Professionalization and Expertise in Care Work: The Hoarding and Discarding of Tasks in Nursing
Kessler I., Dopson S., Heron P.
Although health and social care workforces are heavily professionalized, the mainstream human resource management literature has been slow to engage with debates in the field of organizational studies on this distinctive group of employees. This lacuna is addressed by focusing on how the search for more flexible working practices in care services has affected the professions and especially their relationship with their assistant coworkers. The character of this relationship is seen as contingent on the logic of professionalization, in turn based on different notions of expertise, with implications for the allocation of tasks. The article distinguishes between a specialist expertise, encouraging the profession to discard routine tasks, and a holistic expertise, nurturing the hoarding of tasks. This distinction is used to explore the nurse professional project in Britain, a critical case where the statutory regulation of the nursing workforce has remained relatively weak. While noting shifts over the years in the British nursing professions’ adherence to these two logics, workplace data on the nurse–health care assistant relationship reveal a fragmented pattern of nursing work consistent with a specialist-discard logic, albeit underpinned by a residual ambiguity among nurses about their preferred professional logic.