Critical Care Nurses’ professional identity constructions in an Australian Intensive Care Unit: Contextual and Contingent

Professional identity is a social identity that is informed by the experience of being a member of a professional group and undertaking work activities within a specific professional jurisdiction. Despite a dominant ideology of professionalism within university based nursing degrees, in practice, professional identity among nurses is often marked by ambiguity and a lack of clarity. Some writers have described a disconnection between the ideology of professionalism that informs nursing’s professional identity, and the experience of nursing practice. This thesis uses a social constructionist approach and ethnographic methods to explore professional identity among Critical Care Nurses (CCNs). The research aimed to build an in-depth understanding of the ways that CCNs, as specialty nurses, construct their professional identity in the context of their practice. The research was conducted in a single Intensive Care Unit (ICU) in Tasmania, Australia over a six-month period. The data was collected from participant observation of 13 CCNs as they went about their work and semi-structured interviews with 8 CCNs. The fieldnotes and interview transcripts were analysed using a process of thematic analysis. The analysis found that CCNs actively construct their professional identity through subjective meaning making and multidimensional processes of similarity and difference (boundary work) within and across dynamic professional boundaries. CCNs were found to attach meanings to particular actions, symbols, rituals and utilisation of artefacts to construct their professional identity. These were then used to negotiate boundaries of difference between themselves and other nurses as well as other health professions. The analysis also revealed that CCNs’ experiences of professional identity are complex and contingent due to the influence of structural and organisational forces that shape and constrain their meaning making during everyday work interactions. These findings provide new theoretical and empirical knowledge about the ambiguity of professional identity and its contextual construction at inter- and intra-professional levels. They also show that for CCNs, professional identity is actively constructed through interactions and practice. This contributes to a more insightful understanding of the subjectivity of CCNs’ professional identities within the context of ICUs, and thus, not only offers the basis for comparative studies of professional identity between nursing specialties, but also between nursing and other health care professions/occupations. The thesis findings also suggest that there is incongruence between nursing’s ideology of professionalism and the structure of employing organisations that do not always acknowledge or support postgraduate nursing qualifications or the development of advanced nursing practice roles. A strong sense of professional identity appears to increase worker satisfaction and contributes to the capacity of professional groups to achieve improved working conditions. As such, barriers to the development of professional identity among CCNs have implications for the lived experiences and may help explain high levels of worker turnover in this nursing speciality.