The mobilisation of professional identity: A scoping and lexical review

Interprofessional care obliges different healthcare professions to share decision-making and sometimes, practices. Given established hierarchies, it can be difficult to promote interprofessional care, partly because of the need to reshape professional identities. Despite interest in effective interprofessional care, there is limited research on how professional identity can be mobilised to promote it. A scoping review as well as lexical review of academic publications was conducted to address this void. After searching seven academic databases and screening the identified publications, 22 publications met the inclusion criteria. They collectively reported on 22 interventions, most of which were used in healthcare. The scoping review suggested there is some evidence that professional identities can be mobilised. Yet, of the 22 interventions, only ten explicitly targeted professional identity. The most common intervention was a training or development program, followed by workplace redesign. The need for internal motivation to mobilise professional identity was reported as was the impact of external drivers, like extending the scope of practice. Extending these findings, the lexical review demonstrated that, among the 22 publications, the relationship between professional identity and mobilisation did not feature prominently within the discourse. Furthermore, it seems that geography matters-that is, while all the publications spoke of professional identity, they differed by region on how they did this. Given these findings, concentrated scholarship is needed on the relationship between professional identity and interprofessional care, lest interprofessional care programs have limited, sustained effect. Implications for scholars and practitioners are explicated.

I became a leader by coincidence: specialised nurses as leaders in the field of mental health and substance abuse

PURPOSE

This study aims to examine nurses' motivation for leadership and explore important challenges nurses face in leadership positions.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

FINDINGS

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

RESEARCH LIMITATIONS/IMPLICATIONS

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

PRACTICAL IMPLICATIONS

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

ORIGINALITY/VALUE

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

Professional identity research in the health professions-a scoping review

Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.

Assembling care: How nurses organise care in uncharted territory and in times of pandemic

This article draws on ethnographic research to conceptualise how nurses mobilise assemblages of caring to organise and deliver COVID care; particularly so by reorganising organisational infrastructures and practices of safe and good care. Based on participatory observations, interviews and nurse diaries, all collected during the early phase of the pandemic, the research shows how the organising work of nurses unfolds at different health-care layers: in the daily care for patients and their families, in the coordination of care in and between hospitals, and at the level of the health-care system. These findings contrast with the dominant pandemic-image of nurses as 'heroes at the bedside', which fosters the classic and microlevel view of nursing and leaves the broader contribution of nurses to the pandemic unaddressed. Theoretically, the study adds to the literature on translational mobilisation and assemblage theory by focussing on the layered and often invisible organising work of nurses in health care.

Between Multiple Identities and Values: Professionals' Identity Conflicts in Ethically Charged Situations

This study explored identity conflict dynamics in interpersonal interactions in professionals facing ethically charged situations. Through semi-structured interviews (N = 47), we conducted a qualitative study among doctors and nurses working for the English National Healthcare Service and analyzed the data with grounded theory approaches. Our findings reveal that identity conflict is triggered by three micro processes, namely cognitive and emotional perspective taking, as well as identifying with the other. In these processes, identity conflict is signaled by emotions and recognized as a clash not only between identities and their values, but also within one identity and its multiple values. Behavioral and psychological outcomes of identity conflict involve seeking peer support, doing reflective practices and identity growth. This article contributes to identity literature by providing a multilevel approach of identity conflict dynamics able to account for both interpersonal and intrapsychic processes, deeply hold values and emotions, as well as crucial behavioral and psychological consequences.

How to be a hero: How managers determine what makes a good manager through narrative identity work

The turn to identity within management studies has revealed important insights into management, by recognising its complex, contingent and relational nature, and through focusing on the personal experiences of managers and how they develop an identity as a manager. However, research has focused on processes of being and becoming a manager, rather than how individuals determine what makes a good manager, and what they are actually seeking to be. I therefore present an extended theorisation of narrative identity work which highlights the overlooked role of the ‘personal social landscape’ constructed through narrative, which gives meaning to the actors and actions within it. The theory is illustrated through detailed analysis of three manager accounts, which reveals processes by which managers construct personal versions of the same organisation, as social landscape to their self-narratives, and how these different organisational constructions create different meanings to their self-narratives as acting well as a manager.

After the Pain: Reflexive Practice, Emotion Work and Learning

We consider how reflexive practices can enable learning from negative emotional experiences. We study these experiences in academic organizations through a relationally reflexive autoethnographic method. Our findings contribute to theory in three ways. First, we show how learning involves practices with different modalities of emotion work and reflexive orientations that internalize or externalize the effects of this work. Second, the subsequent characterization of emotionally responsive reflexive practices shows how isolation and a sense of inadequacy can be avoided and, third, leads to a process model that shows how learning is potentiated in a supportive social context that accommodates emotional vulnerability.

Caring Leader Identity Between Power and Powerlessness

This paper investigates what happens when managers’ identity is centred on caring, an underappreciated aspect of leadership. Drawing on a case study of managers in elderly care, we distil an ideal-typical caring leader identity as well as contextualised interpretations that suggest both problematic and constructive aspects. The caring leader identity implies a self-understanding as being highly present, supportive and helpful to subordinates’ development. We find that the belief of making a decisive difference to others’ development by caring for them can be a deceptive fantasy that incites over-dependence among subordinates, particularly for ambitious managers who experience pressing situations and little power. Under better but likely less common conditions, managers can develop more modest expressions of a caring leader identity, leaving space for subordinates themselves to define problems and explore solutions.

The leadership and followership challenges of doctors in training during the COVID-19 pandemic

Research carried out in 2016 by the authors investigated the challenges that doctors in training experience around leadership and followership in the NHS. The study explored contemporary healthcare leadership culture and the role of followership from the perspective of early career doctors. It found that the leadership and followership challenges for these doctors in training were associated with issues of social and professional identity, communication, the medical hierarchy, and relationships with senior colleagues (support and trust). These challenges were exacerbated by the busy and turbulent clinical environment in which they worked. To cope with various clinical situations and forms of leadership, doctors in training engage in a range of different followership behaviours and strategies. The study raised implications for medical education and training and suggested that followership should be included as part of formal training in communication and team working skills. The importance of both leadership and followership in the delivery of safe and effective patient care has been brought sharply into focus by the COVID-19 pandemic. This article revisits these challenges in light of the pandemic and its impact on the experiences of doctors in training.

Professional Values and Managerialist Practices: Values work by nurses in the emergency department

Interest in values work – the purposeful effort of actors to create, maintain and disrupt the values of organizations, professions and other institutions – is growing among scholars. We ask: How do frontline professionals engage in values work while enacting managerialist practices inside organizations? We investigate this question using a case study of nurses enacting managerialist practices associated with time-efficient work flow in a hospital emergency department in Australia. Our findings show that professionals engage in values work by categorizing the values of the profession and taking actions within the managerialist practice to (1) defend a superordinate value category, (2) contain erosion of a subordinate value category, and (3) integrate a basic value category. Our study brings attention to how multiple values complicate the processes of values work when particular values become implicated in organizational practices. Frontline professionals become motivated and take actions to accomplish values within a relational system of multiple values according to relative importance and relevance to the local context. Our study offers a way forward for understanding the performance of values work within the ‘new normal’ for professions in contemporary organizational contexts.

Navigating an Identity Playground: Using sociomateriality to build a theory of identity play

The construct of identity play, which involves the exploration and experimentation with possible future selves, is underexplored in organizational literature. To extend theory on identity play, we take a narrative inquiry approach and examine qualitative interview data in the context of virtual environments. Using a sociomateriality perspective, we contribute to theory on identity play in three ways. First, we reveal how identity play unfolds via the sociomaterial intertwining of not just human agency, but also material agency, situated work practices, and self-representations. Second, we offer a new definition of identity play that goes beyond the exploration of possible selves and uncover identity play narratives on the possible self, the improbable self, and the impossible self. We demonstrate how identity play, particularly with impossible selves, shapes others’ experiences and thus has implications beyond the self. Finally, three identity play affordances emerged: plasticity of appearance, plasticity of behavior, and plasticity of perspective.

Stuck in defensive professionalism: Undermining organizational change in an intellectual property law firm

This article examines how professionals employed in professional organizations make sense of the disruption of their work. Based on a qualitative study of an Australian intellectual property (IP) law firm, we shed light on the ways in which the discursive practices of professionals may undermine change in professional organizations. We identify three defensive strategies of IP professionals (denial, regression, and projection) resulting from the inability to resolve conflicts between market-based pressures and their entrenched understandings of professional work. In doing so, we show how professionals can become ‘stuck’ in defensive responses that may further marginalize the role of professional organizations in society. These findings call into question overly deterministic, radical accounts of organizational change that do not take into account the contextual embeddedness of professional organizations.

Good intentions gone awry: investigating a strategically oriented MLD program

Purpose

Complex organizations increasingly rely on middle managers as strategic linking-pins between the top and bottom levels of the organization. Using social identity theory and commitment theory as the foundation, this study evaluates a management and leadership development program (MLDP) intended to engage middle managers as strategy creators and implementers. We also evaluate the cascading effects of leadership development by assessing changes in subordinates' identification with the leader, and commitment to the work unit and organization.

Design/methodology/approach

Using a sample of 107 manager participants and 913 of their subordinates, this study measures differences in both manager and subordinate identification and commitment prior to and after the completion of a 6 months strategically oriented MLDP.

Findings

Despite the organizations' best intentions, manager identification with and commitment to the organization decreased after completion of the MLDP. Similarly, subordinates identification with the leader and commitment to the organization also decreased at Time 2.

Research limitations/implications

The results paint a complex picture of the nuances of social identification as an outcome of MLDPs, and problematize the notion of cascading effects on subordinates within the organization. Researchers are encouraged to further examine organizational attitudes and perceptions as outcomes of MLDPs.

Practical implications

Suggestions are offered regarding how practitioners can manage strategically oriented MLDPs in order to avoid identity confusion and promote strategic action.

Originality/value

Strategically oriented MLDPs are increasingly popular in organizations. This study is one of the first to evaluate the theoretical mechanisms through which these programs may affect managers and problematize these effects for complex organizations.

Constrained leader autonomy: You are the stoker in hell—No matter what you do, you are wrong!

This study explores how formal leaders at various levels experience and respond to exercising their own autonomy in relationships with superiors and staff in a knowledge-dominated healthcare organization. Proposing the notion of constrained autonomy, the study suggests a way of understanding how formal leaders in mid-level positions work within autonomy–authority tensions. Based on interviews with formal leaders, I argue that formal leaders are highly aware of and deal with the autonomy tensions that occur in contradictions between structural requirements, ability to lead, and decision-making power in such complex ways that tensions are upheld and left more ambiguous than they first appeared. Thereby, the study develops literature on autonomy tensions and leadership. It also contrasts research suggesting that formal leaders sometimes deny tensions, are unaware of them, or seek to control or eliminate them and questions the sharp division between autonomy and authority often found in literature. The notion of constrained autonomy may also assist formal leaders navigate daily workplace tensions in knowledge-dominated healthcare contexts.

A discourse analysis of managerialism and trust amongst nursing professionals

This study explores the effects of New Public Management (NPM) on trust amongst nursing professionals, nurses and nurse ward managers within the British National Health Service (NHS). Thirty-nine nurses and nurse ward managers, recruited randomly, participated in semi-structured interviews. The original data, collected in 2000-2002, are re-analysed from a discourse analysis perspective. The findings support and extend contemporary research. They show that nurses have a strong professional identity and commitment and that increasing managerialism is eroding trust. Nurses both accommodate and resist managerialist discourses. They conceptualise trust in terms of their own ward environment, line-manager and colleagues. Trust is reciprocal and related to previous experiences and other factors. Trust is beneficial to healthcare organisations, healthcare professionals and their patients. Good communication and openness positively influence the development of trust. Nurse ward managers play a pivotal role in translating contested managerialist discourse into nursing practice to sustain trust and effect professional patient care.

Beyond ‘blue-collar professionalism’: Continuity and change in the professionalization of uniformed emergency services work

The sociology of professions has so far had limited connections to emergency services occupations. Research on emergency occupations tends to focus on workplace culture and identity, often emphasizing continuity rather than change. Police officers, firefighters, and paramedics have their historical roots in manual, technical, or ‘semi-professional’ occupations and their working lives still bear many of the hallmarks of blue-collar, uniformed ‘street-level’ work. But uniformed emergency services—like many other occupations—are increasingly undergoing processes of ‘professionalization’. The organizations in which they are employed and the fields in which they work have undergone significant change and disruption, calling into question the core features, cultures, and duties of these occupations. This article argues that sociology of work on emergency services could be helpfully brought into closer contact with the sociology of professions in order to better understand these changes. It suggests four broad empirical and conceptual domains where meaningful connections can be made between these literatures, namely, leadership and authority; organizational goals and objectives; professional identities; and ‘extreme’ work. Emergency services are evolving in complex directions while retaining certain long-standing and entrenched features. Studying emergency occupations as professions also sheds new light on the changing nature of ‘professionalism’ itself.

Organizational Identity Struggles and Reconstruction During Organizational Change: Narratives as symbolic, emotional and practical glue

The article offers a novel perspective on the formation of organizational identity (OI) during major organizational change. The empirical context of our studies is the establishment of a new acute care department and the reorganization of care, where nurses and managers struggle to construct and reclaim a legitimate identity within the hospital and simultaneously strive to gain a leading position among acute care departments in the country. We use Bourdieu’s theoretical ideas combined with a focus on narratives as an original and fertile perspective for studying OI. We propose that OI is inherently temporal, embodied and socially configured and cannot be separated from the institutionalized context of its setting because it is interlaced with (in this case) health professional logics. We show how OI is constructed through the strategizing moves of managers and nurses. This includes their narrative constructions of their quest for care progression and a legitimate OI that function as symbolic, emotional and practical glue.

Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis

OBJECTIVE

Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions.

METHODS

The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles.

RESULTS

A total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles.

CONCLUSION

The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socio-economic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.

Leader identity development in healthcare: an existential-phenomenological study

PURPOSE

The purpose of this study is to take an existential-phenomenological perspective to understand and describe the experienced leader identity development of healthcare leaders working in dual roles. Leader identity development under the influence of strong professional identities of nurses and doctors has remained an under-researched phenomenon to which the study contributes.

DESIGN/METHODOLOGY/APPROACH

Existential-phenomenology serves as a perspective underpinning the whole research, and an existential-phenomenological method is applied in the interview data analysis.

FINDINGS

The study showed leader identity development in healthcare to be most strongly influenced and affected by clinical work and its meanings and followers' needs and leader-follower relationships. In addition, four other key categories were presented as meaningful in leader identity development; leader identity development is an ongoing process occurring in relations of the key categories.

ORIGINALITY/VALUE

The existential-phenomenological approach and analysis method offer a novel way to understand leader identity development and work identities as experienced.

Identities in Organization Studies

Identities scholarship, in particular that focused on self-identities, has burgeoned in recent years. With dozens of papers on identities in organizations published in this journal by a substantial community, doubtless with more to come, now is an appropriate juncture to reflect on extant scholarship and its future prospects. I highlight three key strands of self-identities research in Organization Studies with particular reference to six articles collected in the associated Perspectives issue of this journal. In reviewing the contribution that work published in Organization Studies has made to debates on the nature of identities, how identities are implicated in organizational processes and outcomes, and the micro-politics of identities formation, I seek also to contribute to ongoing deliberations and to raise issues and questions for further research. I conclude with a call for increased efforts to integrate self-identities issues into the research agendas of sub-fields within organization theory.

Interpretation of Multiple Institutional Logics on the Ground: Actors’ Position, their Agency and Situational Constraints in Professionalized Contexts

Our study examines how interdependent actors in a professionalized context interpret the co-occurrence of a professional logic and a policy-driven logic. The empirical setting comprises two hospitals in the English National Health Service. Two issues stand out. First, our study shows that any logic is variegated and ambiguous, so policymakers and organizational managers cannot assume that they are easily blended. Second, it shows how nurse consultants exhibit agency in blending these two logics in pursuit of positional gain in professional and managerial organization. They can do so because of their ambiguous status level: in comparison to doctors, their status as nurses is low; within the nursing profession their status is high. Theoretically, by focusing upon interpretation of multiple institutional logics at the micro level, our study renders visible the agency of interpreting actors, interdependency of actors, their interpretation of institutional logics, situational context, and the effect of, and upon, social position of actors.

"Doctors on the move": Exploring professionalism in the light of cultural transitions

As the world becomes "flattened" and travel is easier, doctors and other health professionals move and live around the world in large numbers: some for short periods (such as student electives) others on a longer-term or permanent basis. Similarly, as wider migration patterns play out, all doctors need to learn to work in multi-cultural environments, whether they move countries or work in their "home country". We consider cross-cultural aspects of "professionalism" in terms of medical students' and graduates' assimilation into different cultures and some of the aspects of professional practice that may be problematic where cultural expectations and practices may differ. Specifically we explore professional socialization, identity formation, acculturation and cultural competency as related concepts that help our understanding of challenges for individuals and strategies for curriculum development or support mechanisms.