Rankin, JanetEwashen, CarolRingham, Catherine2017-03-102017-03-1020172017Ringham, C. (2017). Tracking the Social Organization of Nurses’ Practices in Level 2 Neonatal Intensive Care Units: An Institutional Ethnography of Feeding Work (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28498http://hdl.handle.net/11023/3668The character of neonatal nurses’ work is episodic and discontinuous. While nurses play an integral role in mediating the ebb and flow of constantly changing priorities, in the Level 2 Neonatal Intensive Care Units (NICU) their work is also complicated by new technologies, safety work, and institutionally driven quality improvement (QI) projects. As the numbers and types of QI, safety, and standardizing strategies proliferate, they can overwhelm nurses’ responses to infant’s needs, particularly late preterm infants (LPIs) who require less technological interventions during their care in the NICU. An institutional ethnographic approach was used to examine the social organization of nurses’ work with LPIs in Level 2 NICU. Feeding work, a central organizer of nurses’ work, emerged as the main thread of analysis. The data showed that feeding work does not unfold as an orderly, stepwise procedure. Observations revealed how feeding episodes for all infants were broken up by the need for a nurse to attend to technologies developed for ‘safety’ and to meet standardized protocols. The work relies on nurses’ capacity to notice, to respond, to flex, and to adapt. However, nursing tasks are being broken into disparate pieces as nurses become subject to ideological practices that rely on a form of logical/rational thinking about how work can be planned and organized to unfold safely. Often in the milieu of nursing activity, LPIs were viewed ‘out of the corner of nurses’ eyes,’ socially organized to be rendered peripheral to nurses’ full attention. The research findings explicate serious tensions in nurses’ work, particularly with feeding LPIs. The findings call into question the foundations on which standardized protocols and practices are built and offers an opportunity for policy makers, health care leaders, and nurses themselves to understand how neonatal nurses’ work is organized and to begin creative discussions to resolve tensions and to direct further research in Level 2 NICUs.engUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Education--HealthEducation--Social SciencesEducation--TechnologySociology--OrganizationalNursingNeonatal Intensive Carenurses' worklate preterm infantsfeedinginstitutional ethographysocial organizationdoctoral thesis10.11575/PRISM/28498