The Limits of Professional Autonomy: An Interview-based Comparative Analysis of the Workplaces and Perceptions of Educators and Healthcare Professionals

Abstract

Workplaces are the locations of significant social outcomes that are worth studying in their own right. In addition to pursuing and achieving their own intended outcomes (i.e. a well-educated and healthy public, in the case of the American public education and American healthcare systems), they are resources on which individuals rely for social, psychological, spiritual, and economic fulfillment and identity. Central to a person’s overall efficacy within the workplace is the extent to which they exercise influence over their time and behaviors. In contrast to sociological works on bureaucracies, research on professional autonomy tends to be symbolic-interactionist and qualitative in its theoretical approach and methods (the latter tending toward ethnographic and interview-based studies). There is significantly more sociological literature on bureaucracies than on professional autonomy. The few works on professional autonomy have done little to change thinking on bureaucracies – perhaps because they have limited their focus to the needs and opinions of workers and not the needs and opinions of the bureaucracy (as expressed by the bureaucracy executives). The following 3-part, interview-based dissertation examines the perceptions and opinions about professional autonomy of two sets of professionals: 1) public high school teachers and principals in Louisiana, and 2) doctors and healthcare executives in one New England (U.S.A.) state. Professional autonomy is revealed to be a highly subjective idea – that is to say that the way an interviewee defines and thinks about professional autonomy depends on the things that matter most to them in the workplace. A nurse, for example, defined professional autonomy as the right to be treated as a doctor’s equal because she was very frustrated by people treating her as less than a doctor. Interviewees attempt to balance these desires with the needs and mandates of their organization (and the superiors who enforce those mandates), and are often frustrated by their inability to accomplish both. Nearly every interviewee expressed strong emotions toward the experiences and feelings they associate with professional autonomy, and revealed their workplaces to be locations of emotionally intense conflicts about, and struggles over, influence in the workplace.