Professionalism as Dissent: Historical Insights to the Evolution of a Collective, Rebellious Staff Nurse Identity and the Disaffiliation of the Massachusetts Nurses Association from the American Nurses Association

This dissertation examined one of several highly polarized conflicts within nursing that took place within the national nursing community in the last decade of the 20th century. The conflict resulted in the severing of a 100 year relationship between the Massachusetts Nurses Association (MNA) and its national parent organization, the American Nurses Association (ANA). For the first time in MNA history, unionized staff nurses gained control of the organization and set forth an agenda prioritizing issues they viewed as most relevant for nursing.;Internal divisions between nurses who provide direct patient care and nurses who define and control that work have marked nursing's modern history. Consequently, calls for internal unity are not new. However, some policy analysts examining the most recent shortfall of registered nurses (RN's) have proposed that nurses and nursing organizations must unite if they are to transform the historical conditions that fuel the enduring dissatisfaction that underlie recurrent nurse labor shortages. What is largely missing from their position, as well as other discussions on problems related to the nursing labor supply, is a larger consideration of the implications of nursing's social history. Additionally, few practical approaches have been offered toward building professional unity in nursing. This study sought to contribute insights into the sources of nursing's internal discontent and stimulate discussion among policy makers, nurse educators and nursing organizations responsible for policy responses intended to guide the future of nursing and the nursing workforce.;Set against a history and literature that has identified nurses as exploited, oppressed and largely apolitical, this study also sought to identify the beliefs and motivations of the nurses within these two groups and understand why they organized in conflict, rather than uniting as a force following two decades of system wide health care restructuring. Additionally, I questioned, if professional unity is possible, how might a higher level of professional cohesiveness be effectively achieved?;Critical theory and feminist perspectives on the research enterprise served as the framework for this inductive, grounded theory study. A purposeful sample generated primary, qualitative data derived from 47 semi-structured interviews. Forty-two interviews were conducted with MNA member nurses who cast votes to determine the disaffiliation outcome. Five additional interviews were conducted to clarify or build on historically relevant events that emerged from the primary interviews analyzed. Extensive review of archival and media materials provided additional data sources for comparison and confirmation of oral data. Together these data aided in achieving an additional goal of this study, which was to contribute to the evolving social history of nursing.;The social history of nursing's evolution, the sociology of professions and professionalism, and theories on social class, oppression, and social movements provided both context and frameworks from which to examine the emergent findings. Data analysis suggests that an evolving critical consciousness in staff nurses led to the development of a collective rebellious professional identity in the face of oppression within the nursing professional hierarchy. Participants within the two groups were divided on the disaffiliation issue largely related to perceived differences in what it means to be professional and what the priorities of professionalism in nursing should be. Additionally, how best to achieve their goals based on those beliefs was at the heart of the disaffiliation conflict.;Policy implications of this study are related to strengthening, advancing, and protecting nursing's pivotal role in patient care and are based on the recently established knowledge that registered nurses are key to improved patient outcomes. They also recognize that "unity" with purpose, whether in the form of "collegiality" among professionals or "solidarity" within labor unions, is necessary to protect specialized knowledge in the face of economic imperatives. A recommendation that nursing leaders and nursing organizations initiate a pedagogical dialogue toward developing a liberated, positive professional identity is based on a model proposed by Roberts (2000).