Nursing Boundaries and Work Identity Construction Among Nurses Exercising an Advanced Role: A Qualitative Study

Abstract

Background: Studies of the nursing profession are becoming more and more prominent in medical sociology. Grounded in the theoretical legacy of the two main sociological trends, functionalism and symbolic interactionism, these studies have developed understandings of the interplay between nursing and medicine. By contrast, the production of theoretical perspectives on both the heterogeneity of the nursing profession and its interplay with other professional groups such as nurse assistants is still very limited. Objective: This article aims to contribute to addressing this gap by developing a new theoretical perspective in the sociology of the nursing profession. The objective is to examine some of the effects of the introduction in the French health system of nurses exercising advanced roles on the evolution of the professional group of nurses, in terms of internal conflicts of interest, processes of construction of nursing identity and boundary work. Methods: Data were collected through an ethnographic survey conducted between January and April 2019, in four hospitals, one health centre and one cancer centre control, situated in the Paris area. Theywere involved in a pilot-project on Advanced Practice Nurses entitled the Prefiguration of Clinical Nurse Specialists (PrefICS) project.Participants were nurses exercising an advanced role (10), physicians (10), generalist nurses (2), managers of care units (1), representatives of the care board and hospital management (6). Results: The article describes different processes of construction of work identity initiated by nurses exercising an advanced role. These nurses engage in different forms of boundary work at the interface with doctors and nurse assistants, while dealing with conflicts of interest arising within their professional group of nurses. Some nurses exercising advanced roles considered themselves as resource persons for nurses and nurse assistants. They engaged in activities aiming at developing and sharing nursing knowledges and competencies with their colleagues within different frames of work. Other nurses exercising advanced roles were mostly engaged in emancipating themselves from physicians. They expressed both the will to reform work environments, and were critical of the professional posture of generalist nurses who were not used to developing their autonomous role in taking care of patients in collaboration with physicians. Conclusions: Professional boundaries appear as social and symbolic constructs arising from several forms of negotiation and collaboration. Far from being simple demarcations, in these particular cases nursing boundaries represent spaces of structuring new types of ties between different groups of health professionals and brokering knowledges between them.

Keywords: advanced nursing role, Ethnography, work identity construction, nursing boundaries, interactionism.