Still Blue‐Collar after all these Years? An Ethnography of the Professionalization of Emergency Ambulance Work

Abstract

This paper explores the professionalization project of paramedics, based on an ethnographic study of UK National Health Service (NHS) ambulance personnel. Drawing on concepts derived from institutional theory and the sociology of professions, we argue that the project is enacted at two levels, namely a formal, structural and senior level reflecting changing legitimation demands made on NHS practitioners and pursued through institutional entrepreneurship, and an informal, agentic, ‘street level’ enacted by the practitioners themselves via ‘institutional work’. Focusing on this latter, front‐line level, our ethnographic data demonstrate that the overall impact of the senior level professionalization project on the working lives of paramedics has been somewhat muted, mostly because it has had limited power over the organizations that employ paramedics. Given the slow progress of the senior level professionalization project, paramedics at street level continue to enact subtle forms of institutional work which serve to maintain ‘blue‐collar professionalism’ – a form originally identified in Donald Metz's ethnography of ambulance work. Our analysis draws attention to the complex and contested nature of professionalization projects, in that their enactment at senior and street levels can be somewhat misaligned and possibly contradictory.

A qualitative study of decision-making and safety in ambulance service transitions

“…Findings from the ethnographic study of McCann et al 70 into changes in the paramedic role are consistent with findings from our study; they comment that, contrary to the notion of paramedics having a degree of decision autonomy, fear of litigation, lack of support from managers and concerns over making errors and causing harm to patients result in self-limiting actions. The authors also emphasise the need for allocating resources to build on service improvements, for example more advanced training, new patient pathways and more sophisticated vehicles and information technology systems.…”

“…This is reinforced by findings from an ethnographic study of changes in the paramedic role, which identified work intensification and a target culture as placing huge pressures on 'road staff'. 70 …”

A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety

“…Similar issues were identified in an ethnographic study of changes in the paramedic role which identified work intensification and a target culture as placing huge pressures on 'road staff'. 21 The aim of this study was to explore multi-level system influences on decision making by paramedics, focussing on care transitions and potential risk factors. The findings highlight the increased scope and complexity of paramedic transition decisions.…”

Emotional labour in paramedic practice: student awareness of professional demands

“…In McCann et al (2013) participant observational study of paramedics within one ambulance service it was noted that respondents focused on the technical aspects of caring for patients as a tactic in coping with their emotions, and that by doing so they avoided becoming emotionally connected to the patient. A majority of respondents (76%) indicated they had not received sufficient training to cope with the emotional effects of incidents but instead relied upon a level of 'street level professionalism', interpreted as a 'fall-back' coping mechanism in the face of organisational targets, abusive patients and unpredictable environments.…”

“…Respondents identified that talking to colleagues was a key coping mechanism and acted as an informal de-briefing exercise. McCann et al (2013) also emphasised the importance of debriefing and in their research noticed the loss of ability to informally debrief due to time pressures as significant in how paramedics managed their emotions following distressing events.…”