Between market and bureaucracy: Public healthcare reforms in China and nurses' terms and conditions

The public healthcare system of China has witnessed a series of reform since the 1980s, with considerable impact on the working conditions and well-being of its nursing workforce. This study examines the employment terms and conditions of clinical nurses in the public hospitals in China, using qualitative data from three case study hospitals. We explore issues relating to their employment contract, grading and work organization, remuneration and representation through an institutional perspective to highlight the role of various actors, existing or emerging, who co-shape the employment environment within the healthcare system. We also deploy hierarchy theory to identify sources of power, or the lack of it, of these institutional actors (e.g. the State, the hospital employer, the trade union, the clients and the nursing workforce) within the administrative and operational structure of hospitals to understand the relative positions of the nurses and their experience of work and employment outcomes.