Organized professionalism in healthcare: articulation work by neighbourhood nurses

Abstract

Organizational and professional logics are often viewed as intrinsically conflicting. Organizational influences either encroach on professional work or professionals resist change and evade organizational rules. Increasingly however, this dualistic view is supplemented with the perspective of organized professionalism, which focuses on the negotiated and reciprocal relationship between organizational and professional logics. In this perspective, professionals increasingly engage in new organizational issues and incorporate those into their professional work. We build on these insights, but take the debate on organized professionalism one step further. Using the sociological concept of articulation work, we show that organizational tasks are not always ‘new’, but can be inherent to professionalism. In a study of Dutch neighbourhood nurses (NNs), we find three types of articulation work: intraprofessional, interprofessional, and lay articulation work. NNs perform articulation work to provide and organize care at the same time. They integrate taylorized home care services, coordinate the work of different professionals, and stimulate informal care. We conclude that articulation work traditionally lies at the heart of professionalism, but is not static and acquires new meaning because of changing organizational conditions and policy reforms.