Professional boundary struggles in the context of healthcare change: the relational and symbolic constitution of nursing ethos in the space of possible professionalisation

Abstract

The paper draws on Bourdieu's conceptualisation of the symbolic order and his little used concept of ethos in order to gain novel understandings of boundary struggles between nursing and medicine as well as internally in nursing. The constituents of boundary struggles are analysed in the context of healthcare transformation, focusing on organisational, institutional and political boundary undertakings. Changing conditions for boundary demarcations and professionalisation include a preference for evidence-based knowledge and practice, seen as a remedy against common problems in health care. The paper shows how nurses use the changes in 'the space of possible professionalisation' in their struggle for professionalisation when they expand their scope of practice and embark on what is conceptualised as a curing ethos, where nursing is understood as a discipline performing practices that lead to cure. However, this is repudiated by the medical profession at all levels. Moreover, curing stands opposed to the caring ethos in nursing and boundary struggles surface as 'ethos confrontation' between caring-and curing-oriented nurses in practice. The boundary struggles analysed in this paper raise important questions about healthcare manageability and the development of sustainable professional environments.

Knowing, relating and the absence of conflict: relational leadership processes between hospital boards and chairs of nurse councils

“…This literature sees conflict as a “[…] natural process that begins when agents in a system begin to ideate around novel solutions in the face of complexity pressures.” (Uhl-Bien et al , 2020). Conflicting can then be a helpful source for collaborating across organizational (Ernst, 2020; Farchi et al , 2022) and professional boundaries (Noordegraaf, 2020; Langley et al , 2019), and can even be part of dialogically working together (Uijl, 2022).…”

“…(Uhl-Bien et al, 2020). Conflicting can then be a helpful source for collaborating across organizational (Ernst, 2020;Farchi et al, 2022) and professional boundaries (Noordegraaf, 2020;Langley et al, 2019), and can even be part of dialogically working together (Uijl, 2022).…”

All the good care: Valuation and task differentiation in older person care

“…A wealth of research has been conducted on boundary work in inter‐professional collaborations (Currie et al., 2012; Ernst, 2020; Maaijen et al., 2018; Tye & Ross, 2000). This literature shows that professionals are often set on defending their privileged positions and their acquired professional values stipulating good professional practice (Currie et al., 2012; Fournier, 1999; Wallenburg et al., 2016).…”

“…This reorganisation and realignment of professional work is not without difficulties, as many studies in the field of professions and organisations have shown (Ernst, 2020; Maaijen et al., 2018; Martin et al., 2009; Tye & Ross, 2000). Old patterns of competition between organisations and professional groups may remain and professional associations often resist formal shifts in accountability, as this would pose a threat to their established privileges (Abbott, 1988; Currie et al., 2012; Martin et al., 2009).…”

Introduction

“…The Professions and Professionalization (Carter & Spence, 2014;Ernst, 2019Ernst, , 2020Larsen & Harsløf, 2020;Larsen, Hindhede, Larsen, Nicolaisen & Henriksen 2020;Nairz-Wirth & Feldmann, 2019;Schinkel & Noordegraaf, 2011;Spence et al, 2017), Multinational Corporations and Intercultural communication (Bjerregaard & Klitmøller, 2016;Lauring, 2011;Levy & Reiche, 2018), CSR (van Aaken, Splitter, & Seidl, 2013) and Management and Organizational History (Kerr, Robinson, & Elliott, 2016;Lyke, 2017;Robinson & Kerr, 2017).…”