CONTRADICTORY COUPLINGS: PROFESSIONAL IDEOLOGY IN THE ORGANIZATIONAL LOCALES OF NURSE TRAINING

Nursing is a contemporary occupation which has developed an explicit ‘professional project’. In the UK this has centred around an occupational ideology which stresses managerialism and credentialism. This occupational ideology comes into contradiction with older conceptions of professionalism which are couched in vocational terms. The vocational meaning is shown to be situated and reproduced in organizational locales which serve to undercut the managerialist and credentialist meanings. The focus of these cross-cutting meanings is the interpretation of a ‘good nurse’. Using a ‘negotiated order’ perspective, focusing on ‘contradictions’, case study material suggests that there are important gaps between formal representations of the professionalism project and the actual, situated practice of ‘nursing’. For trainee nurses these gaps are particularly apparent. In day-to-day organizational life they have to negotiate contradictory conceptions encountered in the diverse locales of ward work and nurse training. In addition, the different meanings may be encountered even in the same locales.     

Interrogating an accounting-based intervention on three axes: Instrumental, moral and aesthetic

Accounting research is beginning to concern itself with mapping the operation of accounting in specific empirical settings. This paper has a similar aim — to track the effects of an accounting-based intervention in a rationalized lifeworld that is constituted by three cultural spheres with their associated modes of rationality —instrumental, moral and aesthetic (Habermas, J., The Theory of Communicative Action, Vol. 1, Heinemann, 1984). The institutional setting chosen is the U.S. health-care industry and the empirical event focused upon is the introduction of a prospective payment system in 1983. The empirics raise some interesting suggestions for future research. It appears that accounting struggles as an instrumental technology but enables action by providing a way out of moral dilemmas and in so doing enacts substantive power effects upon human bodies, both individual and collective.