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CHAPTER 1 "Not Merely a Profession" Writers on the professions have set forth conflicting definitions and interpretations, but all acknowledge the special place that professions occupy in the world ofwork. Common usages reveal the near-mystique associated with the concepts of professions and professionals. When we comment that someone is "a real professional," we bestow high praise: we mean an expert, someone fully qualified to perform the task at hand, one who can be trusted to assess and act on important problems. Professionals are their own bosses, not subject to the same close discipline as most workers. They occupy a special place in their communities: they are well paid, come home with clean hands, live in the best part of town. While others punch out at the end ofthe day, professionals carry their work identity into their private lives: friends and neighbors may even call them "Doc," "Judge," "Pastor," or "Professor ," instead oftheir given names. Conversely, the label "unprofessional " is a weighty epithet, connoting haphazard, incompetent work; a casual, undignified approach to a serious matter; behavior that is unseemly, even morally suspect. Nursing leaders, like members of many struggling occupations, have long sought to identify themselves with the prestige and the privileges of the professions. I have already suggested that they did not represent nursing's mainstream: the framework ofprofessionalization can only encompass one part of a wider history. Moreover, I will argue here that it distorts that history, for nursing is not and cannot be a profession . My interpretation begins with a revisionist critique of the concept of professionalization, a perspective that dispels 16 CHAPTER 1 the mystique of the professions to present a more critical account of their structure and functions. This chapter then tests and extends that critique by applying it to the case of nursing. As an occupation seeking professional prerogatives, nursing offers a perspective on the social process of professionalization . As women's work, it illuminates the assumptions about gender that are built into professional ideology. Finally, I assess the impact of professional ideology on nursing , explicating the critical view of nursing leaders presented throughout "The Physician's Hand. JJ As a strategy for nursing, professionalization is doomed to fail; as an ideology, professionalism divides nurses and weds its proponents to limiting and ultimately self-defeating values. Many sociological and historical analyses of the professions simply confirm and elaborate upon the assumptions about professions that are revealed in everyday usage. Because they evoke these commonplace assumptions and because they have dominated the scholarly literature as well, I call them conventional or consensus interpretations. These accounts portray professions as the legitimate domains of expertise. Their members have extended theoretical knowledge in a body of esoteric and highly prized knowledge. They share a special altruism or commitment to service. Consensus interpretations acknowledge the professional's unusual autonomy in work and present this independence as appropriate, even essential. Possessors ofspecial knowledge, professionals alone are fully equipped to judge and direct its application. The profession's clientele can grant this broad license with confidence because ofthe altruism that distinguishes the profession from ordinary callings. Released from most external supervision , professionals develop their own codes ofethics to ensure the responsible use of their knowledge. Members of professions set up mechanisms of peer review designed to monitor and regulate their practice. In addition, professionals carefully control access to their special privileges, setting standards for the education and certification ofnew practitioners to guaran- "NOT MERELY A PROFESSION" 17 tee their competence and worthiness. Some observers also emphasize professionals' special orientation to work. Not only do they perform their duties with unusual altruism, but they also identify strongly with work, making it a part oftheir personalities in a way that workers in more mundane jobs increasingly resist. 1 Critics ofthe conventional model have complained ofits vague parameters, arguing persuasively that the definition does not provide meaningful distinctions among occupations. How long is "extended" training? How abstruse is "esoteric" knowledge? What are the boundaries between apprenticeship and theoretical education? How can we judge a profession's commitment to service in any objective way? Calling for a historical approach to the rise of the professions, one critic dismissed the consensus interpretation as "the sociologist's decoy" and pointed to its conservative implications. This formulation assumes that hierarchical organization ofknowledge is necessary and desirable, and that a profession's power is derived primarily from the support ofa broad social consensus . Accepting professionals' descriptions oftheir work at face value, sociologists (and historians) have ended by legitimating the...


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