In Search of a New Identity: An Institutional Consultation at a Sub-Acute Inpatient Unit in a General Hospital

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Introduction: Hospitals are constantly morphing under the pressure of ever-evolving health care technologies, procedures, and reimbursement practices. In turn, healthy institutional identities and personnel allegiance contribute to counterbalance the potentially destabilizing effects of those changes. An institutional consultation was requested at a general hospital recently created sub-acute unit (SAU) due to malaise and dissatisfaction in the nursing staff. Method: The consultation included a total of 3 group meetings with the SAU nursing staff as well as observation of procedures and milieu in this and adjacent units. In the course of this process, a structure of demeaning narratives about the unit and the nursing personnel’s own role in the context of changes within the hospital was detected, destabilized, and transformed, and the kernel of a new identity for the unit was developed, using a shift in a routine evaluation procedure for patient’s progress as a fulcrum for generating change. Results: Follow-up evaluation indicated a qualitative improvement in the unit milieu and nurses’ job satisfaction, resonating with an enhancement in the staff’s identification with the unit’s reformulated mission as part of a constructive continuum of care. This improvement was also acknowledged and rewarded by hospital administration. Discussion: While maintaining a stance of positive connotation, assumptions of good intent, and a systemic view of the organization, demeaning collective narratives can be transformed through timely interventions that restitute pride and meaningfulness to the personnel and improve the unit’s quality of care.

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