The advantages of a third party in the health executives “work organization”. A search - intervention based on an educationaldevice[Le bénéfice du tiers dans le « travail d’organisation » des cadres de santé]

The organisation of production care is a task that requires three different levels of competence: operational, structural and learning skills. The organisational requirements (OR) of the Head Nurse (HN) are often centered on the operational level, to the detriment of the two other levels. This difficulty is due to the organisation which presents limited political, cognitive and pragmatic levels of rationality. The aim of this study is to identify the impact of a third party in regards to the organisation and its effect of the HN's OR. An educational device puts HN students in the position of a third party to allow them to work on an organisational problem delegated by a HN. The research-intervention followed 17 projects over one year. This device has legitimised the problem by recognizing the difficulties in nursing and re-configuring relations between healthcare professionals in a political dimension. The methods employed by the third party reassured the HN and completed their knowledge, bringing particular focus on the importance of methodology and managerial posture. In practice, the third party relaunched the HN in his power to act and coordinate different actors of a team. The third party helps develop the HN's OR and complete certain limits of his rationality. Nevertheless, difficulties still remain in the development of practices outside the medical team, limiting its reach to other services. A unit managerial support, a collective schedule and open spaces of discussion are recommended to bring structure and support to the OR.