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evident may feel physically tired thus becoming ―too tired to think‖. Equally,
this happens as a consequence of staff shortages and sickness, so that
energy needed to instigate change is not always available to the nurse.
She cannot see wider than her immediate care giving and her sense of
systemic agency is unavailable to her. Like the elephant in the bus, her
head becomes stuck in the immediate priorities of organising and
managing care. She does not see wider than her own ward.
Some research has shown that reflective practice develops nurses‘
political awareness (Glaze 2002, Taylor 2001, Platzer 2000b). Glaze (2002
p645) found nurses would take into account others agendas cultivating
―likeminded colleagues in order to influence the health agenda‖. While
Platzer et al (2000b) suggested nurses became less rule bound, more
confident in their decision-making processes and willing to challenge the
status quo. Taylor (2001 p.411) argued that developing a culture that
included acknowledgement and ―positive strokes‖, providing strong
leadership, dealing with issues as they arose directly through using
policies and procedures, engaging with conflict resolution, looking at the
determinates in a situation to ―turn them around‖, encouraging nurses to
support each other and develop a ―united front‖ to senior staff enabled
effective nursing. The findings of this inquiry are remarkably similar.
However, I would add to the list: an understanding of ―timing‖, developing
effective relationships with managers and colleagues by naming the
difficulties through supportive challenge, pointing out the contradictions in
the system, challenging as well as working with hospital policies, wider
networking, managing the unconscious games played out in practice, and
possessing a tenacity to follow through with actions for change. These are
all aspects of developing systemic agency.
We do not need to be defensive about our practice but this is
understandable in a political environment where a person can be picked
off when they put their head above the wall, paradoxically reducing the
likelihood of admitting mistakes and taking responsibility for one‘s actions.
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