The discourse of registered nurses in practice fields: negotiating professionalism and the demands of work in 21st century Australia

Through processes of Critical Discourse Analysis, this study examined the contemporary role of registered nurses in relation to their abilities to act as professionals. Data were elicited from 12 experienced registered nurses in Australia to reveal the discourses that they utilised to articulate and explain their practices, their role performance and their cultures of practice. The findings were examined against social theory and a theory of professionalism to conclude that professional nursing does exist in contemporary Australia, but it sits precariously between nursing’s occupational expectations for professionalism and the realities of nurses’ clinical practice. Considering professionalism in a broad sense, the study was framed within Fairclough’s (1992, 2001b, 2003) critical social theory and a theory of professionalism espoused by Stronach et al. (2002). Both theories offered valuable frames for this study, which examined whether practising registered nurses could exhibit behaviours of professionals as they negotiated the demands of their jobs. The nurses’ narratives were elicited through interviews and analysed through methodological processes modelled from Fairclough’s (1992, 2015) concepts of utilising three angles of analysis: at the levels of text, discursive practice and sociocultural practice. The findings were examined against discourses prevalent in contemporary nursing studies, thus using the research literature to explore the wider sociocultural context of nursing. The discourses that were analysed from the nurses’ discussions of their work revealed expectations for care giving that competed with the necessities to complete that care. Work intensity, a litany of task-based patient care and pervasive audits, consumed much of the nurses’ time and focus, leaving small margins for more comprehensive, holistic care. The nurses revealed emotions related to their nursing roles, ranging from pride in one’s work to fear of failing the patient and causing harm. The discourses they utilised showed multiple tensions among institutional mandates, enculturated routines, nursing ideals and variable perceptions of patients’ healthcare needs. The nurses shared ways they dealt with the competing discourses they faced. These were most frequently mechanisms for re storying themselves within the personal aspects of their jobs, such as professional development or employment conditions. They provided examples of challenges in relation to their ability to exert control over their daily work practices and they often expressed negative discourses, including a lack of hope for future improvements. Amongst the agitation of daily work, the nurses showed professional behaviours in their practice. These often emerged when independent actions, emanating from their individual store of knowledgeable judgement and expertise, were needed in response to the demands at hand. At times, the nurses did show professional behaviours and could be called professionals in their work. The research showed they had the capabilities to act professionally, their ability to do so was hampered by the system constraints surrounding them. To continue as professionals, the nurses’ contexts of labour must provide room and scope for them to act agentically. Improvements in system constraints are warranted in tandem with preserving and nurturing their capabilities