Professional Segmentation as a Barrier to Reform in Turkish Nursing.

This paper argues that segmentation within Turkish nursing is a major factor holding back the modernisation of nurse management. Since the millennium Türkiye's healthcare system has been transformed by NPM-style reforms that changed financing mechanisms and strengthened aspects of performance management, but had only limited impact on nursing management. The entrenched power of the medical profession and persisting influence of a civil service 'officer culture' have been major obstacles to change, but a third factor is division within the nursing workforce. Our qualitative study identifies four orientations among hospital nurses. Plans for innovation proposed by bureaucratic modernisers and professional modernisers are resisted by traditionalists and pragmatists, and modernisers themselves disagree about the way forward. Western discourses concerning nurse professionalisation and leadership have had uneven impact. Interdisciplinary working is largely absent, as are the hybrid management/clinical roles and movement of nurses into executive management positions. Instead, nurse managers seek to advance a curtailed form of professional development centring of continuing professional education, evidence-based practice, guideline development and creating spaces to exercise limited autonomy. Given the huge political difficulties of reducing medical power and achieving civil service reform, the best prospect of progress is to address the tensions within nursing itself.