The purpose of this study is to describe nurses’ experiences of public and private sector environments and cultures, and to understand their workplace choices. This is achieved through the exploration of the lived experiences of registered nurses in Australian public and private healthcare sectors.
The literature suggests that public and private sector workplace environments are different. To date, differences are found in the sector’s funding models and casemix. Also, nurses’ satisfaction with their role in these disparate workplaces is influenced by idiosyncratic organisational stresses, perceived respect received, moral distresses, and cultural and physical characteristics. Ultimately, many of the phenomena identified for nurses’ workplace preference in this study can be explained through the sociological literature of identity theory.
The sixteen participating registered nurses (RNs) have worked in both sectors, but specified a preference for one sector as this was where they felt a sense of belonging. They shared their stories in repeated, semi-structured, interviews. Paul Ricoeur’s hermeneutic phenomenological anthology underpinned data collection and the transcripts’ thematic analysis (with generated themes and subthemes). The data was further explained through application of theoretical triangulation with the interpretive paradigm of Ricoeur’s theory, to facilitate deep understanding of nurses’ experiences. Participants who felt a sense of belonging in the public sector held a belief in social justice which was best reflected in public sector practice. They valued ongoing improvement in clinical skills, worked collaboratively with doctors and allied health professionals, with the common goal of achieving the best outcome for the patient. These RNs felt that sharing their skills and voicing clinical opinions were central to their professionalism. However, work satisfaction gained from professional support was often dampened by a stressful public milieu. Participants were either attracted to or repelled by the pace and structure of the public health sector. Ultimately, demanding patients, international staff, in a busy, loud environment provided the motivation for some nurses to move to the private sector where their valued behaviours were better met. Participants who felt a sense of belonging in the private sector valued orderliness in the workplace and close working ties with nursing colleagues. Their sense of professionalism was focused more on holistic patient care. They valued the flexibility of private sector work which facilitated a good balance between work and family. Private sector nurses also recognised that they had to satisfy their main client, the doctor, because the doctor generated revenue for the organisation and thus their wage. However, lack of an extensive medical and allied health professional presence meant that private sector nurses required very high level skills in patient assessment, acute intervention and communication. Sadly, the absence of a sense of belonging between nurses and with the organisation resulted in participants’ felt negative emotions and being bullied.
Furthermore, RNs recognised they had to be financially responsible in both sectors, yet participants’ experiences of institutional thrift were different. The public sector was publicly financed and had an indeterminate demand, whereas the private sector’s purpose was to ensure an increased profit with a regulated throughput. The type of procedures conducted, patients admitted and the number of nurses rostered on a shift were regulated to achieve this end in the private sector. All participants shared an understanding of these situations, and indeed influenced where they felt belonging in the workplace.
The theoretical triangulation application of Ricoeur’s phenomenological framework has provided evidence of the validity of the analysis. The self-constancy provided for public sector nurses and also the nurses who ‘belonged’ in the private sector enabled them all to live a “good life” and achieve an ethical identity. The overtly ethical nature of nursing through working with and for others aligns with Ricoeur’s concept of what the human spirit aspires to, that is, a “good life, with and for others in just institutions”.
The key phenomenon, belonging, a fundamental human motivation, can be further understood through the literature and research of Identity theory. Individuals seek interactions with others who affirm one’s self-worth, self-esteem, self-efficacy and values. Participants satisfied these needs when they worked in the preferred sector with others who held similar personal, social and role mores. However, negative emotions emerged when participants were not able to verify salient self-meanings, or when another did not appreciate the individual’s self. These instances were reported of working in the non-belonging sector. Strategies for the individual to alleviate a sense of not belonging and ameliorate negative feelings of guilt, anger and shame, along with ways to learn greater self-compassion and resilience, and thus foster connections with others are recommended. Organisations and individuals who embrace authentic, compassionate interactions will facilitate positive social growth, workforce retention and improved patient care. Understanding how nurses experience the two sectors and factors influencing their preference in sector workplace will enhance recruitment and retention activities.