'They'll still get the bodily care'. Discourses of care and relationships between nurses and health care assistants in the NHS

This paper examines the impact of recent changes in work organisation in the NHS, drawing on research undertaken in two English hospital wards. Nurses' and health care assistants' responses to the introduction of a new skill mix are explored through qualitative interview data. The nurses' perceptions are explored in relation to theories of occupational closure. These suggest that claims to distinct knowledge and ownership of the process of care may be undermined by the reproduction of hierarchical models of work organisation. The data suggest that the nurses' ambivalence, recognised by managers, seems to limit their effectiveness in resisting fordist practices of routinisation and deskilling. It also impacts upon health care assistants, who seem to be excluded from nursing's occupational project and whose contribution to care may, as a consequence, be devalued.