Dutch healthcare has to deal with significant challenges in healthcare delivery and financial sustainability due to the growing ageing population, mounting social and healthcare needs and the increasing complexity of care, combined with rising shortages in nursing and medicine. This has led to a national focus on the possibilities of reorga- nizing healthcare practices, including deploying professionals differently, reallocating professional tasks and differentiating professional roles. Meanwhile, healthcare profes- sionals feel the need to further develop their profession, distinguishing their knowledge and expertise from others to protect and enhance their domain. However, professional role development is often initiated top-down at a national policy level, designed by expert committees and rolled out over the professions. Several studies show that this approach is problematic. Role distinctions are heavily debated, are complex to define or once defined, lack guidelines on how to implement and differentiate the roles in daily professional practice. Although the value of differentiation is widely recognized, it is not clear how it should be done within professions and be embedded in daily organizational practice. We need to investigate the microprocesses of professional role development in healthcare organizations to deepen insight into the process and actors who influence it.
The aim of this thesis is to investigate how nursing and medical professionals develop their roles in everyday healthcare practice, both intra- and interprofession- ally, shaping their roles in close collaboration with managers, directors and internal advisors. We show how external parties influence the internal process of professional role development and how managers must find a balance between internal needs and external requirements. Using a sociological, institutional and practice-based perspec- tive, the analysis sheds light on the iterative process and complex constellation of (f) actors in professional role development.
We studied professional role development with an ethnographic multiple-case study. Ethnography provides in-depth insights into people’s actions and accounts in everyday contexts and using an array of data resources but generally focusing on a few cases. Working with multiple cases provides the opportunity for a cross-case analysis. Over the course of six years we investigated role development in the medical profession, in the nursing profession, and role development and nursing-medical role development in mutual relationship. We selected three convenient samples. First, we investigated the development of an emergency physicians’ (EP) role in three top clinical teaching hospi- tals. Second, we investigated role development by nurse practitioners (NPs) in a nursing home organization who, as members of the medical team, partly replaced elderly care physicians (ECPs). Third, we participated in a case study on nursing role development in a teaching hospital, following nurses in four wards in the development of distinct VN and BN roles. Together the results provide an answer to the main research question: “How do healthcare professionals shape new professional roles in everyday healthcare practices?”

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