Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Sena, Barbara

doi:10.7577/pp.1900

Cited by 24 publications

(23 citation statements)

References 53 publications

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“…It has been observed that despite the ongoing academisation process taking place in many countries in continental Europe (Laiho, 2010;Lahtinen, Leino-Kilpi, & Salminen, 2014), the level of autonomy of the profession is still relatively low: nurses remaining broadly under the domination of doctors. This ascertainment has been shown as well in recently academised countries, such as Italy (Sena, 2017), as where academisation started way earlier, like in the USA (Judd, 2010). Tied to its past, the nursing profession seems incapable of throwing off its symbolic designation as "paramedical," which trap it in 3 the status of a "would-be profession" largely subordinate to doctors and hospitals (Freidson, 1970).…”

Section: Introductionmentioning

confidence: 67%

An Ambivalent Recognition: The Academisation of Nursing in Switzerland

Toffel¹

2020

P&P

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Despite the academisation process the profession goes through in many western countries for decades, the level of autonomy of the nursing profession is still relatively low; nurses remain broadly under the domination of doctors and hospitals. The opening in 2009 at the University of Lausanne of a master’s degree marked a new stage in the history of the profession in Switzerland. With new resources, the emergence of this nurses’ profile disrupting professional relationships, both with respect to doctors as well as within the profession. After having presented the stakes of going through an academic training based on scientific knowledge, the article shows the attempt of redefinition of the practical and symbolic roles to which it gives rise as well as some of the effects of this diploma and its resources are having on the professional relationships.

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Section: Introductionmentioning

confidence: 67%

An Ambivalent Recognition: The Academisation of Nursing in Switzerland

Toffel¹

2020

P&P

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“…The phenomenon persists in Canada, despite various degrees of change to PC delivery Canada [ 55 , 58 , 60 ]. It is considered a hindrance to the development of other health care professions [ 64 , 65 ], can lead to conflict between providers [ 67 ] and is therefore undesirable when the goal is to support interdisciplinary PC.…”

Section: Discussionmentioning

confidence: 99%

“…While medical dominance has declined overall compared to the 1960s, the concept remains important internationally and particularly to studies of interdisciplinary practice [ 56 ]. While the dominance of the medical profession is challenged through various professional, legislative and cultural changes [ 64 ], it continues to act as a barrier to the professionalization and gaining of autonomy of other professions, such as nursing in Italy [ 65 ] or clinical pharmacy in Nigeria [ 66 ]. Stronger examples of conflict caused by medical dominance can be found in Nigeria in the form of strikes and other service disruptions [ 67 ].…”

Section: Introductionmentioning

confidence: 99%

Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces

Wranik

Haydt

2018

Hum Resour Health

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BackgroundPrimary care in Canada is the first point of entry for patients needing specialized services, the fundamental source of care for those living with chronic illness, and the main supplier of preventive services. Increased pressures on the system lead to changes such as an increased reliance on interdisciplinary teams, which are advocated to have numerous advantages. The functioning of teams largely depends on inter-professional relationships that can be supported or strained by the financial arrangements within teams. We assess which types of financial environments perpetuate and which reduce the challenge of medical dominance.MethodsUsing qualitative interview data from 19 interdisciplinary teams/networks in three Canadian provinces, as well as related policy documents, we develop a typology of financial environments along two dimensions, financial hierarchy and multiplicity of funding sources. A financial hierarchy is created when the incomes of some providers are a function of the incomes of other providers. A multiplicity of funding sources is created when team funding is provided by several funders and a team faces multiple lines of accountability.ResultsWe argue that medical dominance is perpetuated with higher degrees of financial hierarchy and higher degrees of multiplicity. We show that the financial environments created in the three provinces have not supported a reduction in medical dominance. The longstanding Community Health Centre model, however, displays the least financial hierarchy and the least multiplicity—an environment least fertile for medical dominance.ConclusionsThe functioning of interdisciplinary primary care teams can be negatively affected by the unique positioning of the medical profession. The financial environment created for teams is an important consideration in policy development, as it plays an important role in establishing inter-professional relationships. Policies that reduce financial hierarchies and funding multiplicities are optimal in this regard.Electronic supplementary materialThe online version of this article (10.1186/s12960-018-0299-3) contains supplementary material, which is available to authorized users.

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“…The professional actor does not follow their own selfish interest, as their profession is developed to solve problems and or issues to the best of society. Therefore, their ethics is based on the needs of the client (Parson 1975 ), and the professional groups define performance standards as well as ethical codes for its members in accordance with thorough training (Mastekaasa, 2011;Scott, 1998, Sena 2017. The "power" of a profession is among several, to identify and safeguard the content and practices of its work (Abbott, 1988, Sena, 2017.…”

Section: The Field Of Psychiatrymentioning

confidence: 99%

“…Therefore, their ethics is based on the needs of the client (Parson 1975 ), and the professional groups define performance standards as well as ethical codes for its members in accordance with thorough training (Mastekaasa, 2011;Scott, 1998, Sena 2017. The "power" of a profession is among several, to identify and safeguard the content and practices of its work (Abbott, 1988, Sena, 2017. Furthermore, Freidson (2001) concludes that autonomy and discretion are more important than professional knowledge and expertise, because upholding autonomy is the only way a profession can secure control and protect their standards, autonomy and discretion (Abbott, 1988).…”

Section: The Field Of Psychiatrymentioning

confidence: 99%

Organizing as negotiation. The making of a pathway in Norwegian psychiatry.

Nesbø¹

2020

Preprint

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The purpose of this article is to provide a thorough examination on the making of a pathway in Norwegian Psychiatry. During the last decades, much research has examined implementations and outcomes of different public health sector reforms and services in Western societies. However, there has been a lack of research on the process and the making of these reforms and/or services, in particular how they emerge as constructs in context policy, profession and practice. Based on qualitative data and theories on institutional logics, it shows how the two main actor groups are guided by values belonging to a specific logic when understanding the concept of a clinical pathway. The findings show that actors within the political field believe in control and efficiency, in contrast to actors in psychiatry guided by values of discretion and autonomy. This led to a debate of the concept of clinical pathway and psychiatry. The discussion became a polarization between concerns for patients as opposed to efficiency concerns. The making of the pathway was led by the Directorate of health, health professionals operating in the political domain, and with knowledge on both logic`s values. The end result became a logistic pathway were both “logics” got to keep their values, but where the original aims were highly negotiated.

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Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Cited by 24 publications

References 53 publications

An Ambivalent Recognition: The Academisation of Nursing in Switzerland

An Ambivalent Recognition: The Academisation of Nursing in Switzerland

Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces

Organizing as negotiation. The making of a pathway in Norwegian psychiatry.

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