Making the invisible visible: nurses' stealth work to legitimize their telemedicine coordination role

When new digital technologies are implemented, nurses are usually delegated several new organizing tasks and responsibilities. This accumulation of tasks does not always translate into improved roles for nurses, especially when their organizing work remains invisible to, and underestimated by, physicians. We explore what nurses might do to legitimize their organizing work to physicians. Empirically, we conducted a longitudinal case study of a new telemedicine system in Italy, where nurses appropriated coordination responsibilities. We discovered how nurses enacted 'stealth work' to successfully upgrade their role. Their stealth work included: (i) appropriating organizing tasks when these were understood as scut work by physicians, thus avoiding jurisdictional conflicts; (ii) gatekeeping the organizing domain to develop unique expertise that others could not replicate or replace; and (iii) upgrading 'scut work' into 'heart-sink' work to claim epistemic legitimacy. Our findings contribute to the 'ecological' debate in the sociology of professions, explaining how lower-status professionals can legitimize their 'invisible work' and improve their role in care processes. Stealth work is an affordable relational work for nurses: they can exploit the initial invisibility to appropriate new tasks, gatekeep the jurisdiction, develop unique expert knowledge, and use this as an effective resource for negotiation with higher-status professionals. Our findings also contribute to the 'epistemic injustice' debate in the literature, explaining how nurses can transform physicians' perception of organizing work from 'scut work' (requiring non-expert knowledge) to 'heart-sink work' (i.e., requiring expert knowledge that physicians are 'too late' or 'too busy' to develop).