INTERACCIÓN FLUIDO – PARTÍCULA

While continuing some degree of clinical time was seen as an ideal way to maintain credibility with frontline practitioners, it was not without its problems. Principally, interviewees found that when they tried to take a clinical role, clinicians tended to treat them as line managers:

“People see you there, and they’ll collar you for – ‘I need to discuss this with you’, ‘I

need to discuss that with you’, or you get a phone call, you get – and you’re pulled

out all the time. So you find you spend your whole time apologising to the woman

you’re caring for, because you’re going backwards and forwards and someone’s

after you and interrupting all the time. And to me, that makes it more

uncomfortable, because I’d much rather be able to spend the time with the women

I’m caring for, to be able to go through that uninterrupted, so that they get my time

and appropriate care” – Louise, matron.

I asked Heather whether she believed frontline staff saw her as a midwife or as a manager when she tried to work in the clinical area:

“They see me as a manager dipping into midwifery, I think (laughing)… Yeah, you

know, and I’ll often be looking after somebody, and I’ll get a phone call from the

head of midwifery, or one of the consultants from clinic, and I’ll have to come out of

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sometimes be just a five minute phone call, and then I’m back, or – or members of

staff will stop me in the corridor and say, ‘Can I come in and see you? Can I make

an appointment to see you?”

Given the problematic nature of achieving the status of ‘just a midwife’, the main mechanism through which the interviewees attempted to demonstrate their continued group membership was visibility. This was a significant theme in almost all the narratives, with visibility taking a variety of forms. For some interviewees, visibility was achieved through ‘walking the floor’:

“I think you need to be visible, people need to know where you are, get used to

seeing you around and about, and – and when you are visible and walking about,

that you have got time for everybody, whether it is the housekeeper or whether it’s

the porter… I think – and then yeah, they know who you are, they’re used to seeing

you in the – They don’t think, ‘My God, what’s she here for? Why is she walking

through the unit?’ Or, ‘There must be something wrong, because she’s here’.

Because you are part and parcel of that, you know” – Karen, matron.

The other common way interviewees achieved visibility was through an ‘open door’ policy, although this was not without its challenges:

“And when I’m here, I have my door open all the time, so midwives, when they’re on

a shift, they want to see me – ‘Can I have two minutes?’ It’s so easy for them to

access me” – Heather, matron.

The interviewees were able to identify a number of reasons as to why visibility was important, which generally related to credibility. Several voiced the idea that visibility enabled staff to express concerns and to know that leaders do see the problems in clinical life:

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“And being me, being in my clinical area, I can see what’s going on every day, and

so when anything comes up in the management realm, to do with the service that

we provide, I’m visible, hands on, I can see what’s going on, and you have a

different concept to feed back to them” – Pauline, matron.

The potential to defuse difficult situations was also seen as a benefit of clinical visibility: “There are days when I know I’m going to walk the floor and I’m going to get an

ear bashing. There are days, but I can’t put it off, I have to do it, because it’s better

to do it and try and… defuse. It’s better to face it, defuse it, get on with it” – Lesley,

matron.

Communication and interaction were key points in clinical visibility for the interviewees, particularly in relation to helping clinicians see them as more than ‘just’ a manager:

“Some will see me as a midwife, because when – they often refer to sort of the

senior management team, and often really, we’re kind of classed in that senior

management team, when they’re sort of criticising. But, ‘I’m part of that team. Is

that what you think I’m like?’ And they’re like, ‘No, no, you’re here all the time,

you’re kind of one of us’” – Louise, matron.

The idea of visibility as a means of emphasising their continued midwife group membership was raised consistently throughout the interviews, and appeared to be a theme interviewees had reflected upon at length, particularly in relation to a fear of being seen as purely managers. As described above, interviewees believed they should demonstrate awareness of clinical issues, and also believed visibility meant they were more likely to be seen as ‘one of us’ rather than ‘one of them’. Heather sympathised with the view of clinicians that she should be visible and accessible, describing her disquiet at being moved from the clinical area to the management corridor:

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“It didn’t go down well. And I can understand it, you know. I feel like – I feel like I’ll

just be another manager – you know, soulless manager, really”.

Empathy with clinical staff’s views of managers was also expressed by Louise:

“A lot of the criticisms you hear of sort of the senior team is that they don’t

understand. They can’t possibly understand, because they don’t see the fire-

fighting that may happen, or what it’s like when it’s a stressful, busy day. And so

therefore, you can’t possibly understand it. And that’s heavily sort of criticised”.

The issue of visibility appears closely linked to the theme of communication according to a midwife identity, raised in the previous chapter. Interviewees believed their visibility was key to identification with the professional group, and were able to rationalise this in a number of ways, with the conclusion that they felt able to justify their identity as ‘one of us’ (midwife) rather than ‘one of them’ (manager).