ABSTRACT
The study of power and professional practices within health care has been of longstanding interest to medical sociologists (Parsons 1954; Freidson 1970; Witz 1992; Elston 2009). Such analyses have revealed that the medical division of labour and associated organisational hierarchies cannot be solely explained in terms of the technical knowledge and capacities of the practitioners. Rather, the distribution of power in the health care arena has been shaped by a complex intersection of historical, social, cultural and economic factors, central to which are gender relations. This intersection has been understood by sociologists in terms of ‘professional projects’, whereby health care occupations have sought to secure a distinctive market position for themselves (Abbott 1988). Such studies reveal a historical interplay between ‘professionalism’ and ‘professionalisation’. Professionalism refers to a distinctive ethic of conduct: an altruistic disposition combined with claims to expertise. Professionalisation, on the other hand, is characterised by the attainment of extensive occupational autonomy, grounded in a state-endorsed monopoly of practice. This chapter draws on insights from the sociology of the medical professions, and on a recent empirical study (Cant et al. 2011), to explore and explain efforts by nurses and midwives to integrate complementary and alternative medicine (CAM) into hospital practice within the United Kingdom. Since the late 1980s, CAM has been implicated in attempts by nurses and midwives to enhance their occupational jurisdiction, professional power and quality of work experience. This reflects a historical contingency: a dramatically expanding market for CAM services occurred simultaneously with a coordinated drive by nurses and midwives to augment their legitimacy, credibility and autonomy of practice. Central to such attempts was the positioning of nurses and midwives as ‘knowledgeable doers’; autonomous professionals, with a unique, holistic, caring orientation, able to determine their own parameters of practice and judge their own competency. In practice, though, their professionalisation strategy emphasised university credentials and focused on the technical, procedural and bureaucratic elements of nursing and midwifery practice. A consequence was that many practitioners felt that the caring, feminine1 aspects of their work had been devalued. CAM appeared to provide a territory in which aspirations for both professional autonomy and person-centred practice could be realised, leading to a groundswell of interest by nurses and midwives (Mitchell et al. 2006; Rankin-Box 2004; RCN 2003).
