The Social Organization of Neonatal Nurses' Feeding Work.

ABSTRACT

PURPOSE: We report findings from an institutional ethnography (IE) of nurses' work of feeding infants within an increasingly technical organization of NICUs. SAMPLE Five primary informants; 18 secondary informants. DESIGN: The institutional ethnographic approach included field observations, interviews, and phone and e-mail conversations. Our analysis followed accounts of what actually happened within the textual organization of nurses' work. MAIN OUTCOME: Nurses' feeding practices are directed by protocols that arise within multiple documentation systems and clinical technologies. These systems produce barriers to nurses' efforts to skillfully feed infants. RESULTS: Prioritization of quality and safety perspectives can obscure and constrain the ordinary yet critical clinical reasoning neonatal nurses employ during feeding work. Clinical technologies that have been developed to improve safety can paradoxically disrupt the ability of nurses to respond in the moment to neonatal feeding cues. This finding provides nurses, leaders, and policymakers with insight into why policies and procedures may not be followed as expected.