Ph.D. Research Profile: Lee Thompson
Profession and Place: Challenging Professional Boundaries at the Margins
I’m sick of being seen as a stop-gap – such were the heated words of a frustrated rural primary care nurse working in a predominantly nurse-run health centre. She is referring to the perception that a primary health service is not a ‘real’ service unless it contains at least one doctor. She perceives that the service that she and her colleagues provide is seen by many doctors and policy makers to be temporary until ‘rectified’ by successfully addressing the problem of the retention and recruitment of rural general practitioners in New Zealand.Yet in some of the more remote parts of the South Island of New Zealand, and also on several off-shore islands nurses have been the key providers of primary health care services for the best part of a century. The ‘stop-gap’ is lengthy it seems.
The roles that nurses (both men and women) perform in these rural/remote areas encompass everything from the mundane sore toe to the aftermath of a high-speed car accident. It is only possible to practice in this way in rural areas; that is, the same range of clinical competence is not needed ordinarily in urban settings.
My research aims to investigate the ways that rural primary care nurses construct these hybrid professional identities in relative isolation. I am interested in the ways that profession and place are co-constitutive.
Nurses’ roles are characterised by their extreme flexibility. They are flexible in clinical, temporal and spatial terms. Yet this flexible work moves well beyond a simple understanding that would locate these nurses as ‘good rural women meeting needs’. This research is theoretically informed by feminist and poststructuralist literatures.
Foucault’s idea of governmentality, understood as the conceptual point of intersection between technologies of power (rule by force) and technologies of the self (rule by consent), has proven to be a useful tool to understand and explain the ways that nurses construct and regulate their own professional identities at a distance from direct control and intervention by managers and super ordinates.
I expect that this research will contribute to knowledge about rural professional work, which is currently very poorly represented in the literature. It may also serve to move discussions on from what often seems to be a stalemate surrounding the perceived necessity of providing doctors as first point of contact in primary care.
General practice (GP) work has been declining in attractiveness to medical graduates for some time and one way of addressing this decline may be to reassess the idea that it is necessary to have doctors as first point of contact.
This PhD research, using qualitative methodologies, began in February 2002. All New Zealand fieldwork (in-depth interviews) was completed by July 2003. Data constructed from these interviews has been analysed using discourse analytic techniques.
Recent work:
- Thompson, Lee (2004) Rural primary care nurses: Governing (im)mobile selves, Health Sociology Review 13 (2): 178-186.
- Thompson, Lee (2005) Emplaced professional identities: Restructuring and the contested space of town nursing skill, New Zealand Geographer 61 (1): 29-39.