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Determinants of the Occupational Strategies Adopted by British Hospital Nurses

This paper focuses on the position of the nurse in the division of labor in health care and the occupational strategies British hospital nurses have adopted in response to their changing employment situation. The authors suggest a Marxist framework as an alternative to current approaches to the study of occupational strategy, which tend to focus on the level of distribution relations. An adequate analysis of the situation of hospital nurses, the paper suggests, depends upon locating the occupation within the wider setting of the mode of control and delivery of health care. The central feature of this setting is the dominance of medicine and medical technology, and the main factors shaping it are the activities of individual capitalists involved in the health industry and the State operating within the constraints of capital in general and within the context of class struggle. It is suggested that the characteristic feature of nurses' occupational strategy—the vacillation between professionalism and unionism—can best be understood in relation to the changing mode of control and delivery of health care and nurses' contradictory position within the social relations that constitute that mode.