Shifting occupational boundaries in British healthcare: Threatening or furthering the professional project

Over the last decade, the British government’s attempt to modernise healthcare provision by developing cost efficient and effective services has led to fundamental challenges to established occupational jurisdictions. This has been reflected in the emergence of new occupational roles working in support of professionals. Amongst semi professionals such as nurses these assistant roles might be seen as having contradictory consequences, potentially threatening and helping further the professional project. For semi professionals claims to exclusivity have often been founded upon holistic service provision. As assistants take over from nurses as the principal providers of direct care under the guise of relieving nurses, such claims to holistic care become less credible. Yet the delegation of ‘dangerously routine’ tasks allowing nurses to undertake specialist and technical activities has often been seen as the route to occupational closure and assured professional status. This paper focuses upon occupational jurisdictions between nurses and healthcare assistants in two case study hospitals. Drawing upon data from over 100 interviews with nurses and healthcare assistants and around 150 hours of on ward observation, it explores whether and how job boundaries have shifted and whether this is perceived to have strengthened or weakened nurse professionalisation. The paper contributes to debates by: exploring the dynamic of professionalisation in the context of shifting job boundaries; generating data on the nature of a relatively new occupational role, that of the ‘assistant’; and looking at how public policy shifts can stimulate changes in the division of labour.