Carving out a place for new health care occupations: An ethnographic study into job-crafting

Over the past few years several new occupations have been introduced in health care next to those of vested professionals. In this chapter we analyze the introduction and development of the physician assistant (PA) as one of them. A PA is an allied professional or nurse who has obtained additional university training and who is allowed to work independently in health care practice, conducting certain medical procedures. The central question this chapter addresses is: ‘How do new professionals craft their job by carving out a place in health care practice?’ To explore this topic we build on the theoretical notions of place (Creswell, Place: a short introduction. Blackwell, 2004) and job crafting (Wrzesniewski and Dutton, Acad Manag Rev 26(2):179–201, 2001). Data comes from two case studies; one in emergency care and one in neonatology. Through ethnographic research we analyze how new professionals continuously develop their job and how this changes their place in everyday health care practice. Our results show that increasing experience, developed routines, specialization and trust among the medical and nursing staff enables PAs to gradually expand their occupational place, highlighting the fluidity of its boundaries. PAs do not only create and occupy their place; they add specific meanings to it and in the process create both individually and collectively a new work identity for the PA as an occupation.