Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care

Abstract

The pattern of occupations engaged in the care of patients has grown steadily more complex, and is characterised by the creation of new occupations, additional specialisation within existing occupations, and extensions to existing occupational roles. This paper presents empirical data from a study of professionals working with heart failure patients in the English National Health Service, focusing on the discourses employed by nurses and by three different specialties within medicine to legitimise their occupational boundaries. We identify four themes that characterise such discourses, specialised expertise, competence, organisational efficiency and patient-centredness, though these are deployed to different degrees by the different professions. The findings point to a theory of 'occupational legitimation talk' in which newer occupations utilise a wider set of legitimacy claims as a means of strengthening their role and credibility within an increasingly complex and fluid healthcare environment.

Professional relations in sport healthcare: Workplace responses to organisational change

“…Norris's (2001) analysis of the jurisdictional narratives of competing musculo-skeletal treatment providers emphasised three main themes: limitation (of others), holism (of one's own techniques), and prevention (through the treatment of causes rather than symptoms). Sanders and Harrison (2008) identified various professional "legitimation discourses", including: reference to the scientific basis of work; identification of particular skills and expertise; the holistic and patient-centred nature of practice; the provision of care and emotional support; organisational efficiency and accountability; and claims to competence. The differences between the discourses specific professions use are, they noted, "striking" (Sanders & Harrison, 2008, p. 304).…”

“…The neglect of intra-professional relations is also identified as a characteristic of this field (Martin, Currie & Finn, 2009). Sanders and Harrison's (2008) analysis of the legitimacy claims of cardiologists, geriatricians, GPs and specialist nurses in heart failure care is a notable exception, as is Martin, Currie and Finn's own work on the divisions between GPs with a specialist interest in genetics and geneticists. This paper responds to these critiques by examining how the changing organisational context of healthcare provision in UK sport has affected the intra-professional relations within both sports medicine and sports physiotherapy, as well as the interprofessional relations between these respective groups.…”

How midwives’ discursive practices contribute to the maintenance of the status quo in English maternity care

“…This was important, as the blurring of professional/occupational boundaries can be problematic (Rushmer, 2005;Stevens et al, 2007;Sanders and Harrison;.…”

“…The interview also addressed role extension and overlap. All these factors are known to contribute to professional tensions (Meerabeau et al, 1999;Pollard, 2003;Stevens et al, 2007;Sanders and Harrison, 2008). Midwives were also given opportunities to raise other issues; appropriate questions were included in subsequent interviews.…”

Boundary work in inter-agency and interprofessional client transitions

“…Allen 2000Allen , 2001Håland 2012). While boundary work is usually performed to establish hierarchies among professions, the interprofessional context may also encourage the crossing of boundaries and the associated reframing of problems, as well as shared understanding and commonly agreed goals among professions (Gachoud, Albert, Kuper, Stroud, & Reeves, 2012;Sanders & Harrison;Slembrouck & Hall (2014).…”