Doctor of Philosophy
Department of Sociology
Herdman, Elizabeth, The deskilling of registered nurses: the social transformation of nursing work in a New South Wales hospital, 1970-1990, Doctor of Philosophy thesis, Department of Sociology, University of Wollongong, 1992. http://ro.uow.edu.au/theses/1729
This study tests the validity of the enskilling thesis as it applies to registered nurses in a major New South Wales public hospital from 1970 to 1990. From a critical sociological perspective it examines the social transformation of nursing work during this period.
A major problem in nursing literature, past and present, is the fact that the experiences of the practising nurse have been obscured by the dominance of the idealised image of nursing which focusses on the 'ideal' rather than the experiences of the practising nurse.
As a case study of nursing work this thesis builds upon feminist analyses of sex-based occupational segregation and Braverman's 1974 analysis of the transformation of the labour process under monopoly capital to examine how patriarchy and deskilling operate within the workplace. By examining the transformation of nursing work within the context of professionalisation and rationalisation the study reveals how both internal and external forces influence the nature of change within an occupation.
Using the methods of ethnography, which include participant observation, in-depth interviews and analysis of nursing discourses this study enables registered nurses to describe their reality of nursing work.
By examining the nature of nursing work from the perspectives of nurses' experiences in an organizational setting within the wider social context the study provides an alternative to the enskilling thesis. Instead it provides evidence that registered nurses have been deskilled in the following ways: Registered nurses now carry out the work previously carried out by student nurses. Registered nurses are increasingly engaged in work that is also carried out by workers without formal qualifications. Work previously carried out by registered nurses has been taken over by other health workers such as occupational therapists, physiotherapists, dieticians and specialist nurses. There is a separation between conception and execution in nursing work that prevents registered nurses from attaining autonomy or control over their work.
Moreover, this study reveals the fact that the rhetoric of the dominant groups in nursing does not reflect the reality of nursing experience as it affects the majority of practising nurses. The idealised image of nursing reflected by the dominant nursing discourse obscures the conflict and power struggles that are constantly at play within nursing.