Changing Images of Professionalism: The Case of Public Health Nurses JOAN R. BLOOM, PHD, CHARLES A. O'REILLY, III, PHD, AND G. NICHOLAS PARLETTE, MPH
Abstract: A survey of 89 public health nurses in a California county explored factors that might account for the growing support of unions and subsequent militancy among nurses. As predicted, changes in the backgrounds of public health nurses have occurred over time: 1) older nurses are more likely to have graduated from a diploma program and to have parents of lower educational and occupational attainment than younger nurses; 2) older nurses are more likely to view nursing as a calling and less likely to desire representa-
tion in collective bargaining by the union or to believe striking professional; 3) older nurses and those from lower social class backgrounds were less likely to belong to the union and less likely to participate in a county-wide strike. Because age and parental background factors are independently related to our indicators of militancy-union membership and participation in a strike-the results are interpreted as a change in nurses' images of professionalism. (Am. J. Public Health 69:43-46, 1979.)
Health services are increasingly being provided by large bureaucratic organizations. Both the recent HMO (he4lth maintenance organization) legislation and current proposals for national health insurance encourage this trend. At the same time, we have evidence that the health professionals working in these settings are organizing to bargain with management over pay, working conditions, and domains of authority. These include physicians as well as hospital and community-based nurses.' As unionism increases among health professionals, it becomes important to understand the factors influencing its acceptance and active participation therein. Two changes in nursing are, theoretically at least, important predictors of unionism among public health nurses. First, nurse recruits are now coming from families of higher socioeconomic backgrounds than in the past. This is especially true for graduates of baccalaureate programs.4 Children from higher social class backgrounds have been shown to be more self-directed and desiring of autonomy, while children from lower class backgrounds are more conforming to authority. Limited education and constricting job conditions-rather than variables such as aspiration, personality, and ethnicity-have been implicated by Kohn as the causes of these differences.5
Second, within the past 20 years, there have been changes in both the type of school from which most nurses enter the profession and what has been taught in that school. The long-range trend has been in the direction of upgrading the quality of nurse training programs. As a result, nurses are becoming increasingly capable of exercising a domain of professional expertise and are demanding a new role for themselves that includes greater authority, autonomy, and self-regulation with regard to the conditions of work. These two factors result in conceptions of work and appropriate work arrangements held by the professional group that are different from those held by the administrators, which may lead to tension in the work setting. While the fully professionalized groups have sufficient power to influence how work arrangements are devised, semi-professionals and professionalizing groups like nurses do not. Striving to gain this power, they inevitably challenge both administrators' conceptions of work and administrator-designed work arrangements.6 A recent survey of nurses7 demonstrated that it is but a short step between feeling that administration is unresponsive and organizing to gain power through collective action. Professionalization can be a militant process whereby members of an occupation attempt to wrest power from those currently in control.8 Because many of the changes in nursing are recent, the individual who entered nursing in an earlier era may not have grappled with issues of appropriate definition of work and work arrangements and may hold different attitudes regarding the "proper place" of nursing. Empirical documentation for this argument comes from the field of nursing as well as from an analogous occupational group-teaching. Several
Address reprint requests to Joan R. Bloom, PhD, Assistant Professor, Department of Social and Administrative Health Sciences, School of Public Health, University of California, 409 Earl Warren Holl, Berkeley, CA 94720. Dr. O'Reilly is at University of California, Los Angeles; Mr. Parlette is at University of California, Berkeley. This paper, submitted to the Journal October 11, 1977, was revised and accepted for publication March 31, 1978.
AJPH January 1979, Vol. 69, No. 1
43
BLOOM, ET AL.
studies of teachers have demonstrated differences in attitudes and behavior as a function of age9-12 and professional
orientation.8'9 The intent of this study was to examine the effects of background factors on the professional orientations of nurses, their attitudes toward collective bargaining, and their militant behavior.
Method Background Soon after a state law opened the door to unionization of public employees, the public health nurses in a West Coast county health care agency selected a union to represent them, thus becoming one of six county employee bargaining units. Although membership in the union is not mandatory, it is automatic; employees may withdraw during a yearly open
period. Both management and the union consented to the study soon after a 17-day county-wide strike ended. The results of preliminary interviews and a draft of the questionnaire were presented and approved by both management and the union stewards.
Subjects Respondents were all public health nurses in the county. Ninety-five of a possible 106 respondents (90 per cent response rate) were surveyed.* The sample analyzed consisted of 78 staff nurses in three different grades and 11 supervisory nurses,** a total of 89 nurses.
Procedure A letter explaining the nature of the research was distributed through the county mail system along with the questionnaire. To protect confidentiality of the respondents, the surveys were returned directly to the researchers in a stamped, self-addressed envelope provided. Measurement The survey included questions on the nurses' backgrounds-age, education, and education and occupation of parentsl3-attitudes toward professionalism,"4 and attitudes toward collective bargaining. In addition, information on union membership and strike participation was requested and verified through both county and union records.
Results Changes in Nursing Using correlation analysis, we found that older nurses are more
likely to have parents with lower educational and
*Six surveys returned after the data analysis was in progress were not included. **The supervisory nurses were combined with the staff nurses after it was determined that organizational position was independent of age, union membership, and strike behavior. 44
TABLE 1-Per Cent of Older and Younger Nurses with High Professional Orientations Per Cent High Each Scale Professional Orientations
Professional organization as major referent Belief in public service Belief in self-regulation Sense of calling to the field Autonomy
Older %
Younger %
Chi Square
Correlation Coefficient
52.4
34.1
3.61
0.22*
40.5 9.5 58.1 69.8
34.1 4.4 40.9 69.8
2.15 0.95 1.94 0.06
0.07 0.14 0.19* -0.07
*p < .05
occupational attainment than are younger nurses. Although all of the relationships are in the expected direction, only fathers' educational (r = -.26, p < .05) and occupational (r = -.24, p < .05) attainment are significant. Changes in the entry program have also occurred. Older nurses were likely to have come from either a three-year diploma (45 per cent) or a five-year baccalaureate program (38 per cent). Eighty per cent of younger nurses entered nursing through a four-year program. These results support our initial contention. Age and Attitudes The second analysis considered the effect of age on professional orientation. The nurses were asked to indicate their agreement (on a five-point scale) to a series of 15 statements representing their belief in the professional organization as a major referent, belief in public service, belief in self-regulation, sense of calling and autonomy.14 These items were selected from the 50-item professional inventory on the basis of factor analytic results present by Snizek. 15 As indicated in Table 1, there was a high degree of agreement with all items by both groups (age was dichotomized, based on a bimodal distribution, as less than 36 years and 36 years and older). The strength with which two of these values are held by the older nurses is indicated by the correlation analysis. Older nurses were more likely to see the professional organization as their major referent and to view nursing as a calling; both of these relationships are statistically significant. When we turn to the public health nurses' attitudes toward collective bargaining, a different picture emerges (Table 2). Using contingency analyses, we found that younger nurses were more likely to feel that the union represents their professional interests and to consider the union as a professional organization. They did not believe that collec-
tive bargaining was incompatible with professional standards, nor did they believe that striking was inappropriate for nurses. All of these relationships are statistically significant. A majority of both age groups agreed with the statement indicating a belief that collective bargaining is a positive force for the nursing profession and that it is appropriate for nurses to bargain with management. In summary, age AJPH January 1979, Vol. 69, No. 1
CHANGING PROFESSIONAL IMAGES OF NURSES TABLE 2-Frequency and Per Cent of Agreement with Collective Bargaining Attitudes for Each Group of Nurses Agree
Collective Bargaining Attitudes
Older
Younger
Chi Square
I consider the union as a professional organization. I believe that strikes are inappropriate for nurses. Collective bargaining is a positive force for the nursing profession. Collective bargaining is incompatible with professional standards. I believe the union represents my professional interests. I believe it is appropriate for public health nurses to organize and to bargain with management.
8 (19.5)
24 (55.8)
4.78*
27 (65.9)
15 (34.9)
6.86**
30 (69.8)
36 (83.7)
1.63
15(34.9)
4 (9.1)
17 (39.5)
27 (61.4)
3.32
37 (86.0)
41 (93.2)
0.55
7.03**
*p < .05 one-tailed test *p < .01 one-tailed test Note: Percentages given in parentheses
had an effect on public health nurses' attitudes toward collective bargaining on four of the six relationships tested. Nurses were also asked for their preference for representation in collective bargaining. Results presented in Table 3 show that younger nurses were almost equally divided as to their preference for the union or the professional association, while 75 per cent of the older nurses preferred the professional association (16 persons selected the "other" category, which is not analyzed here).
Background, Age and Behavior When correlations were computed between age and parental background with two behavioral measures-union membership and participation in the strike (Table 4)-we found that younger nurses and nurses whose parents had higher occupational and educational attainment were more likely to belong to the union and to go out on strike than were older nurses and those from families with lower attainments. To determine whether the difference can be attributed to the expected liberalness of youth or to actual changes in profes-
TABLE 3-Preference for Representation in Collective Bargaining for Younger and Older Respondents Professional Age
Union
Organization
Total
Younger n = 37 Older n = 36
21(56.8)
16(43.2)
37(100.0)
9(25.0)
27(75.0)
36(100.0) N
*16 missing observations Note: Percentages given in parentheses
AJPH January 1979, Vol. 69, No. 1
=
sional images, partial correlation coefficients were computed. Controlling for age, parental education is still significantly associated with unionism and participation in the strike, but father's occupation is no longer significantly related.
Discussion The premise underlying the current study was that professional orientation would mediate in the relationship between age and attitudes toward collective bargaining. It was also expected that changes in the recruitment and in the entry program into nursing would explain differences in professional orientation. The general expectation was that more professionally oriented nurses would be younger, have more positive attitudes toward collective bargaining, and be more militant in their behavior. Although the latter part of this argument is supported by these data, the link to professionalism* is not. In fact, we found that for two of Hall's Professional Orientation Scales-the Professional Association as Referent and the Sense of Calling to the Field-older nurses accepted these orientations more than did the younger nurses. Perhaps this is not surprising in light of the general desirability of professionalism. In addition, the Hall scales measure fairly traditional professional values. The sense of calling to the field, for example, is closely akin to Nightingalism-the belief that one should be dutiful and deferential. Father's educational and occupational attainment and type of program from which an individual entered nursing were the background variables which showed the strongest
73*
*It may also be that our sample is too homogeneous to reveal any differences that we might find in a sample containing both hospital and public health nurses. 45
BLOOM, ET AL. TABLE 4-The Relationship of Age and Parental Background with Union Membership and Militancy Pearson Product-Moment Correlation Coefficients Mother
Father
Behavior
Age
Education
Occupation
Education
Occupation
Union Membership Strike Participation
-.31** -.30**
-.22* -.26**
-.05 -.18
-.26** -.34***
-.17 -.24**
*p < .05 one-tailed test **p < .01 one-tailed test ***p < .001 one-tailed test
association with age. Age, as well as parental educational attainment and father's occupation, was significantly related to militancy. That nurses from higher status backgrounds were more militant is consistent with Engel and Schulman's findings' for medical residents. We had predicted these relationships to be a function of values and beliefs of the nurses. Nurses from lower social backgrounds are conforming and accepting of the status quo, while nurses whose parents had higher educational and occupational backgrounds are more self-directed and see militancy as a way of bargaining with management. In this analysis, organization position (supervisory vs staff nurse) was independent of age, and thus not related to the dependent variables. Since the supervisors are in the same bargaining unit, this is not a surprising finding. Given a different set of organizational arrangements, however, staff position might have significant effects and, thus, would need to either be controlled for or considered as a predictor variable. Attitudes relating collective bargaining and professionalism are the most interesting findings, showing shifts in the images of nurse professionalism.* Collective bargaining for nurses is an accepted fact. Who the bargaining agent should be and how militant one should be seem to be the key questions. Older nurses were more comfortable with professional organizations, while younger nurses seemed to find that unionism and militancy are compatible with professionalism. Because of the changes in recruitment into nursing and the programs of entry, the trend toward union representation in collective bargaining activity and militancy should continue.
*While the sample is small and from one geographical area and therefore may not be representative of public health nurses in general, added credence of these findings is provided from the authors' preliminary analyses of data from two other counties, albeit in California. 46
REFERENCES 1. Engel G and Schulman M: The relationship of unionism to professionalism in medicine. J. of Medical Education 51:132-134, 1976. 2. Hughes E, Hughes HM and Deutcher I: Twenty Thousand Nurses Tell Their Story, Philadelphia: Lippincott, 1958. 3. Davis F, Olesen V and Whittaker E: Problems and issues of collegiate nursing education. In Davis F (ed.), The Nursing Profession: Five Sociological Essays, New York: Wiley, 1966. 4. Simpson R and Simpson I: Woman and bureaucracy in the semiprofessions. In Etzioni A (ed.), The Semi-Professions and Their Organizations, New York: The Free Press, 1969. 5. Kohn M: Class and Conformity, Homewood, IL: The Dorsey Press, 1969. 6. Scott WR, Dornbusch S, Sagatun I, et al: Task conceptions and work arrangements. Paper presented at the Annual Meeting of the American Sociological Association, Denver, 1971. 7. Godfrey M: Someone should represent nurses. Nursing 76:7385, 1976. 8. Corwin R: Militant Professionalism: A Study of Organizational Conflict in High Schools, New York: Appleton-Century Crofts, 1970. 9. Cole S: The unionization of teachers: Determinants of rank and file support. Sociology of Education XLL66-87, Winter 1968. 10. __. Teachers' strike: A study of the conversion of predisposition into action. American J. of Sociology 74:506-520, 1969. 11. Cox H: Professionalism and teacher militancy. Paper presented at the Annual Meeting of the American Sociological Ass'n, New York, 1976. 12. Alutto J and Belasco J: Determinants of attitudinal militancy among teachers and nurses. Indus. & Labor Relations Review 27:216-227, 1974. 13. U.S. Bureau of the Census. 1970 Census of Population Classified Index of Industries and Occupations, Washington, DC: U.S. Government Printing Office, 1971. 14. Hall R: Professionalization and bureaucratization. American Sociological Review 33:92-104, February 1968. 15. Snizek WE: Hall's professionalism scales: An empirical assessment. American Sociological Review 37:109-114, 1972.
ACKNOWLEDGMENTS We gratefully acknowledge the support provided by the Committee on Research, University of California, Berkeley. An earlier version of this paper was presented at the meeting of the American Sociological Association, Chicago, Illinois, September 9, 1977.
AJPH January 1979, Vol. 69, No. 1
Abstract: A survey of 89 public health nurses in a California county explored factors that might account for the growing support of unions and subsequent militancy among nurses. As predicted, changes in the backgrounds of public health nurses have occurred over time: 1) older nurses are more likely to have graduated from a diploma program and to have parents of lower educational and occupational attainment than younger nurses; 2) older nurses are more likely to view nursing as a calling and less likely to desire representa-
tion in collective bargaining by the union or to believe striking professional; 3) older nurses and those from lower social class backgrounds were less likely to belong to the union and less likely to participate in a county-wide strike. Because age and parental background factors are independently related to our indicators of militancy-union membership and participation in a strike-the results are interpreted as a change in nurses' images of professionalism. (Am. J. Public Health 69:43-46, 1979.)
Health services are increasingly being provided by large bureaucratic organizations. Both the recent HMO (he4lth maintenance organization) legislation and current proposals for national health insurance encourage this trend. At the same time, we have evidence that the health professionals working in these settings are organizing to bargain with management over pay, working conditions, and domains of authority. These include physicians as well as hospital and community-based nurses.' As unionism increases among health professionals, it becomes important to understand the factors influencing its acceptance and active participation therein. Two changes in nursing are, theoretically at least, important predictors of unionism among public health nurses. First, nurse recruits are now coming from families of higher socioeconomic backgrounds than in the past. This is especially true for graduates of baccalaureate programs.4 Children from higher social class backgrounds have been shown to be more self-directed and desiring of autonomy, while children from lower class backgrounds are more conforming to authority. Limited education and constricting job conditions-rather than variables such as aspiration, personality, and ethnicity-have been implicated by Kohn as the causes of these differences.5
Second, within the past 20 years, there have been changes in both the type of school from which most nurses enter the profession and what has been taught in that school. The long-range trend has been in the direction of upgrading the quality of nurse training programs. As a result, nurses are becoming increasingly capable of exercising a domain of professional expertise and are demanding a new role for themselves that includes greater authority, autonomy, and self-regulation with regard to the conditions of work. These two factors result in conceptions of work and appropriate work arrangements held by the professional group that are different from those held by the administrators, which may lead to tension in the work setting. While the fully professionalized groups have sufficient power to influence how work arrangements are devised, semi-professionals and professionalizing groups like nurses do not. Striving to gain this power, they inevitably challenge both administrators' conceptions of work and administrator-designed work arrangements.6 A recent survey of nurses7 demonstrated that it is but a short step between feeling that administration is unresponsive and organizing to gain power through collective action. Professionalization can be a militant process whereby members of an occupation attempt to wrest power from those currently in control.8 Because many of the changes in nursing are recent, the individual who entered nursing in an earlier era may not have grappled with issues of appropriate definition of work and work arrangements and may hold different attitudes regarding the "proper place" of nursing. Empirical documentation for this argument comes from the field of nursing as well as from an analogous occupational group-teaching. Several
Address reprint requests to Joan R. Bloom, PhD, Assistant Professor, Department of Social and Administrative Health Sciences, School of Public Health, University of California, 409 Earl Warren Holl, Berkeley, CA 94720. Dr. O'Reilly is at University of California, Los Angeles; Mr. Parlette is at University of California, Berkeley. This paper, submitted to the Journal October 11, 1977, was revised and accepted for publication March 31, 1978.
AJPH January 1979, Vol. 69, No. 1
43
BLOOM, ET AL.
studies of teachers have demonstrated differences in attitudes and behavior as a function of age9-12 and professional
orientation.8'9 The intent of this study was to examine the effects of background factors on the professional orientations of nurses, their attitudes toward collective bargaining, and their militant behavior.
Method Background Soon after a state law opened the door to unionization of public employees, the public health nurses in a West Coast county health care agency selected a union to represent them, thus becoming one of six county employee bargaining units. Although membership in the union is not mandatory, it is automatic; employees may withdraw during a yearly open
period. Both management and the union consented to the study soon after a 17-day county-wide strike ended. The results of preliminary interviews and a draft of the questionnaire were presented and approved by both management and the union stewards.
Subjects Respondents were all public health nurses in the county. Ninety-five of a possible 106 respondents (90 per cent response rate) were surveyed.* The sample analyzed consisted of 78 staff nurses in three different grades and 11 supervisory nurses,** a total of 89 nurses.
Procedure A letter explaining the nature of the research was distributed through the county mail system along with the questionnaire. To protect confidentiality of the respondents, the surveys were returned directly to the researchers in a stamped, self-addressed envelope provided. Measurement The survey included questions on the nurses' backgrounds-age, education, and education and occupation of parentsl3-attitudes toward professionalism,"4 and attitudes toward collective bargaining. In addition, information on union membership and strike participation was requested and verified through both county and union records.
Results Changes in Nursing Using correlation analysis, we found that older nurses are more
likely to have parents with lower educational and
*Six surveys returned after the data analysis was in progress were not included. **The supervisory nurses were combined with the staff nurses after it was determined that organizational position was independent of age, union membership, and strike behavior. 44
TABLE 1-Per Cent of Older and Younger Nurses with High Professional Orientations Per Cent High Each Scale Professional Orientations
Professional organization as major referent Belief in public service Belief in self-regulation Sense of calling to the field Autonomy
Older %
Younger %
Chi Square
Correlation Coefficient
52.4
34.1
3.61
0.22*
40.5 9.5 58.1 69.8
34.1 4.4 40.9 69.8
2.15 0.95 1.94 0.06
0.07 0.14 0.19* -0.07
*p < .05
occupational attainment than are younger nurses. Although all of the relationships are in the expected direction, only fathers' educational (r = -.26, p < .05) and occupational (r = -.24, p < .05) attainment are significant. Changes in the entry program have also occurred. Older nurses were likely to have come from either a three-year diploma (45 per cent) or a five-year baccalaureate program (38 per cent). Eighty per cent of younger nurses entered nursing through a four-year program. These results support our initial contention. Age and Attitudes The second analysis considered the effect of age on professional orientation. The nurses were asked to indicate their agreement (on a five-point scale) to a series of 15 statements representing their belief in the professional organization as a major referent, belief in public service, belief in self-regulation, sense of calling and autonomy.14 These items were selected from the 50-item professional inventory on the basis of factor analytic results present by Snizek. 15 As indicated in Table 1, there was a high degree of agreement with all items by both groups (age was dichotomized, based on a bimodal distribution, as less than 36 years and 36 years and older). The strength with which two of these values are held by the older nurses is indicated by the correlation analysis. Older nurses were more likely to see the professional organization as their major referent and to view nursing as a calling; both of these relationships are statistically significant. When we turn to the public health nurses' attitudes toward collective bargaining, a different picture emerges (Table 2). Using contingency analyses, we found that younger nurses were more likely to feel that the union represents their professional interests and to consider the union as a professional organization. They did not believe that collec-
tive bargaining was incompatible with professional standards, nor did they believe that striking was inappropriate for nurses. All of these relationships are statistically significant. A majority of both age groups agreed with the statement indicating a belief that collective bargaining is a positive force for the nursing profession and that it is appropriate for nurses to bargain with management. In summary, age AJPH January 1979, Vol. 69, No. 1
CHANGING PROFESSIONAL IMAGES OF NURSES TABLE 2-Frequency and Per Cent of Agreement with Collective Bargaining Attitudes for Each Group of Nurses Agree
Collective Bargaining Attitudes
Older
Younger
Chi Square
I consider the union as a professional organization. I believe that strikes are inappropriate for nurses. Collective bargaining is a positive force for the nursing profession. Collective bargaining is incompatible with professional standards. I believe the union represents my professional interests. I believe it is appropriate for public health nurses to organize and to bargain with management.
8 (19.5)
24 (55.8)
4.78*
27 (65.9)
15 (34.9)
6.86**
30 (69.8)
36 (83.7)
1.63
15(34.9)
4 (9.1)
17 (39.5)
27 (61.4)
3.32
37 (86.0)
41 (93.2)
0.55
7.03**
*p < .05 one-tailed test *p < .01 one-tailed test Note: Percentages given in parentheses
had an effect on public health nurses' attitudes toward collective bargaining on four of the six relationships tested. Nurses were also asked for their preference for representation in collective bargaining. Results presented in Table 3 show that younger nurses were almost equally divided as to their preference for the union or the professional association, while 75 per cent of the older nurses preferred the professional association (16 persons selected the "other" category, which is not analyzed here).
Background, Age and Behavior When correlations were computed between age and parental background with two behavioral measures-union membership and participation in the strike (Table 4)-we found that younger nurses and nurses whose parents had higher occupational and educational attainment were more likely to belong to the union and to go out on strike than were older nurses and those from families with lower attainments. To determine whether the difference can be attributed to the expected liberalness of youth or to actual changes in profes-
TABLE 3-Preference for Representation in Collective Bargaining for Younger and Older Respondents Professional Age
Union
Organization
Total
Younger n = 37 Older n = 36
21(56.8)
16(43.2)
37(100.0)
9(25.0)
27(75.0)
36(100.0) N
*16 missing observations Note: Percentages given in parentheses
AJPH January 1979, Vol. 69, No. 1
=
sional images, partial correlation coefficients were computed. Controlling for age, parental education is still significantly associated with unionism and participation in the strike, but father's occupation is no longer significantly related.
Discussion The premise underlying the current study was that professional orientation would mediate in the relationship between age and attitudes toward collective bargaining. It was also expected that changes in the recruitment and in the entry program into nursing would explain differences in professional orientation. The general expectation was that more professionally oriented nurses would be younger, have more positive attitudes toward collective bargaining, and be more militant in their behavior. Although the latter part of this argument is supported by these data, the link to professionalism* is not. In fact, we found that for two of Hall's Professional Orientation Scales-the Professional Association as Referent and the Sense of Calling to the Field-older nurses accepted these orientations more than did the younger nurses. Perhaps this is not surprising in light of the general desirability of professionalism. In addition, the Hall scales measure fairly traditional professional values. The sense of calling to the field, for example, is closely akin to Nightingalism-the belief that one should be dutiful and deferential. Father's educational and occupational attainment and type of program from which an individual entered nursing were the background variables which showed the strongest
73*
*It may also be that our sample is too homogeneous to reveal any differences that we might find in a sample containing both hospital and public health nurses. 45
BLOOM, ET AL. TABLE 4-The Relationship of Age and Parental Background with Union Membership and Militancy Pearson Product-Moment Correlation Coefficients Mother
Father
Behavior
Age
Education
Occupation
Education
Occupation
Union Membership Strike Participation
-.31** -.30**
-.22* -.26**
-.05 -.18
-.26** -.34***
-.17 -.24**
*p < .05 one-tailed test **p < .01 one-tailed test ***p < .001 one-tailed test
association with age. Age, as well as parental educational attainment and father's occupation, was significantly related to militancy. That nurses from higher status backgrounds were more militant is consistent with Engel and Schulman's findings' for medical residents. We had predicted these relationships to be a function of values and beliefs of the nurses. Nurses from lower social backgrounds are conforming and accepting of the status quo, while nurses whose parents had higher educational and occupational backgrounds are more self-directed and see militancy as a way of bargaining with management. In this analysis, organization position (supervisory vs staff nurse) was independent of age, and thus not related to the dependent variables. Since the supervisors are in the same bargaining unit, this is not a surprising finding. Given a different set of organizational arrangements, however, staff position might have significant effects and, thus, would need to either be controlled for or considered as a predictor variable. Attitudes relating collective bargaining and professionalism are the most interesting findings, showing shifts in the images of nurse professionalism.* Collective bargaining for nurses is an accepted fact. Who the bargaining agent should be and how militant one should be seem to be the key questions. Older nurses were more comfortable with professional organizations, while younger nurses seemed to find that unionism and militancy are compatible with professionalism. Because of the changes in recruitment into nursing and the programs of entry, the trend toward union representation in collective bargaining activity and militancy should continue.
*While the sample is small and from one geographical area and therefore may not be representative of public health nurses in general, added credence of these findings is provided from the authors' preliminary analyses of data from two other counties, albeit in California. 46
REFERENCES 1. Engel G and Schulman M: The relationship of unionism to professionalism in medicine. J. of Medical Education 51:132-134, 1976. 2. Hughes E, Hughes HM and Deutcher I: Twenty Thousand Nurses Tell Their Story, Philadelphia: Lippincott, 1958. 3. Davis F, Olesen V and Whittaker E: Problems and issues of collegiate nursing education. In Davis F (ed.), The Nursing Profession: Five Sociological Essays, New York: Wiley, 1966. 4. Simpson R and Simpson I: Woman and bureaucracy in the semiprofessions. In Etzioni A (ed.), The Semi-Professions and Their Organizations, New York: The Free Press, 1969. 5. Kohn M: Class and Conformity, Homewood, IL: The Dorsey Press, 1969. 6. Scott WR, Dornbusch S, Sagatun I, et al: Task conceptions and work arrangements. Paper presented at the Annual Meeting of the American Sociological Association, Denver, 1971. 7. Godfrey M: Someone should represent nurses. Nursing 76:7385, 1976. 8. Corwin R: Militant Professionalism: A Study of Organizational Conflict in High Schools, New York: Appleton-Century Crofts, 1970. 9. Cole S: The unionization of teachers: Determinants of rank and file support. Sociology of Education XLL66-87, Winter 1968. 10. __. Teachers' strike: A study of the conversion of predisposition into action. American J. of Sociology 74:506-520, 1969. 11. Cox H: Professionalism and teacher militancy. Paper presented at the Annual Meeting of the American Sociological Ass'n, New York, 1976. 12. Alutto J and Belasco J: Determinants of attitudinal militancy among teachers and nurses. Indus. & Labor Relations Review 27:216-227, 1974. 13. U.S. Bureau of the Census. 1970 Census of Population Classified Index of Industries and Occupations, Washington, DC: U.S. Government Printing Office, 1971. 14. Hall R: Professionalization and bureaucratization. American Sociological Review 33:92-104, February 1968. 15. Snizek WE: Hall's professionalism scales: An empirical assessment. American Sociological Review 37:109-114, 1972.
ACKNOWLEDGMENTS We gratefully acknowledge the support provided by the Committee on Research, University of California, Berkeley. An earlier version of this paper was presented at the meeting of the American Sociological Association, Chicago, Illinois, September 9, 1977.
AJPH January 1979, Vol. 69, No. 1
