Academic journal article Health Sociology Review

Changes in Professional Human Care Work: The Case of Nurse Practitioners in Australia

Academic journal article Health Sociology Review

Changes in Professional Human Care Work: The Case of Nurse Practitioners in Australia

Article excerpt

One of the key features of early modernity in western societies was the shift of labour from the country and the establishment of national labour markets. Not only did people have to leave the home to go to the factory to work (Pocock, Williams, & Skinner, 2009), but increasingly the provision of health and educa- tion shifted to institutions outside of the home (Voydanoff, 2007). A distinctive feature of modernity was the split of the public realm of work (where products were created within set working hours with the value coming from the time required for production (Land & Taylor, 2010)), and the private realm (which was the place to seek personal health and fulfilment (Wajcman, Bittman, & Brown, 2008)). Further, as men's work was mechanised at the time, the workplace became the site for the imper- sonal and rational, with workers expected to leave relationships at the factory door (Grandey, 2000). These changes, which started in the late 18th Century and extended through the 19th Century, were amongst the most dramatic in the history of western nations.

Not surprisingly, these dramatic shifts resulted in the emergence of new ways of thinking about economy and society. The growth in public work, mass production and collective grouping of workers made structural approaches to theorising work more pertinent. Increasingly in industrial society, politics was the realm of classes pitted against each other in a competition for resources, while political affiliation was influenced primar- ily by income, education or union membership (Inglehart, 1977). In this context, Marxist and structuralist perspectives were highly influential (Bonefeld & Holloway, 1991).

However since the 1970s, another significant change has been identified in western society (Hall & Jacques, 1989), which has been vari- ously labelled as 'post-industrial' (Bell, 1974), 'post-material' (Inglehart, 1977), and 'post- Fordist' (Amin, 1994). While there is a sig- nificant degree of disagreement over the use of these terms by those in and outside of the related debates (Amin, 1994), common ground can be found in an emphasis on the growth of service work, the emergence of a knowledge economy, and the role of greater individual autonomy/ reflexivity (Giddens, 1998; Kumar, 1995). As Hall and Jacques (1989) put it, each of these 'posts' are different ways of trying to explain the changing links between capitalism and society in late modernity.

Hence, with late modernity we see a shift from the clear industrial divide of previous generations (Bonefeld & Holloway, 1991). More labour occurs back in the home and community, in part as the result of less involvement in mecha- nised and regulated factory work and in part due to the influence of new technologies (Prosser, Wendt, & Tuckey, 2013). Some theorists have identified this as a blurring of work and life cat- egories (Cherniss, 1980; Geurts & Demerouti, 2003; Land & Taylor, 2010; Pocock, Skinner, & Williams, 2008; Wajcman et al., 2008; Williams, Pocock, & Skinner, 2009). There is a growth in the supply of health services by private pro- viders, while increasingly the responsibility for managing these services falls to the community- based professional, individual or carer, rather than the institutionally paid professionals (Dow & McDonald, 2007; Duckett, 2007). Further, where such services were supplied previously in the context of Keynesian welfare systems using Fordist rationales, there is now an emphasis on flexible service delivery, community-based approaches and client choice (Baum, 2009).

Following Pocock et al. (2009), we argue that it is at times of significant socio-economic change that the connections between mar- kets, workers, communities and individuals are most visible. Further, we would argue that as new arrangements emerge, the onus is on scholars to develop new conceptual approaches that provide rigour to understandings of these changes. …

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