Introduction

In the 1980s the Norwegian public sector was subject to substantive modernisation. As in most Western countries the principles of new public management (NPM) were introduced to overcome rigid bureaucratic and inefficient systems and improve flexibility. The new managerial regimes paved the way for different professional working patterns. Deregulation and a radical decentralisation of employment practices are part of the restructuring process. Politicians and managers, in line with researchers, perceived the health workforce to be in need of flexibility and called for more outsourcing of functions and increased use of temporary staff. As a consequence, the use of contract employees was increased. However, the assumption that NPM can solve labour problems in the public sector is highly controversial. Although NPM regimes vary across countries (Sehested, 2002; Lian, 2003), a general critique is based on the underlying political spirit of liberal individualism that focuses on ‘freedom of choice’ and individual values. This ‘freedom’ may create new constraints for individuals and also have adverse effects on the organisation of care. The use of contract employees may create, for instance, a lack of continuity and a diminution of available knowledge.

This chapter focuses on agency nurses, who constitute a new category of contract healthcare workers. Following Bates (1998), agency nurses are defined as those who have their work life organised by a private contractor, known generally as an agency, to carry out work within any number of medical institutions within the working week. The choice of becoming an agency nurse – as, for example, a contract nurse rather than a member of nursing staff at a hospital – highlights the issues involved in the controversy. Why do they choose agency nursing? Is it through ‘choice’ or lack of other options? The chapter starts with an overview of theories on work flexibility and its applications and moves on to explore the gendered implications of flexible work. The Norwegian context is then set out, together with findings from a qualitative study of agency nurses in Norway. Finally, conclusions are drawn on the symbolic boundaries in the nurse workforce and how they are shaped and reshaped by the changing organisation of care.