Self-Employed Nurses as Agents of Change in Canada

The position of the nurse in the currently existing medical system has been a debated issue for a certain amount of time (Gotlib Conn, Kenaszchuk, Dainty, Zwarenstein, & Reeves, 2014). This paper discusses an article by Wall (2014), which considers the phenomenon of self-employed nurses in Canada and their contribution to institutional change in the sphere of medicine.

In her article, Wall (2014) discusses self-employed nurses and the challenge that they bring to the field of medicine. On the one hand, it is stated that the currently existing medical institutions in Canada are hospital-based and physician-centered, relying heavily on doctors and not using the potential of nursing professionals to its full capacity (Wall, 2014).

On the other hand, there are nurses who challenge the existing system by practicing as self-employed professionals, demonstrating good effectiveness and high levels of job satisfaction (Wall, 2014).

It is also shown that, while these nurses bring change to the modern sphere of Canadian medical services, they are strongly opposed by professional associations and traditional institutions, for these mainly care about the quality of the service and thus are skeptical towards any pioneering (Wall, 2014).

It should be noted that the problem of not using the untapped potential of nurses in providing high-quality care to patients is a well-known issue (Gotlib Conn et al., 2014). Nurses may rather often be viewed as assistants, whereas their professionalism and qualification are often more than enough to work as independent practitioners.

Doing so might not only help nurses better realize themselves (which it does, as is demonstrated by Wall (2014)) but also to improve the overall effectiveness of the health care sphere considerably.

Thus, on the whole, some friction and conflicts between the innovators and the conservative institutions are inevitable, but the self-employed nurses discussed by Wall (2014) may serve as a bright example that independent, self-employed nursing practitioners might serve as agents of institutional change, also providing a considerable contribution to the quality of medical care in general.


Gotlib Conn, L., Kenaszchuk, C., Dainty, K., Zwarenstein, M., & Reeves, S. (2014). Nurse-physician collaboration in general internal medicine: A synthesis of survey and ethnographic techniques. Health and Interprofessional Practice, 2(2), eP1057|1-eP1057|14. doi:10.7772/2159-1253.1057

Wall, S. (2014). Self-employed nurses as change agents in healthcare: Strategies, consequences, and possibilities. Journal of Health Organization and Management, 28(4), 511-531.

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