At odds: How intraprofessional conflict and stratification has stalled the Ontario paramedic professionalization project

Historically, self-regulation has provided some professions with power and market control. Currently, however, governments have scrutinized this approach, and priorities have shifted toward other mandates. This study examines the case of paramedics in Ontario, Canada, where self-regulation is still the dominant regulatory model for the healthcare professions but not for paramedics. Instead, paramedics in Ontario are co-regulated by government and physician-directed groups, with paramedics subordinate to both. This paper, which draws on interviews with paramedic industry leaders analyzed through the lens of institutional work, examines perspectives on the relevance of self-regulation to the paramedic professionalization project. Participants had varying views on the importance of self-regulation in obtaining professional status, with some rejecting its role in professionalization and others embracing regulatory reform. Because paramedics disagree on what being a profession means, the collective professionalization project has stalled. This research has implications for understanding the impact of intraprofessional relationships and conflict on professionalization projects.

Identity, positionality and reflexivity: relevance and application to research paramedics

This article introduces the reader to the concepts of identity, positionality and reflexivity and outlines their relevance to research paramedics. We outline how a researcher's identity and positionality can influence all aspects of research, including the research question, study design, data collection and data analysis. We discuss that the 'insider' position of paramedics conducting research with other paramedics or within their specific clinical setting has considerable benefits to participant access, understanding of data and dissemination, while highlighting the difficulties of role duality and power dynamics. While positionality is concerned with the researcher clearly stating their assumptions relating to the research topic, the research design, context and process, as well as the research participants; reflexivity involves the researcher questioning their assumptions and finding strategies to address these. The researcher must reflect upon the way the research is carried out and explain to the reader how they moved through the research processes to reach certain conclusions, with the aim of producing a trustworthy and honest account of the research. Throughout this article, we provide examples of how these concepts have been considered and applied by a research paramedic while conducting their PhD research studies within a pre-hospital setting, to illustrate how they can be applied practically.

Impacts of Professionalization and Wellbeing Policies on Scottish Prison Workers

Prison workers occupy a niche role. Balancing the care and welfare of prisoners while simultaneously restricting their freedoms is a stressful job, laced with danger, that occurs entirely within the bounded context of the prison. Here, wellbeing and professionalism are closely linked and articulated through a range of policies. This article explores the perceptions and experiences of staff in relation to a range of wellbeing and training policies in the Scottish Prison Service (SPS). We interviewed 10 SPS employees, some working directly with prisoners and others in more centralised policy development and support roles. Thematic analysis found a high degree of contentment with such policies but highlighted tensions between their implementation and specific challenges of the prison context. Emerging themes included: supporting wellbeing within the complex dynamic of the prison world; addressing inherent tensions borne out of the underlying threat of violence; and the impact of professionalization. We conclude that while the prison service aspires to offer employees wellbeing and professionalization opportunities similar to those in other sectors, there is a need for such policies to more clearly reflect the unique context of prison work. This might involve co-design of policies and more careful consideration of the pressures, tensions and idiosyncrasies of that rarefied environment.

The police and ‘the balance’—managing the workload within Swedish investigation units

Professionals within street-level organizations are essential for the delivery of public services to citizens. However, among a number of difficult dilemmas, they have to deal with an extensive workload. The police can be seen as a good example of this; they are expected to solve most crimes, including the so-called mass crimes and the more spectacular cases that make it into media headlines, and often on a continually decreasing budget. A key regulating mechanism for investigation departments in the Swedish police is the so-called balance. The balance can be described as a basket in which they put the cases that there is a desire and potential to work on but not in the immediate term. The purpose of this article is to analyse the balance as a way of rationing the workload within the Swedish police. Working with the balance consists of two processes: limiting and buffering the workload. Limiting is the practice of reducing the work in a situation. Buffering is the process of putting some work on hold to deal with later, of which the article identifies five kinds; functional, problematic, quasi, progressive, and symbolic buffering. The exploration of ‘the balance’ contributes to our understanding of how street level organizations attempt to defend their professional jurisdictions, their well-being, and their ability to complete their duties.

Red tape and psychological capital: a counterbalancing act for professionals in street-level bureaucracies

Assuming that red tape is inevitable in institutions, and drawing on positive organizational behavior, we compare the impact of individual psychological capital on the ability of street-level bureaucrats (SLBs) with different professional backgrounds to work within the confines of red tape. The two SLB professions investigated here are nurses and local government employees; and the work outcomes of interest to this study are well-being and engagement. The findings show that red tape has a different impact on each professional group but, encouragingly, they also indicate that psychological capital has a compensatory effect. Implications include nurses requiring more psychological resources than local government employees to counteract the negative impact of red tape. A practical implication for managers is that, if perception of red tape in organizations is set to increase or to stay constant, enhancing the psychological capital of professionals in SLB roles, through specific interventions, may be beneficial to professionals and organizations alike.

‘Not one action but many’: institutional work by commissioners of children's mental health services in the English NHS

This article enhances our understanding of institutional work, through a study of professional health commissioners in the English National Health Service. Using a case study of mental health policy implementation, commissioners are conceptualized as institutional agents involved in shaping the organizational field and its boundary. Health service commissioners face a series of challenges as institutional agents. Commissioning is a relatively new health profession. It lacks a strong professional association and has predominantly been externally professionalized. Commissioners have limited direct organizational strategic management control. In the case study, commissioners were charged with leading implementation of the policy, which required them to address fragmentation in the field. Using existing typologies as an analytical frame, activities by commissioners in the case study are identified and explored as different modes of institutional work. Commissioners created a new normative network and instigated specific processes to embed and routinize cross-organization working. They undertook boundary-spanning cognitive institutional work, creating new knowledge by commissioning education of school staff in the basics of children’s mental health. Their institutional work involved challenging existing working practices, both in the health field and in the contiguous education field. The article elucidates connections between different modes of institutional work and attends to boundary work by commissioners in parallel with institutional work in the field. It also outlines how a profession seemingly lacking many of the ingredients of institutional power might pursue its own professional project through institutional work. Findings have resonance in other geographical and policy areas and fields.