experience of Leadership in Assisted Living: A Situational Analysis" (2008). Dissertations & Teses. 135.
htp://aura.antioch.edu/etds/135
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NURSES’ EXPERIENCE OF LEADERSHIP IN ASSISTED LIVING:
A SITUATIONAL ANALYSIS

CAROLE HERSEY BERGERON

A DISSERTATION

Submitted to the Ph.D. in Leadership & Change Program
at Antioch University
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy

January, 2008
This is to certify that the dissertation entitled:

NURSES’ EXPERIENCE OF LEADERSHIP IN ASSISTED LIVING: A SITUATIONAL
ANALYSIS

prepared by

Carole Hersey Bergeron

is approved in partial fulfillment of the requirements for the degree of doctor of Philosophy in
Leadership and Change.

Approved by:

________________________________________________________________________
Dr. Elizabeth Holoway, Chair date

________________________________________________________________________
Dr. Peter B. Vail, Commite Member date

________________________________________________________________________
Dr .Laurien Alexandre, Commite Member date

__________________________________________________________________________
Dr. Heather M. Young, External Reader date
Copyright 2008 Carole Hersey Bergeron
All rights reserved
Dedicated to the nurses who contributed to this study. Every day, these nurses bring their deep
experience and gentle caring to the service of elders. Like their nursing forbearers, they put
themselves in unfamiliar surroundings and courageously re-define the field of care.
Acknowledgments
The road to a confident belief in myself has been an important one. During this time, I
have been accompanied by people who ‘saw’ me before I felt fully present. The treasures of my
life are my sons Adam and Jud. Their brave choices and mature acceptance of consequences
have inspired me to risk envisioning a different professional life. Their families--- Samantha,
Jaimi, Nina and Jesse---give me great delight and deep joy as I know that love, respect, courage
and appreciation will continue to be a precious part of all our lives. Dear friends have
encouraged me as I wondered whether this PhD road was one I could successfully walk; and
once begun, they have supported me in its completion. Larry, Ceci and Leo, Sheldon and Judy,
Kathy and Bob, and Jean have all wiped tears and comforted me, listened and challenged my
thinking, provided meals and solace, cheered me on, and unwaveringly believed in me. The
family I found at Antioch, my dear friend and astute research buddy Judy Ragsdale, the
Grounded Theory group of Michael Shoop and Cara Meixner, along with my colleague Elaine
Jane Cole have all provided caring insights, intelligent counsel and gentle friendship, for which I
am deeply grateful.
The Antioch faculty has afforded me the uncompromising challenge and professional
respect that a community of scholars embraces. For four years, I have been the lucky beneficiary
of the wisest and most generous guidance from Peter Vaill. As my Advisor, Peter has shepherded
me through difficult challenges and supported me as I rediscovered nursing’s deep and honorable
essence. As my Dissertation Chair, Elizabeth Holloway created a nurturing place within which I
could explore the subject that captured my interest and would not let it go. Elizabeth perceptively
and skillfully supported both intellectual and emotional journeys, while devoting innumerable
hours to thinking with me and helping to clarify the visual accounts of my study. Laurien
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Alexandre provided inspiration and a consistent actualization of intelligent, sensitive leadership.
Deb Baldwin, Academic Librarian Extraordinaire, cheerfully guided me through the maze of
‘search and discover’ challenges. Deb’s tireless enthusiasm and dogged persistence added delight
to the research process. My nursing mentors, Susan Reinhard and Heather Young, both
reinforced and challenged my process, resulting in deeper understandings of the issues. I am
honored to have been accompanied on this journey by all these wise, trusted, and caring
professionals.
My final appreciation is to the field of nursing itself. Over these four years, I have
wrestled with the conflicts that have been an integral part of my long practitioner experience.
The real gift that Antioch and this dissertation afforded was a settling, an acknowledgement, and
an affirmation that the worth of the nursing profession and the contribution that it makes to
humanity are deeply important and inherently valuable---as are the people who intelligently and
caringly perform its functions every day.

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Abstract
This study concentrates on the voice of registered nurses as they describe their experiences of
leadership within the nontraditional, non-institutional, non-hospital environment of assisted
living. It further expounds upon regulatory and corporate information as context for the nurses’
leadership experiences. The desire to hear nurses describe their personal experiences of
leadership influenced the decision to use grounded theory as a methodological process. The
belief that voice requires context to be most effectively understood influenced, in turn, the
addition of a situational analysis approach to the grounded theory methodology. As a result,
interviews and scrutiny of contextual elements form the core of this study. The expectation that
registered nurses will assume a leaderly presence has increased during the past 20 years as
significant changes in the overall climate of health care have taken place. The study identifies
many of the factors included in this change, specifically an alteration in the locus of care from
hospitals exclusively to more diverse settings. Because of the limited presence of physicians in
the extra-hospital world, nurses and administrators now form a leadership dyad in these settings
and are charged with managing organizations delivering complex chronic patient care. Assisted
living is a creative residential option that has been developed for elders who prefer individual
choice in addition to physical care support. This study analyzes the themes and overriding
influences explicated in personal interviews with nursing leaders in a variety of assisted living
communities in one state. It also describes the contributing elements inherent in the healthcare
and assisted living environments for their contextual implications. One important aspect of this
study is its separation of nurse and physician leadership elements. It seeks to highlight those
factors that emerge as supporting or denigrating nursing leadership experiences in an
environment that is not itself mired in the conventional role expectations of the traditional
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healthcare world. It is anticipated that this study will bring to light the pressure that nurses feel as
they are caught between the inherent value of patient advocacy and the corporate and regulatory
requirements of assisted living communities

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TABLE OF CONTENTS

Acknowledgments i
Abstract iii
Table of Contents v
List of Tables viii
List of Figures ix
Forward: Two Motions x

Chapter I: Background of the Study 1
Rationale for the Study 1
Brief History of Nursing 1
Nursing Leadership 4
Changes in Healthcare Focus 5
The Pressure of Competing Priorities for Nurses 6
The Asisted Living Environment 7
Overview of the Research Aproach 8
Situating the Researcher 10
Conclusion 12

Chapter I: Literature Review 13
Contextual Factors 14
Patriarchy Related to Nursing 14
Power Related to Nursing 18
Gendered Healthcare 22
Aging of the Population 30
Factors Intrinsic to Nursing 3
Identity and Knowledge in Nursing 3
Knowing in Nursing: Nursing Theory and Practice 35
Empirics: The Science of Nursing 37
Esthetics: The Art of Nursing 39
A Component of Personal Knowledge 41
Ethical Ways of Knowing 46
Sociopolitical Knowing 47
Reflection 48
Empowerment in Nursing 50
Nursing Shortage 56
Nursing Leadership 62
The Asisted Living Environment 75
Conclusions 82

Chapter I: Methodology 84
Grounded Theory and Situational Analysis: Methodological Fit 84
Functionalist Theory 85
v