Investigating nurses' professional identity construction in two health settings in New Zealand

Abstract

The increasing nursing shortage experienced in healthcare institutions alongsidethe communicative issuesrelated to multiculturalnursing teams have placed nurses at the centre of the stage in a growing body of healthcare-related research. In this context, the values, beliefs and conceptualizations which characterize a nurse‘s professional identity play a significant role in organizational life since they guide nurses‘ decisions on the kind of clinical practices they adopt and influence their work performance. However, there islittle empirical evidence on how nurses discursivelyconstruct their professional identity.To date most sociolinguistic research on professional identity in healthcare environments has focused on the power asymmetries characterising doctor-patient, doctor-nurse and nurse-patient discourse, largely disregarding nurse-nurse interaction. Thus, moving away from the traditional approach taken to this area of enquiry, this thesis considershow nurses from an array of ethnic backgrounds construct their professional identity throughdiscursive practices as they interact with other nurses in workplace meetings. The data for this study involve nurses and nurse managers in a ward of a public healthcare institution andata private healthcare institution in New Zealand. The data consist of audio and video recordings of four roster and five handover meetings from the hospital and four clinical and four staff meetings from the clinic, collected by employing Interactional Sociolinguistics as a methodological approach which provides anethnographic lensand afocus on context and culture. To investigate professional identity construction, the analysis takes a theoretical stance which draws on social constructionismand social identity theoryand exploresprofessional identity as it emerges within the boundaries of local interaction and practices. Nurses‘ professional identity formation is consideredin three interactional contexts, namely, voicing and responding to complaints, displaying professional expertise, and negotiating professional values. Findings demonstratethat nurses index multiple group membership alignments as a way to ̳indirectly‘ voice direct complaints and to respond to them in community-appropriate ways as they build in-group solidarity and rapport, and observe interactants‘ face needs.In addition, considerations ofthe use of question-answer adjacency pairs, medical jargon and rationality of case presentation show how expertise construction belongs in a dynamic continuum which is actively transited by nurses as they construct themselves and others as more or less expert on differentaspects of professional practice. Consideringnurses‘ expert claims astemporary, nurses are shown to construct multiple self and other subject positions at the local and wider community levels in order to achieve different interactional goals.This thesis also shows how, when evaluating professional practice, nurses negotiate their professional values at both local and wider community levels by indexing multiple group alignments and displaying expertise that positively construct their professional stance,and by using persuasion techniques that ascribe preferred professional images with the aim of standardising professional practices. Overall, theresearch highlights the partial nature of identity construction as other-initiatedclaims cause nurses to re-consider their stance in order to orienttowards a preferred professional image of themselves, makingsituationally motivated selections of their discursive resources to craft their identity claims.