‘Playing’ Doctors and Nurses? Competing Discourses of Gender, Power and Identity in the British National Health Service

Abstract

This paper adopts a feminist poststructuralist approach to demonstrate the ambiguities and complexities which exist in the relationship between work and subject. Recent studies in organizational sociology have argued that the discourses of work, and changing working cultures, have had a powerful effect on the production of subjectivities. New forms of working behaviour have been constructed as desirable, which often draw on personal qualities such as gender. This paper draws on research conducted with doctors and nurses in the British National Health Service to reveal the ambiguities which exist in the ways in which individuals position themselves in relation to these discourses. The discourses of work and organization are constantly mediated through, and destabilised by, the intertextuality that exists with competing discourses such as those of professionalism, gender, home and performance. Although organizational discourses are clearly powerful in the construction and performance of subjectivities, the interplay between discourses means that these are constantly destabilised and undermined.

Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care

“…A similar discourse has been identified in studies by Norris (2001) and Timmons and Tanner (2004). It is notable, however, that our respondents did not deploy the kind of direct appeal to the virtues of 'caring' as emotional reassurance found in earlier studies by Leonard (2003) and Timmons and Tanner (2004). Rather, 'patient-centredness' in our study entailed not conceiving the patients and their condition in terms narrowly related to heart failure.…”

“…The specialised expertise discourse consists of relatively narrow claims to be uniquely able to deal with particular clinical circumstances. All groups other than GPs employed a broadly similar expertise discourse, similar to that reported in Leonard's (2003) study. This, however, contrasts somewhat with the findings of earlier studies by Foley and Faircloth (2003) and Welsh et al (2004) discussed above; none of our respondents sought to legitimise their occupation in terms of a more overarching discourse of 'science'.…”

“…The organisational efficiency discourse was employed only by our nurses and focused on claims that the specialist heart failure nursing role occupied a niche between the specialist work of cardiologists and the ongoing responsibility of GPs. Although this position is somewhat similar to that espoused by both doctors and nurses in Leonard's (2003) study, who referred to getting the job done efficiently in order to meet government targets, our respondents made no such references to external or internal managerial pressures, implying that such efficiency is self-evidently desirable (Dent and Whitehead 2002). The patient-centredness discourse, employed by all groups other than cardiologists, represented patients as wanting or needing holistic and personalised care, and the respondent's own profession as well-placed to provide it.…”

“…First, occupations may seek to legitimise their work with reference to 'science', for instance by stressing a common scientific basis of professional practice (Welsh et al 2004, Foley and Faircloth 2003, Mizrachi et al 2005. Secondly, occupations may stress the high level of skill and expertise that they possess (Leonard 2003). Thirdly, occupations may stress holism and patient-centredness, asserting that their practice treats the whole patient and is tailored to their individual circumstances (Norris 2001, Timmons andTanner 2004).…”

“…Fourthly, occupations may stress 'caring' and the giving of emotional reassurance to patients (Leonard 2003, Timmons andTanner 2004). Occupations may also emphasise their contribution to organisational efficiency (Abbott 1988: 99;Leonard 2003) or assert that professional licensure provides a means of accountability (Timmons and Tanner 2004). Such claims may be employed both to stress a similarity and to establish a contrast with another occupation.…”