Discretion among street level bureaucrats: A case study of nurses in a public hospital in Cape Town

Abstract

There are often noted gaps and tensions arise between official government policies and what is implemented on the ground. The two theories that consistently argue antagonistically about the policy processes are the rational bureaucratic model also called the "top-down approach" as opposed to the incremental or bottom-up approach. This research was inspired by a bottom-up perspective and involves a detailed investigation of Lipsky's street level bureaucracy (SLB) theory. Over the years since Lipsky's research much international work has be done on the subject of discretion among policy implementers but in the South the focus has been more on top-down ideas such as increasing state capacity and monitoring workers and not on the Lipsky problematic. Hence, this study specifically focuses on studying the extent, intentions and uses of discretion. Intentions are look e at in a threefold manner: good, bad and conflicting, among nurses as SLBs in a public hospital in Cape Town, in view of the t wo conflicting approaches to policy implementation. I found that the discretion practices among nurses do 'more good than harm' as opposed to the view held by the top down approach. The study further revealed that discretion is also often conflicted or ambivalent. Moreover, it is often based on tacit collective understandings and practices among groups of nurses. This is one element that needs to be explored further in future studies in order to contribute to the body of knowledge. Notably, there appears to be a gap in South African literature on this vital subject area. 111