PhD defence J. (Jannine) Van Schothorst - Van Roekel

Summary:

The development of new nursing and medical roles in the healthcare organization is central to this dissertation. Our findings show that developing new professional roles is a layered process that takes place on several levels: the work floor, within organizations and at the levels of professional associations and policy making. Development is a ‘back and forth’ process, whereby new professionals are meant to fulfil organizational needs (shortage of ECPs, unavailability of expertise in emergency rooms, staff turnover), while simultaneously having to maintain the domains of traditional professions. This leads to ongoing conflict in which new professional groups find it hard to establish their new professional role. However, by zooming in in this ethnographic study, we discerned more precisely what takes place within healthcare organizations. Then we also see success stories, often facilitated by the support of managers and internal policy advisers. These parties constantly act to tie together the internal and external interests, moving between vested and new professions, whereby especially the new professions have to handle disappointments. This leads to 1) ongoing uncertainty and the urge to prove, which may negatively affect not only resilience, but also quality of care; 2) problematic discussions on (medical) final responsibility, which hinders the development of other professions and causes control, protection of domains and a lack of recognition and distrust; 3) fragmentation: new roles take shape slightly differently in different contexts; 4) which leads to weak reflection and representation on the overarching and even national level. New professional roles appear to be mainly organization driven, a new form of organized professionalism, with an emphasis on the organization. This causes a high degree of dependence. It can be questioned how sustainable professional role development is and whether the grand expectations of new professions can be realized.