‘I always wanted to be a nurse’ how do sexual health nurses construct their identities within the context of role change?

Wisby, Deborah Ann (2014) ‘I always wanted to be a nurse’ how do sexual health nurses construct their identities within the context of role change? Doctoral thesis (EdD), Manchester Metropolitan University.

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Abstract

In the United Kingdom there are increased pressures to extend the role of nurses as a result of policy reform, rising demands for health care, a shortage of doctors and financial constraints within the National Health Service (Faithfull and Hunt, 2005). As nurses are called upon in times of ‘crisis’ to fill the skills gap, the development of nurse-led services and the consequent shifting of professional boundaries between health care groups have led to certain challenges and tensions within the discourse of modernisation in delivering compassionate, safe and effective care for people in the 21st century (Maben and Griffiths, 2008). This thesis focuses on the nursing biographies of ten sexual health nurses (nine female and one male) in the North West of England. They describe how they came to be nurses and their experience of their on-going clinical practice as their roles and responsibilities change as a result of reorganisation. Using narrative interviewing as a means for data collection, the theoretical and interpretative framing of this study is based on Gee’s (2011) theory of ‘Big D’ Discourse and Holland, Lachicotte, Skinner and Cain’s (1998) theory of Figured Worlds, emphasising the role of narrative in identity construction and the ways in which individuals draw on the figured nature and cultural models of the nursing world. I argue that while a recurrent narrative theme describes childhood and adolescent experiences of ‘always wanting to be a nurse,’ the majority of the respondents appear to have had limited choices, given their academic achievement, family backgrounds and influences and socio-economic status. The single male nurse in the sample offers an account of his career which puts the women’s stories into relief, drawing attention to particular aspects of gender discourses and caring. For women, nursing was in fact, ‘a respectable career for a working class girl,’ and it also fitted in with being a mother. A discourse of caring is also prominent in their accounts and this underpins much of what they say about becoming a nurse and their experience of role change. I argue that whilst their strong values of caring and compassion are sometimes seen at odds with their new role, in some accounts the discourse of caring is clearly incorporated into their developing clinical skills and knowledge. I report that not all the nurses ‘embrace’ role change; their stories present anxieties, conflicts and resistance around new responsibilities, power imbalances within the doctor-nurse relationship and the disruption of their figured world of nursing, which raises issues of perceived inequality of pay and some ambivalences concerning their new role.