Abstract
The nursing professionalization is still a work in progress, especially because forms of medical dominance and conflicts with other health professions often undermine its professional autonomy. This article contributes to the understanding of the relationship between professionalization and autonomy building in the health professions by presenting the case of Italian nursing, where medical dominance, supported by the legal system, is the main factor preventing nursing from achieving professional autonomy. The work aims particularly to understand how professionalization and professional autonomy can follow two parallel and sometimes opposite paths toward building the nursing profession, and the role of academic knowledge and specialized roles to legitimize and strengthen professional autonomy. The analysis draws on the literature addressing professionalization, professional autonomy, and medical dominance, as well as various sources on Italian nursing. They include national legislation, research literature, and national sociological surveys on Italian nurses.
Highlights
The nursing professionalization is still a work in progress, especially because forms of medical dominance and conflicts with other health professions often undermine its professional autonomy
One of the more debated aspects concerns the field’s professionalization, which has been more problematic than in other professions, especially because nursing has historically been subjected to forms of medical dominance and conflicts with other health professions (e.g., Allen, 2007; Ayala, Binfa, Vanderstraeten, & Bracke, 2015; Bourgeault & Grignon, 2013; Etzioni, 1969; Styles, 2005; Varjus, Leino-Kilpi, & Suominen, 2011; Wall, 2010)
In the last twenty years, the Italian nursing profession has been “built” in a changing institutional, educational and health system, and it struggles with several constraints of a different nature
Summary
Many writings have debated the definitions and characteristics of professions and taken various positions on the process of “professionalization.” Generally, the process that leads an occupation to become a “profession” comprises different social, political and institutional phases, which are sometimes co-present with no precise sequence, ranging from the appearance of a certain type of work considered to be full-time employment with a body of specialized knowledge and techniques, to the establishment and development of specialized training schools, creation of professional associations, recognition by the state as professional activity and, in many cases, development of a formal ethical code (Etzioni, 1969; Evetts, 2002, 2011; Frankford, 1997; Freidson, 2001; Muzio & Kirkpatrick, 2011; Styles, 2005; Wilensky, 1964). Medical dominance has undergone a process of decline since the early 1990s due to some changes in health systems, including health system reforms, consumerism, the professionalization of non-medical health occupations, as well as the hyper-specialization and division of the medical profession into different roles, which have weakened and fragmented its power to control health and pharmaceutical services (Andri & Kyriakidou, 2014; Bury & Taylor, 2008; Coburn, 1999, 2006; Gordon, 2005; Parse, 1998; Tousijn, 2002, 2006; Tousijn & Giorgino, 2009) Despite these changes, in the Italian context, the medical profession still plays a dominant role in all jurisdictions in the system of health professions, having a particular influence through the four types of dominance described by Tousijn. Evident is the influence of doctors on the state since they are well represented in Parliament and control the legislative process of many health reforms (Toth, 2015)
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