BACKGROUND: Research on organisational culture in aged care settings is formative. This study gives primacy to the voices of registered nurses (RNs) who are integral to clinical and managerial leadership in rural and regional aged care contexts in Australia. OBJECTIVE: To describe and analyse the reflections and understandings of RNs who are or have been employed in residential and community aged care settings in rural and regional Australia on optimising organisational culture and cultures of care. METHODS: This manuscript reports on a component of a larger study with 14 participants. Five RNs at the board, executive and clinical nurse consultant level employed in residential or community aged care settings in rural or regional Australia during 2017-2024 participated in semistructured interviews. The interview questions were guided by appreciative inquiry, and this facilitated a strength-based approach to discussion on organisational culture. Data were analysed using critical discourse analysis informed by Michel Foucault, which is concerned with an examination of the nature and utilisation of power as a relational force in social systems. FINDINGS: The participants, reflecting on their experience in rural and regional contexts, viewed strong nursing leadership as integral to person-centred cultures in aged care settings. Nursing leadership incorporates nurses working to full scope of practice in settings that support postgraduate study and research and innovation. Interwoven through these perspectives is evidence of Foucault's concepts of governmentality and disciplinary structures informing nursing practice. Power is both a repressive and productive force that shapes professional relationships and the capacity for RNs to be agents of change. A clear separation of the operational and governance arms of aged care organisations was viewed by participants as necessary for effective management, while highlighting the need for more RNs to contribute in roles at the board and executive level. CONCLUSIONS: This study underscores the opportunity for professional nursing bodies, government agencies and the aged care sector to work together to require RN representation on boards of aged care providers; to develop policies that enable RNs to work to their full scope; and to strengthen mentoring, career pathways, and financial assistance for nurses pursuing further education. RNs working in aged care also emphasised the importance of building a research-focused culture that drives improvement and innovation, noting that staff education is essential for enabling meaningful involvement in research and project work.
Magee et al. (Thu,) studied this question.