Utøvelse av ledelse i kommunale sykehjem – handlingsrommets betydning

Abstract

Leaders of municipal nursing homes face challenges when they seek to secure a balance between the quality demands of authorities and the services they provide. In this chapter, we present a qualitative study on the leadership challenges in the municipal nursing homes. The aim is to develop knowledge on leadership challenges and the managerial discretions leaders employ to address the challenges. We interviewed seven middle-level leaders in five nursing homes in three medium-sized Norwegian municipalities using semi-structured interviews. The study revealed challenges connected to temporal nursing home placements made permanent, the time-consuming nature of the search for substitute workers, and the need to improve worker attitudes towards substitute workers’ experience-based knowledge. Attitude change is necessary because different forms of knowledge have different statuses in the nursing homes. The study shows that the leaders seek to meet the challenges connected to nursing home placements by establishing teams of professionals, while they try to persuade the Specialist Health Services to take over the responsibilities for the patients in transition. To meet the substitute worker challenge, the leaders use subjective managerial discretions to develop different strategies, including establishing substitute worker bases, substitute worker lists and delegation of substitute worker search. The leaders promote attitude change by stressing the importance of the substitute workers’ experience-based knowledge in both formal and informal contexts and implementing concrete competence measures. The study indicates that leaders who use subjective managerial discretions save time that they employ to create a balance between different leadership functions. The use of managerial discretions by leaders may affect the learning and organizational changes in nursing homes.