Fase de desarrollo

Esping-Andersen has asserted that, ""'orthodox class theory is nested in an institutionally naked world ” (1994:121). Given the focus o f the present thesis, the discussion o f the identities and beliefs held by nurses and indeed the very occupation of nursing itself have to be contextualised both in terms o f class analysis and in terms of an understanding o f organisational processes. Indeed, the shifting nature o f what it is to be a ‘profession’ and the striving towards occupational professionalisation evident in the recent history o f nursing only really make sense in the context of the changing structure and institutional pattern of work that emerged in the latter part o f the twentieth century. As Savage has argued, the institutions in which people work, coupled with the organisation o f work itself, have formed the largely unacknowledged basis of class analysis : " ...(O)rganisations are both a cause and an outcome o f class relations (which) encode and embody cultures o f class ” (Savage:2000;122).

There are exceptions to this general statement, o f course, one example being the Weberian tradition of class analysis, which focused attention on bureaucratic structures as the ‘ideal-type’ o f modem organisation. However, these were bureaucracies that lacked any sort o f historical specificity. Bureaucracy was a ‘given’ in Weber’s understanding o f class and status. Goldthorpe (1980) developed this notion o f bureaucracy as being a foundation of class with his notion o f the ‘service relationship’. This was the bureaucratic basis out o f which a ‘service class’ o f managers and professionals was said to have emerged; a fusing together of capitalist productive and bureaucratic processes. As Savage argues, these Weberian accounts o f bureaucracy were used as ‘a hook on which to hang an account o f class’ (2000:124). The fact that these bureaucratic ideal types o f organisation are now very much part of history rather undermines this particular attempt to make the link between

organisational structure and class.

Many sociological assessments o f the emergence and power o f the professions do not acknowledge the importance o f organisations and their structures in this process. Here again, the Weberian tradition has been influential in two major ways. First, it tied the professions into a model of social stratification that sees these occupational groups as operating within both economic and social orders. The labour market experiences o f professionals (i.e their relative income levels, job security, etc.) are dependent upon the level o f demand for their knowledge and skills as well as by the level o f concentration o f those skills within the profession, as compared to the rest o f the labour force. This focus on the demands of the capitalist labour market is important, given the way in which the professions are analysed within other sociological traditions, such as symbolic interactionism and Foucauldian-inspired post­ structuralism, as existing outside any notion o f class structure. Second, the greater emphasis placed upon social action than upon structure in Weberian analyses o f social processes has led directly to the development o f the influential notion o f the ‘professionalization’ strategy or project. This Weberian ‘ideal-type’ is employed to conceptualise a particular occupation’s pursuit o f both economic and social interests and its subsequent strategy of ‘social closure’.

Friedson’s work (1970) is a prime example of the use o f this form o f action-orientated analysis, applied to the development o f one profession. Interestingly, however, it contains no explicit reference to Weber’ work on social stratification, although this may well reflect Friedson’s background in the Chicago School o f interactionist sociology (Macdonald:!995;28). As discussed above, Friedson sought to move beyond the then current functionalist orthodoxy concerning the role o f professional groups within a rule-bound organic society, as well as beyond the socially functional ‘traits’ approach informed by Durkheim’s notion o f professional ethics. Friedson was concerned primarily with the day-to-day world o f the medical profession which, whilst employing such abstract professional principles at some ideological level, was in practice actively engaged in the process o f maintaining and developing its power and autonomy. This ‘power approach’, as it was subsequently called, soon became the orthodoxy in sociological analyses of the professions (MacDonald: 1995:5).

Larson’s (1977) equally influential conceptualization o f the professions builds upon the work o f Friedson in the emphasis given to professionalisation strategies, whilst explicitly incorporating a Weberian framework o f social stratification. Larson also introduces some insights taken from Gramsci’s work in relation to the apparent ‘detachment’ o f professionals from the class system o f power and exploitation. Larson sets out four essential features o f the processes that have brought prestige and power to professions. First, he says, their distinctive autonomy is dependent upon the power o f the state and those state elites which ‘sponsor’ them. Second, the normative features associated with professions are not fixed characteristics but are used to set the boundaries o f membership. Third, drawing on Friedson’s analysis, once autonomy has been achieved the task is then to build a position o f prestige independent of the original sponsoring elite in order to occupy a distinctive place in the system o f social stratification. Fourth, an ideology is produced which builds on the normative aspects in order to construct social reality within the areas where the profession functions. Larson seeks to emphasise the social mobility and market control o f professions, not as a straightforward reflection o f skills, expertise, and ethical standards but as the outcome o f this ‘professional project’. Here, specific collective goals and strategies are actively pursued by a given occupational group (Larson: 1977:6). This Weberian- inspired account o f the process o f professionalisation points to the connection between labour market structures which provide secure institutional arrangements, and the demand for the specific forms o f knowledge possessed by professional groups. Professional knowledge is thus able to achieve a level o f legitimacy that allows it to define clients’ problems in ways which require professional practice to solve them (Martin: 1998:667).

There are alternative sociologies o f the professions, namely the approaches influenced by various readings o f Marx and by the work o f Foucault. Marxist-informed analyses o f professions are rather thin on the ground, this should not be too surprising, given Marxism’s emphasis on class analysis. Such approaches have tended to focus on two areas o f explanation. The first of these is the integration o f the processes o f professionalisation and state formation, and here Johnson’s (1980) historical account is particularly influential. Johnson’s position is that the state was actively instrumental in the development o f the professions in the nineteenth century and that there was a trade-off between the professions (e.g.medicine) providing a service for the state and

the latter in return extending the professions’ influence and increasing their membership. The second is the ‘labour process’ approach, which was influenced by the work o f Braverman (1974). Braverman sought to analyse the changing role of the professions in terms o f wider changes to the labour market, and here the processes of ‘de-skilling’ ‘and ‘proletarianisation’ were seen to be increasingly applicable to the work o f the professions. Foucauldian approaches on the other hand tend to emphasise the interpretative role o f the professions and the associated expert discourse, which generate particular standards o f normality justifying disciplinary power. However, this power is seen as diffuse and contingent, and the later works o f Foucault also discuss resistance to this power-discourse (Rabinow:1984)

More recently, the sociological literature has become much less concerned with the power o f collective groups such as professionals and more with those social processes said to be associated with ‘reflexive individualisation’. Savage’s (2000) work, for example, does not dismiss the continuing importance o f certain class-cultural ‘internalizations’ (his work incorporates Bourdieu’s notion o f the ‘class habitus’) but argues for a sociological focus on group goals and strategies. This approach is seen as capable o f accounting for the diminishing of the traditional autonomy of professionals, which is deemed no longer applicable in today’s world o f work with its new modes o f non-hierarchical organisation. The concern here is thus less with the ‘professions’ than with the contemporary position o f the ‘middle classes’. Savage employs the notion o f the ‘career’ as a way o f historically linking conceptions of individual development with ‘structured (job) mobility’ as well as with organisational processes. Until the 1960s, careers were associated with certain ascribed characteristics, as well as with movements ‘through the life course’. One outcome of this process was the concept o f ‘women only’ careers. However, the argument goes that with the trends o f the 1980s and 1990s towards greater organisational restructuring and with it the development o f core and peripheral workers, there has been a ‘de-coupling of the career from its anchorage in bureaucratic hierarchies’. This process is seen to have led to the diminution o f the ‘service class’ and an ‘individualizing’ o f the career (Savage:2000:139-140). On this point o f individualizing, Bourdieu’s notion o f class habitus is utilised in the argument that people’s implicit assumptions about what constitutes a ‘good’ career now play a key role in leading them onto particular career paths (2000:142). Savage’s argument could

be applied to the postwar history o f recruitment to both nursing and teaching in terms o f these being seen as ‘good careers’ for young women drawn from skilled working class and ‘lower’ middle class families. In other words, these were the best they could aspire to, at least until the expansion o f university education in the 1980s.

However, applying Savage’s assessment to the ‘careers’ o f health professionals such as nurses gives rise to a number o f potential problems. This relates to the way in which he pushes the notion o f the ‘individualized’ middle class career to the point where an occupation becomes a ‘project o f the self. Structural and organisational constraints on career development seemingly become less ‘foundational’ in his analysis o f the present day situation, where ‘game playing’ as a career strategy is said to be widespread, and the internalization o f ‘career values’ no longer holds true :

“ This shift represents a new way o f linking individuals and hierarchies. As individuals pursue their project o f the se lf they are able to draw upon those around them, including those 'above and 'below ' them, as resources to help them pursue their tactical moves’’^ (Savage:2000:144).

Implicit in Savage’s argument is the assumption that within less than a generation there has been a fundamental shift in attitudes regarding the place o f work and career in an individual’s sense o f self-identity and by extension in that o f social groups. If this analysis appears almost postmodernist in its universalising about the disintegration o f social barriers, and for that matter notions o f occupational groups and their identity, then it may be seen as a reflection o f the breaking down o f ‘traditional’ sociological models o f professionals and professional labour markets. These latter models certainly do appear to conform much less to the reality o f professionals’ work and career experiences, whilst professionalism as a strategy for maintaining labour market position and advancing occupational interests now has to contend with "... a range o f challenges and limitations, most notably growing competition, shifting market emphasis towards purely technical expertise, and outbreaks o f scepticism about the efficacy o f professional knowledge” (Martin: 1998:661). All these challenges certainly have resonance in relation to the contemporary position o f the medical profession, and they may explain the opportunities now available to nursing to improve its market position in the health care system.