Internal globalization of nursing: flexible professionalism in the second age of modernity
Swedish School of Social Science University of Helsinki Helsinki, Finland
Nursing is a powerful professional ideology about flexible, caring femininity that enabled the formation of modern Western health care as a societal institution. The occupation also became a central vehicle for middle class women?s employment. Despite the salient internationalism of the ideology of modern nursing, the formation of the profession in the different country contexts was anchored in the cultural framings of the respective nation-state projects, as well as in the institutional approaches different states have employed in relation to the professions in general and women?s occupations in particular. At present, however, nursing in all high-income countries is subjected to non-local flexibility techniques.
Using the Nordic context as a critical case, the paper considers the potential of present developments to transform the profession. The paper argues that the nation-state bound organisation of nursing is transformed from within in many high-income countries, when, first, managerialist reforms reorganize nursing work and its boundaries vis-à-vis other health care occupations, and, second, the number of domestic recruits is waning. Health care organisations have turned to international recruitment, not only to secure adequate levels of human resources but to keep labour costs low. Focusing on a high-income country context, it is evident that some groups and individuals within nursing in such countries gain new professional opportunities, at the same time as international recruits from poorer countries gain access to economic mobility by migrating. The terms for their inclusion are often unequal, however, as international recruits tend to be perceived as best suited for narrow work roles. Furthermore, strongly formalized nursing professions in Western countries often engage in protectionist practices vis-à-vis international recruits and consequently, nationality and non-domestic education are emerging as sources for new hierarchies within nursing. As a result, the profession is globalized within national contexts in ways that produce new complex ordering of nurses. Gender and ethnicity are relevant social divisions to consider but as such insufficient explanations for inequality. Finally, the paper considers the usefulness of the thesis about a 'second age of modernity' for the analysis of the present developments within nursing.