Blog post

Learning the New Ways

Male nurse listening to older person at nursing home in the garden. Photo:

Ways of walking, saying, and listening tell us more about the existing hierarchies and power relations in a workplace, Marek Pawlak writes in his blog on different “ways” of nursing in Norway and Poland.

By Marek Pawlak

In our research, we focus on nursing practices and lived experiences within different regimes of immigration and integration. It is not surprising that each of the Polish nurses I have met during my fieldwork has a different story to tell.  The field-driven narratives vary in terms of migration decisions, initial expectations, and opinions about the recruitment procedures, including the role of recruitment agencies. However, most of the Polish nurses agree on one thing – that caring and nursing mean “something different” in Norway.

As an anthropologist, I am interested in the notion of “something different” – in its meanings and the social and cultural practices that it entails. It tells us a lot about the ways of caring and helps to problematize ‘taken for granted’ ideas, imaginaries, and understandings. In other words, by exploring nursing practices and experiences, we not only learn about the health care system, but also about what care means in a particular cultural context and how it is embedded in wider social relations.

While pointing out the differences between nursing and caring in Poland and in Norway, many nurses have used the phrase, “I had to learn how to….” This entails both learning how the Norwegian health care system works, and also learning how to practice nursing and caring in new ways.

Ways of walking, saying, and listening

“I had to learn how to walk,” one Polish nurse, who is working in the hospital outside Oslo, said to me. In Poland, where she had also worked in a hospital for over a dozen years, she got used to a rather rapid pace and doing things quickly. Thus, walking quickly in Polish hospitals was a “normal” and “obvious” way of being a nurse for her. You have to work at a fast pace if you want to cover all the patients during your shift.

So, it was rather surprising to her that her way of walking raised concerns, and even a feeling of emergency, among her Norwegian colleagues and staff. Soon enough, she learned that by walking quickly, she unconsciously creates a nervous atmosphere, a sense that something alarming is happening on the ward. In order to accommodate the new culture of work, she had to slow down and learn a new way of walking through hospital corridors.

Another Polish nurse, who is working in a Norwegian care home (sykehjem), said that she was shocked when she learned that it is fine to say “I don’t know,” when asked a detailed question about a specific nursing procedure by a doctor. According to her, in Poland,  a nurse is supposed to know everything about the patients and their treatment.  Here, in Norway, she can always say “I don’t know, I have to check it.” Many Polish nurses appreciate this sort of approach, since it results in a less tense and frustrated atmosphere in the workplace.

 There are also differences in terms of listening. All of the nurses with whom I spoke emphasised listening as a key factor in practicing nursing and care. Contrary to the situation in Poland, in Norway, you have to listen to your patients and respond to their needs and wishes. Sometimes it might be difficult to follow a patient’s wish, especially when it may impact the treatment. As one nurse told me, “How can you plan the insulin injections when the patient likes cakes and eats them whenever he wants?”

Listening does not only concern the relation with patients, but  is also about being listened to by doctors. Comparing nurse-doctor relations in Poland and in Norway, my informants unanimously agreed that nurse-doctor relations in Poland are a far cry from the ones in Norway. In Norway, nurses are asked for their opinions and are encouraged to propose a course of treatment. Caring in Norway is a collaborative effort.   

Walking, saying, and listening might be perceived as secondary issues in nursing. However, they tell us more than we think.

It’s all in the details

There are obvious differences in the health care systems of Poland and Norway, when we consider economic and political factors. Different policies, taxation, and income redistribution have great impact on how the health care system is organised and managed. Also, there are no perfect systems and we can always identify pros and cons of every system. However, by observing and discussing the minute details of work habits, nursing practices, and care routines, we can achieve rather unexpected outcomes.

Ways of walking, saying, and listening tell us more about the existing hierarchies and power relations in a workplace. In Poland, doctors seem to be at the top of the hierarchy. It is the doctors who have the power, and they use it by commanding tasks which should be fulfilled by nurses without saying. Obviously, in Norway, such a hierarchy also exists, but according to Polish nurses, it is less sharp and visible. The Norwegian approach to caring is a rather  collaborative effort, where doctors, nurses, and patients are equally important. It is more about dialogue, suggestions, and opinion exchange rather than instructions.

Thus, Polish nurses in Norway experience a stronger sense of agency compared to those working in Poland. They also feel respected and have more responsibilities in caring for patients, which they rather appreciate. As a result, Polish nurses quite easily change their habituated attitudes towards patients and follow the Norwegian way. As one of the nurses told me: “In Poland, patients are treated like ‘objects’… here, they are just people.” In other words, the existing relations between doctors, nurses, and patients imply the idea of “empowerment,” which in Norway seems to be an important element of care.

These are just a few different “ways” of nursing, which reveal differing ideological approaches to care in Poland and in Norway. The aim is then to explore such contexts further and raise a more general question about care as a phenomenon and its intersections with social, cultural, economic, and political realms.