Making New Health Services Work.

An ethnographic study of community nurses' contribution to service development

Norway, as many European countries, faces challenges in the delivery and organization of healthcare, leading to increased demands for service development and innovation. The health policy in Norway aims to achieve better and more effective healthcare for individual patients by transferring several tasks and responsibilities from hospitals to municipalities. Consequently, community nurses get more responsibility and perform additional new tasks.

This study explores nurse's contribution to the development of a new politically initiated emergency ward in an already existing emergency service and what competencies guided the nurse's work. The study applies an ethnographic approach to the data collection by combining observations and interviews with nurses in a rural emergency health service. In our analysis, we draw on the theory of the social organization of healthcare work, particularly the concepts 'organizing work' and 'articulation work.' The analysis demonstrates how the nurses navigate in their everyday work, especially their contribution in 'filling the gap' between the political intentions, professional standards and what the service could be within the local health care setting. The nurses continuously shifted their attention from the individual patient to the organization of patient work. In the development of the emergency ward, the nurse's focused on individual patients' potential caring needs, the overall care arrangements, organizational relationships, and the necessary supporting resources.

We argue that nurse's 'organizing work' is a necessary contribution to the local development and implementation of abstract and general political initiatives, and contributes to ensuring that new emergency ward is considered comprehensive services for individual patients.


Helle Krone-Hjertstrøm