Psychiatric nursing and organizational power: rescuing the hidden dynamic.

Reflecting recent discussions on the psychiatric nursing mailbase, a selective overview of the psychiatric nursing literature reveals familiar ways of conceptualizing power. These include the subordinate role of nurses to medical decision making, and the ability of psychiatric nurses to empower otherwise disempowered patients (Barker 1999, Clarke 1999). Abuses of power are also described, such as the physical and sexual abuse endemic on mixed psychiatric wards (Newton 1996). However, perhaps characteristic of the profession's relative lack of interest in the organizational literature, no mention is made of the power inherent in the operating style of the settings within which nurses work. This is both surprising and ironic, given the organizational literature emerging over the last 25 years documenting the way bureaucracies shape professional identity (Georgiades & Phillimore 1975, Pfeffer 1981, Gilbert 1990, Morgan 1997).