The reorganization of the nursing labor process: from team to primary nursing

The author presents a labor process analysis of recent changes in nursing work on hospital wards. In the immediate post-World War II decades, hospital nursing was organized to include stratified nurses--registered and auxiliary nurses (licensed practical nurses and nurses' aides)--in a common labor process called "team nursing." Team nursing adapted Taylorist principles to sharply demarcate tasks between registered nurses (RNs) and auxiliaries. In the 1970s and 1980s, team nursing increasingly replaced by "primary nursing" with a majority of RNs. Auxiliaries were displaced as RNs assumed undivided responsibility for complete nursing care. The transition to primary nursing is partly explained through the convergence of managerial interests with the professionalizing interests of nursing's elite. However, primary nursing was not simply imposed from the top down. Team nursing produced divisiveness between RNs and auxiliaries at the same time that it forced these workers to violate the official differentiation of tasks and held RNs responsible for work performed by auxiliaries. Primary nursing eliminates the problems of team nursing as RNs perform reunified tasks in an unmediated RN-patient relationship. However, primary nursing has produced a new set of contradictions, including an intensified labor process.