Historical continuities and constraints in the professionalization of nursing

The authoritarian reign in American health care

The aim of this article is to increase understanding of the mechanisms of the continuation of elite hegemonic control of a highly valued social system--American health care. White, male physicians and administrators achieved control of the health care industry and its workers, including nurses, at the start of the 20th century. Using critical theorists' work on authoritarianism and incorporating gender analysis, the authors describe the health care system from a critical social- psychological perspective. The authors discuss the meaning and presence of authoritarian hierarchy and gender effects in today's health system through a critical analysis of the profession of medicine, the profession of nursing, corporate and bureaucratic health care, and patients or consumers. It is concluded that the social-psychological behavior of the American health care system has profound implications that must be taken into account in any recommendations for change.

Creating what sort of professional? Master's level nurse education as a professionalising strategy

This paper reports on a detailed analysis of selected findings from a larger study of master's level nurse education. It locates some features of such education within the contemporary situation of nursing as a profession and interprets the role of master's level nurse education as a professionalising strategy. In-depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the United Kingdom. The interview agenda explored participants' perspectives of the characteristics of master's level performance in practice. Interview transcripts were interpreted by drawing upon hermeneutic methodology. The following themes emerged. (a) The credibility of the master's level nurse was of central importance. In terms of the literature of professionalisation, this may be interpreted as a factor in enhancing the legitimacy of nursing as an occupation. (b) The clinical capability attributed to the nurse is interpreted as leading to an increase in the authority commanded by the expert professional. Thus, the individual capability of the master's level nurse enhances the attribution of autonomous skill to the occupation as a whole. (c) The master's level nurse is seen to exercise influence and leadership and this strengthens the power and status of nursing. Nursing does not have the appearance of a 'traditional' profession, neither has it a clear stance as a 'new profession'. Rather it appears to be especially responsive to the tide of public opinion manifest through government edicts. While nursing is employing rhetoric that espouses both positions, the direction of master's level education is anomalous.

The nurse executive: challenges for the 21st century

AIM

The aim of this paper is to examine the challenges facing the nurse executive in the 21st century by questioning the traditional attributions of leadership to the nurse executive role.

BACKGROUND

Historically, the leadership role in nursing has been assumed by the nurse executive. The predominantly female character of nursing, however, has ensured that demonstrations of leadership amongst nurses have been infrequent and compatible with prevailing male-defined ideologies. Examples of this include career restructuring and educational reforms in Australia.

FINDINGS

This paper found that the apparent lack of leadership in nursing was able to be traced back to early management theories which categorized leadership as a function of management.

CONCLUSIONS

If nurses are to assume leadership positions in the health care system of the 21st century, nurse leaders will have to let go of traditional managerial practices and behaviours. In the emerging health care system of the new century, nurse executive practices will focus on achieving change rather than predictability in organizational outcomes.

Revitalize to survive

The important topic of the future of nursing directs members of the profession to consider that future critically. This paper advocates a future-building rather than a future-entering approach as nursing encounters the third millennium. That view is prompted by candid statements, gathered through a national survey of Australian nurse academics, which indicate that the term 'nursing in the future' could be an oxymoron. Discussion reports on and reflects upon deficits to systems of support for scholarly nursing, a current state of exhaustion amongst members of the profession and the perceived existence of inappropriate attitudes to professional responsibilities. The voices of study participants give rich suggestions for the way forward to professional revitalisation. Recommendations include adoption of new paradigms for nursing's identity and creation of means by which the voices of all nurses may be encouraged to participate in discourse concerning nursing's future in health care provision.