Keeping the distance: An ethnographic study of professional autonomy and boundary work among hospital surgeons

Interprofessional collaboration is essential to hospital care, yet ward-level nurse-surgeon relations often appear strained. This ethnography follows 16 surgeons over six months in a Norwegian university hospital to examine how spatial, organisational, and interactional practices shape surgeons' professional autonomy and jurisdictional boundaries, and under what conditions they contribute to professional distance in ward-based collaboration. Bringing together Abbott, Freidson, and Strauss, we treat episodes of interprofessional coordination, including paging, corridor consultations, and ward encounters, as sites where logistical control is negotiated, constrained, or redistributed. The findings show that surgical work was often reactive in its initiation, even when surgeons exercised considerable authority within bounded clinical arenas. Ward co-presence generated ad hoc enlistment and interruptions that disrupted planned work trajectories, making availability both clinically necessary and difficult to sustain. Surgeons responded through spatiotemporal tactics, including avoiding wards, triaging calls, and deflecting nonurgent tasks, to protect logistical control. We reframe apparent 'uncooperativeness' as organisationally conditioned boundary work that protects logistical control while also reproducing professional asymmetries, shifting coordination burdens towards nurses, and generating professional distance. By linking Abbott's concept of jurisdiction, Freidson's theory of professional autonomy, and Strauss's analysis of negotiated order, the study shows how the spatial organisation of hospital work shapes professional relations through uneven distributions of mobility, access, exposure to interruptions, and control over work.