Degree Of Professional Autonomy Research Articles

Balancing professional autonomy and authority at the margins of a fragile state: Front-line health workers’ experiences in Burkina Faso

ABSTRACT The availability of diagnostic equipment, medical products and basic infrastructure is limited in most low-income societies. Poor motivation among health workers as well as recruitment and retention problems are key factors contributing to poor health care services in developing countries. The current paper describes how the front line cope with these difficult working conditions. Data for this study come from anthropological fieldwork in two districts of Burkina Faso and include a total of 27 unstructured and 40 semi-structured interviews with staff at dispensaries and medical centres in the two districts. Analytically, we make a distinction between their professional autonomy and their professional authority. We find that while the health workers experience a certain degree of professional autonomy, in the sense that they rely on their own clinical judgement and their discretion as decision makers and gatekeepers, their professional authority is constantly challenged when working at the margins of the state. Through improvisations and bricolaging, they compensate for the many shortcomings, but many of them feel that their skills are waning and that their professional identity threatened. Thus, massive strengthening of the front-line health worker’s capacity is imperative for future improvement of health care services in Burkina Faso.

Pilot study on university English teachers' professional autonomy in France

Purpose – This paper aims at understanding teachers' (the authors refer to “teachers” in higher education as lecturers or senior lecturers) professional autonomy in the context of the current university English teachers in France. Design/methodology/approach – The authors present here the preliminary results of the test-questionnaire the authors have made to gather main tendencies on the topic (the results were presented orally at the SAES national conference held in Paris from 20 to 22 May 2011, http://saes.univ-paris3.fr). This paper is organized in three different themes that correspond to the three main parts of the test-questionnaire. Findings – The authors first show that the current degree of professional autonomy is both satisfying and an essential factor of self-development. The data underline the fact that teachers' professional autonomy is indeed a very important aspect of teaching as a job within the organizational university context. Then, the authors distinguish individualism from autonomy; stressing the fact that team-work does not entail less professional autonomy, contrary to what people may often think. Finally, most colleagues who participated in this first study have expressed concern that organizational constraints, such as the size of the groups, the obligation to conform to an overly constraining curriculum, the obligation to reach some success quotas or employment quotas, etc. could reduce or even threaten their professional autonomy and self-development. Originality/value – Many books have been written on learners' autonomy and teachers' role on this aspect. Teachers' professional autonomy at university level on the other hand is a much less studied topic. Often taken for granted, this autonomy now appears to be questioned because of the implementation of new organizational systems.

Nursing in a changing landscape

In North America during the 1970s, a concept was introduced into healthcare organisations called ‘shared governance’ which was an evidencebased method for curbing the damaging effects of the shortage of nurses (for example, negative patient outcomes, high cost of agency staff and overtime). Shared governance is also known as ‘shared leadership’ which is a principle that provides nurses with opportunities to participate in the decisionmaking processes that affect their practice. Their ultimate goal is to deliver high-quality health care that is personand family-centred. It empowers nurses to reflect their professional values in order to promote positive behaviour and practice—for example, by promoting care that reflects the needs of the individual patient and their family. The concepts of shared governance and shared decision-making are not new. Philosophy, education, religion, politics, business and management, and now health care, have all benefited from a variety of shared governance process models implemented in many diverse and creative ways across generations and cultures. The traditional approach to a lot of national, regional and local programmes is to set up committees, structures or boards made up of key stakeholders responsible for overseeing a programme of work delivered by a series of subgroups. This can lead to a lack of ownership by those affected, or problems of alignment with local work. We also know that education, professional standards and judgement are not the only determinants of professional nursing practice. Nurses have not always been empowered to fully exercise their clinical judgment for patient and family care, which, according to evidence, is a factor in job satisfaction and ultimately quality of care. Employees must structure their practice within resources and rules set by their organisation or employers, often in the form of policies and procedures, which can have a profound effect on how they deliver health care. Using shared governance as an approach will enable nurses to influence and shape their contribution to quality according to their professional values. Nurses in North America in the late 1980s and early 1990s (Porter-O’Grady, 1987; McDonagh et al, 1989; Metcalf and Tate, 1995) identified shared governance as a key indicator of excellence in nursing practice and described shared governance as a management process model for providing a structure for organising nursing work within organisational settings. It allows strategies for empowering nurses to express and manage their practice with a greater degree of professional autonomy. This allows for personal and professional accountability to be respected and supported within the organisation. Leadership support for nurses delivering frontRory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division line care enables them to maintain quality nursing practice, job satisfaction and financial viability when partnership, equity, accountability and ownership are in place (Green and Jordan, 2002; Anthony, 2004). Using ward/unit/team practice for implementing shared governance at the point of care is about change. But how do we make change painless? With changing technology, increasing patient acuity, and patients and families who are more knowledgeable today about health and social care, change is our only constant. We must embrace new skills, take more professional risks and move further than ever before in advancing nursing for the 21st century and beyond. There is rarely time to become comfortable with new information before it is replaced with new ideas, processes and concepts with a promise of higher quality and lower cost. We must therefore work in partnership and develop strategies to help us as nurses to accept change and realise future possibilities. Change may not be an option, but how to engage in it is open to negotiation and does not have to be painful. For example: ■ Begin with the right attitude ■ Let your confidence show ■ Be autonomous in your practice ■ Be an expert leader ■ Be solution focused ■ Create and innovate ■ Let integrity rule ■ Communicate with everyone ■ Strike a balance between work and play ■ Become a teacher, preceptor, mentor and coach ■ Be flexible and adaptable. Nurses are learning and implementing new ways of providing family-centred care, new technologies and new ways of thinking and working. Organisations now need to learn that the nurse at the front line of the service is crucial to the success associated with changing the environment of care. We must be prepared for new roles, new relationships and new ways of managing and leading. Shared governance is about moving from a traditional hierarchical model to a relational partnership model of nursing practice. BJN

An Analysis of the Implications Between the Theoretical Framework and the Policy Context of Provincial Education Policy in Ontario

Induction is broadly defined in the literature as a formal process of transitioning novice educators into the professional role of teacher. In Ontario, Canada, the establishment of the Education Quality and Accountability Office and large-scale external assessments to measure student learning in grades three, six, and nine has underscored the significance of teacher quality. As a result, the Ontario Ministry of Education has put into policy that all public school boards to deliver the New Teacher Induction Program (NTIP) to new teachers. To a great extent, NTIP includes many of the components discussed in the literature that defines effective practices. Given that NTIP is a relatively new policy in Ontario, it seems timely to make some observations about the profound implications between the theoretical framework and the policy context of this initiative. This paper discusses the fundamental disconnect between two core concepts associated with NTIP policy that relates to the role of the school principal and to the language of Professional Learning Communities. By citing the language of the PLC, and be defining the principal’s role as evaluator, the NTIP policy may in fact be ignoring the research that discusses the conflicts and residual consequences that emerge when professional development initiatives that endorse teacher authority and collaboration clash with hierarchical and bureaucratic realities. The language of NTIP seems to suggest that new teachers have a significant degree of professional autonomy and individual self-determination. It endorses a value-orientation to new teachers’ professional development and growth. Yet, by imposing the evaluative component, the policy may be merely recreating the typical and traditional structure of power relations in the schools and thus taking away from its educative value for the new teacher participants. The evaluation component of NTIP maintains the traditional hierarchy of schools, reaffirms industrial-type connotations of power, control, and status, and ultimately creates a normative assumption of structure that is deemed to be rational.

Professional autonomy in the health care system.

Professional autonomy interferes at a structural level with the various aspects of the health care system. The health care systems that can be distinguished all feature a specific design of professional autonomy, but experience their own governance problems. Empirical health care systems in the West are a nationally coloured blend of ideal type health care systems. From a normative perspective, the optimal health care system should consist of elements of all the ideal types. A workable optimum taking national values into account could be attained by governance structures that also introduce elements from other ideal type systems. Thus a normative approach to medical practice guaranteeing an essential degree of professional autonomy for a relationship of trust between the patient and the physician, could be combined with an efficient and equitable allocation of health care resources.

Re-culturing educational leadership in norwegian schools: a trade-off between accountability and autonomy

Decentralisation has been a key word in educational reforms in Norway since the 1970s, but in moving from central control towards more local control, the question of who should have the responsibility is raised, and the struggle between political and professional power over education has been sharpened. New constructs of principals as managing directors are also growing in prominence and power, and there is a tendency to exert control over teachers' work and teachers' time. This article explores how principals and teachers cope with reform initiatives like the change of established zones of control illustrated by a new agreement on work-time for teachers. The change intends to assist the principal in organising professional staff collaboration in order to improve quality within schools. The discussion is based on qualitative data from two upper secondary schools in Norway. Although the patterns emerging from the two case studies should be viewed cautiously, the study highlights some problematic aspects of changed decision-making structures in schools. The work-time agreement breaks the established practice and work culture of the individual teacher who has for a long time enjoyed a large degree of professional autonomy. It seems the agreement is understood as an external attack upon teacher's autonomy. It seems as if there is a power struggle in society for who should define quality teaching. There are other social groups wishing to define educational quality, but, as yet, they have had little influence upon practice in schools. Teachers are faced with a trade-off between accountability and autonomy in schools. However, an autonomous profession does not necessarily mean better practice

Meanings of Merit

What does discussion of higher education issues tell us about fundamental societal questions? Merit appears to underpin the major issues in higher education at the moment. Yet an inspection of these issues suggests that this is really about larger tensions that we may wish to avoid, such as the role of experts in a democracy, specifically their degree of professional autonomy in setting content and performance standards. A new unifying purpose for higher education—articulate judgement—may allow us to address these societal issues more clearly and the role of higher education more publicly and directly. Fundamentally, we must decide what role we want for the academic professions and how we place articulate judgement in their endeavor. Do we have the moral confidence in our enterprise to assert a capacity and a responsibility for independent, informed, deliberative, and humane judgment and for the capacity to elicit the same in our students?

A Review Article: HMI, OFSTED and the Youngest Children in School: Will the New Watchdogs Bark as Well as the Old Ones?

The under fives and OFSTED — a cause for concern These two recent publications should alert early years practititioners to a development in the monitoring of educational standards which is cause for grave concern. The new regulatory body, OFSTED, has been established on different lines from those of the old inspection service, and has a somewhat different mandate. We have, in England, been accustomed to an Inspectorate which, in spite of all external pressures to conform, led from a well-informed professional standpoint. Up to the mid-1980s there was broad agreement on educational provision for children between three and five which informed decisions throughout the Local Educational Authorities and which made it possible for a devolved administration such as ours to have coherence and integrity. This broad agreement was one that HMI had helped to form. From the Women Inspectors of the turn of the century to The Education of Children Under Five in 1989 we have had cause to be grateful to the Inspectorate for proclaiming that the under fives has particular needs which must be met in particular ways — that they are not just less efficient infants but nursery-aged children who require nursery education. Now that the common-law of educational practice has been replaced by the fiat of central government we have greater need than ever of those understandings about the education of young children. Yet the new inspection arrangements under OFSTED have replaced the old Inspectorate. Will OFSTED inspectors do the job as well as their predecessors? Much hangs on their capacity to understand the needs of the under-fives and to give voice to their insights. There is cause for grave concern about the current trend of thinking on the education and care of children under the age of compulsory schooling. There is also cause for concern about the overall picture of OFSTED's thinking that we get from the two reports. It is unclear and somewhat hard to reconcile — does this mirror a struggle between opposing views, or a failure to'think through a coherent policy? Does it represent the transition between the old and the new watchdogs? These two reports convey that there is, at best, a lack of clarity about what are the needs of very young children. Sadly, this is not all; it is clear that at some level — perhaps not that of individual HMI, who may be having a struggle to retain even a small degree of professional autonomy — OFSTED has accepted, or been instructed to . accept, that children in reception classes will have very different standards of provision from those of the same age who are in nursery schools, centres and classes. Access and Achievement in Urban Education makes it plain that nursery education offers children a much better chance of educational achievement than any of the available alternatives, however 'rich' Messrs Patten, Squire and Blatch may wish us to believe our present diversity to be. However, the report on standards in reception classes (First Class: the Standards and Quality of Education in Reception Classes) appears to restrict its focus to education before five as a preparation for the National Curriculum.

Lateralness in women's work: New views on success

Data from a longitudinal study of postbaccalaureate nursing careers are discussed in the context of the motive-to-avoid-success controversy. Two groups of nurses with continuous work histories were intensively studied. While most had experienced upward professional mobility, a significant minority had “lateral” careers, which, though not characterized by advancement, typically provide rewards of intensification. Further, lateral careers only occurred in specialties allowing a high degree of professional autonomy. Thus, upward mobility and advancement should not be the sole criteria of women's occupational progress. Alternative conceptions of success may be significant in many occupations, although such beliefs may not serve as viable substitutes for professional autonomy and the opportunity for personal development. Lateral movement may also characterize most men's work lives more aptly than descent or ascent; hence the findings underscore the necessity to rethink the image of movement in both male and female work spheres.

Professional Autonomy and Bureaucratic Organization

Autonomy is regarded as an important dimension of professionalism. A number of investigators claim that bureaucratic organization limits professional autonomy. This study was undertaken to determine empirically the validity of this claim. The relationship between bureaucratic structure and degree of professional autonomy within the client-professional relationship was examined by systematically comparing the perceived autonomy of professionals in three types of bureaucratic settings, nonbureaucratic, moderately bureaucratic, and highly bureaucratic. The data revealed that those professionals associated with the moderately bureaucratic setting are most likely and those in the highly bureaucratic setting are least likely to perceive themselves as autonomous. These findings do not support the contention that bureaucracy is necessarily detrimental to professional autonomy.

The Effect of Bureaucracy on the Professional Autonomy of the Physician

Bureaucracy is frequently viewed as being detrimental to certain aspects of professionalism. This paper examines the relationship between bureaucratic structure and degree of professional autonomy within the client-professional relationship. Perceived autonomy of physicians in three types of bureaucratic settings-non-bureaucratic, moderately bureaucratic, and highly bureaucratic-are compared. The data reveal that those associated with the moderately bureaucratic setting are most likely, and those in the highly bureaucratic setting are least likely, to perceive themselves as autonomous. These findings suggest that there is an optimal level of bureaucratic organization with respect to professional autonomy within the clientprofessional relationship.