In Germany, basic nursing training still takes place at technical colleges. This type of training lacks standardisation, leaving considerable freedom to colleges and their…
Abstract
Purpose
In Germany, basic nursing training still takes place at technical colleges. This type of training lacks standardisation, leaving considerable freedom to colleges and their providers. The purpose of this paper is to identify the reasons for the continuation of technical college training for nurses in Germany.
Design/methodology/approach
The paper adopts an actor‐based approach which restricts the notion of “actor” to the level of organisations. The interplay between these actors is put in a context in which institutions maintain traditional structures of training. The study employs the method of document analysis. The method of analysis is qualitative content analysis.
Findings
The investigation shows that it is an interplay between key actors involved in a conflict over nurses’ education which, together with institutions, is responsible for the persistence of technical college‐based nursing training as the standard basic qualification. The relevant institutions are those regulating the health professions and institutions to which a model of ancillary nursing work is oriented. These are in turn embedded in the German system of health care provision and the corporatist health care governance. The study exposes several cross‐relationships between actor‐based and institutional explanatory factors.
Research limitations/implications
The empirical study is limited to the extent that it excludes the micro‐level of nursing work. It provides a framework for comparative research on educational standards in health care in that it pins down specific variables.
Originality/value
The paper develops a framework for analysing the reasons for the continuation of national educational standards of health professions despite a general European process of changing these standards.
Details
Keywords
Abstract
Details
Keywords
The paper addresses the question of the contribution made by health service institutions towards the perpetuation of gender inequality within health occupations.
Abstract
Purpose
The paper addresses the question of the contribution made by health service institutions towards the perpetuation of gender inequality within health occupations.
Design/methodology/approach
Institutions that enable the medical profession to exercise influence over the working, training and examination practices of other health occupations will be looked at in their role as sustaining the dominance of the medical profession over all other health services. Statistically analysing the proportions of women and men in health occupations the paper examines whether this is a gender‐specific form of dominance. Using an institutionalist actor‐centred approach it will be examined whether the stability of the subordination of the allied occupations depends on whether the medical profession is also a corporate actor allotted a central steering function in the governance of the health system. A comparison is made between Germany and Italy.
Findings
In Germany and Italy physicians fulfil the criteria for professional dominance. It is shown that in both countries there exists a gender‐specific segregation across the health occupations, women being under‐represented in the profession of physician, and greatly over‐represented in the subordinate occupations. Therefore, the dominance of the medical profession is gender‐specific. The dominance of the medical profession in Germany is reinforced by several institutions with the consequence of stagnation in the traditional relationship between physicians and allied health occupations. In Italy, more self‐determination of the allied health occupations in the areas of training and examination has become a distinct possibility.
Originality/value
This is the first paper to assess the impact of health care institutions on gender inequality within the health services.