There was once a time when we thought of nurses as angelical, vulnerable and graceful figures, kneeled, cape fluttering, beside wounded men on the battlefield, pictured gesturing silence for a hospital poster or dressed in a brilliant white dress wrapped in the arms of some kissing sailor. That was a time when nurses seemed to conjure up the best blessings of human existence.
In a world crafted by mankind, rather than humankind, there remains a place for romanticism and heroism and the aesthetic representation of the nurse; but much as this idyllic image comes to the fore when we close our eyes and recall that prolific imagery, that is not the basis for this research. It may be assumed that although outside the nursing world people think of the profession in this romantic light, the truth is altogether different. It is, at its heart, a sociological puzzle.
A journey to a hospital poses one intrigue after another in every physical corner, from the surrounding roads, where one overhears ambulance sirens and wonders what misfortune may have occurred, to the very bedside where nurses scribble in patientsâ records. Of course, these thoughts are usually fleeting unless one happens to be a hospital ethnographer. Who are those workers? What do they do? What brought them to this hospital? What is life like here? What do they talk about? Do they laugh like the rest of us? Or, in academic parlance, how is the hospital socially organised and what roles do nurses play within it?
Studying society enables tracing the architecture of relations with each piece containing clues to past and present realities. These pieces reflect the conventions and practices of those who enact social roles. Work is an important part of societyâs functioning and social life. In this respect we ask, should nursesâ work be focused on more purposely as a self-styled profession? The fundamental question being, âis nursing a profession?â, and to what extent does the long-standing debate surrounding the professional nature of this occupation hold relevance? While most of our beliefs, assumptions and knowledge about the nursing profession are dominated by the realities, problems and politics of the US society, this research is different in that it is possibly one of the largest explorations of the profession outside the English-speaking world.
In Chile, where only a few occupations are endorsed with such an investiture, the debate about âprofessionhoodâ pointed to the basics of social stratification at work. This became even more confusing during sociological debates in European circles, though much less so in the UK and the USA. This difference pointed to the need for further examination of cross-national scholarships, which differed greatly based on world views and the role of the state in defining professional groups, allocating status and upholding privileges. Whereas in the English-speaking world, with societies oriented to open-economy dynamics, the notion of âprofessionâ is contested among high-status occupations, in Europe this discussion seems out of place, where the term, rather than an honorific investiture, is applicable to any specialised area of work, and thus the question âis nursing a profession?â seemed meaningless. In this second tradition, the professions (les mĂ©tiers) are subdivided into categories socio-professionelles, whereas the first would primarily dichotomise into professions and craftsâand ranks somewhere in betweenâwhich some would call âsemi-professionsâ. Led by two separate traditions, this divide was most surely crucial to approaching (and explaining) my initial research question.
Engaging the problem in terms of the latter tradition, the answer would have been all too easy. The former, however, offered a more comprehensive frame for a nuanced interpretation of the construction of professions. The attainment of professional status for Chilean nurses has been a constant theme, a theme that seeps into the international debate. With this context in mind, the question is changed to: To what extent is the construction of nursing as a profession shaped by the transformations witnessed by a society? Such change brought aspects of sociologicalâand historicalârelevance to the centre of the field of inquiry.
There are very few dates marked in my work, and in spite of its somewhat historical scent, this is not an historical study (with the exculpated exception of one of its constituent chapters). As a compilation of narratives, this dissertation tells a story, one possibly known by many but told differently. There are unpretentious reasons why I deliberately developed narratives, rather than simply conforming to the plain, formulaic writing of the academy, creating my own way of scientific expression. One aspect is that important perspectives of knowledge come to us in the form of narrativesâas we approach other peopleâs lives through their experiences, their stories bring fresh insights. A second reason is that, while I could not really bring the reader to the actual research field, improving the description of the setting and reconstructing personal stories constituted the most realistic resource to express what I perceived, saw, heard and sensed throughout my field research, otherwise virtually impossible to share in written form. I could also add that narratives modify the mood of the writer (and that of the reader), in ways that facilitate a more intimate connection with the audience, more imagined than visible. Another reason is that, far from being âepistemologically opaqueâ, narratives are intimately connected with inductive ways of knowing, making the researcherâs implicit subjectivity in the construction of data explicit and in the process enhancing the possibilities of an enriched sociological imagination. This is why narrative matters and became central to my writing. With that in mind, I composed the chapters as if they were parts of a conversation with my unseen readers. Unable to refuse these pluses, and aware of the dearth of literary merits in them, I collected the stories fragment by fragment, one fraction of the whole at the time, as I realised that, unlike fictional prose, real settings and real stories are exactly that, real. Their lure lies in their realness.
The importance of this work is that we have not really had a substantial explanation or solution to the problem, should nursing be defined as a profession. Most studies addressing the topic are accounts of nurses simply giving their own viewpoint from a vindicatory perspective. This is the major criticism to nursing researchâit concentrates more on what nurses think than it does on how they do things.
My methodology aimed precisely to bridge this gap. It consisted of an extensive hands-on ethnographic exploration of the nursing world, combining what I observed with in-depth interviews, and analyses of the many documents I compiled throughout my field research.
The data from these different sources were then analysed in order to build a meaningful account of the nursing profession as a systemic unit. This perspective enabled an exploration of its interaction with environing occupations, its exchanges with the landscape, its ideologies, its institutions and its internal stratification. Whereas this exploration drew attention to the functioning of the indisputable success of Chilean nursing, it in turn uncovered other problems of sociological interest, such as the detrimental consequences of its social closure projectâa social pattern that benefits one group while depriving others.
In what follows, Chapter 2 traces the rise of professions in medieval societies and contrasts a range of sociological approaches to professional work. The chapter outlines the concept given to profession within mainstream nursing literature and then expands the discussion by presenting the systemic approach to the profession presenting a framework for systematic analyses.
Chapter 3 looks critically at the incorporation of nursing education into academia as a mechanism participating in the reproduction of social differences on the grounds of the eliteness of graduate professions; ethnographic narratives are provided for a novel argument illustrating a âsocial distinctionâ sense of status elevation through which university-trained nurses have monopolised the title ânurseâ and the practice of ânursingâ.
Chapter 4 adds to the discussion on gender and gender relations at work. While there is considerable scholarship addressing internal boundaries between male nurses and nurses, little is known about the construction of those boundaries in the early stages of socialisation. Not only does this chapter highlight the impairments in life opportunities as gender identity is balanced with nursing identity among male students, it also provides the bases for an argument about the underlying political ideology aimed at portraying an empowered image of nurses.
Chapter 5 profiles a long-standing conflict between two competing occupations, the nurse and the midwife, tracing back the origins of the conflict to the technologisation and managerialism of healthcare. While this chapter brings insights relevant to the appeasement of the conflict, it also points to contextual transformations, external to the professions, as a source or abrasive interaction between remodelling professional jurisdictions.
Chapter 6 sets forth the intricacies of health reform and the participation of professionals in it. As nurses gain new credentials and the credentials themselves gain more symbolic value, the reform process has opened up spaces for wielding power and questioning patterns of power. This argument stresses the increasing system of credentials in nursing and, more broadly, illustrates the transformation of hierarchies and relational patterns among occupations.
Chapter 7 takes a look back to the organisational setting of the reform process previously discussed, in the anticipation that bringing the setting to the fore would favour further insights into exchanges between the professions and their ecology, and how the former does not solely adapt to the latter but also manipulates it.
Chapter 8 concludes by putting in perspective the number of relations that the nursing profession has developed within the system of healthcare, and the different devices nurses use to exert power collectively.
Chapter 9 offers an overview of how I investigated the nursing profession. There is an increasing interest in exploring the professions ethnographically, because then researchers may have access to what is implicit and uncover that which participants may not always be aware of concerning their practices and interactions. By doing this, this researcher also furnished them with the opportunity to reflect upon their work.
The fundamental purpose of this book is to contribute to the resurgent body of literature in sociology regarding professions. Nurses should realise that the aim of critically analysing their profession is, above all, edifying. In the longer term, this work may indeed encourage further thought, debate and research among nurses. The same holds for sociologists.