The Power of Protocol: Professional Identity Development and Governmentality in Post-socialist Health Care

Abstract

The Czech Republic is experiencing a growing trend of health-care worker emigration. Although some emigrate for long periods of time, many return after a few months or years abroad and re-enter the Czech health system. The nurses’ narratives in this study draw on experiences in Czech, British, and Saudi hospitals to explore the role standardised medical policies, procedures, and protocols play in the development and maintenance of a nurse’s professional identity in the post-socialist context. The author suggests that performance of protocols versus informality of practice in health-care settings provides a lens through which to view professional identity in post-socialism. In fields such as health care, standards operate as measures of security that create normative rules of governmentality, regulate behaviour, and prevent harm. The nurses in this study describe the majority of Czech hospitals as lacking standard protocols for patient care. Encountering strict rules of practice in foreign hospitals leads them to evaluate the professionalism and quality of Czech health care and their own selves as nurses. Their assessment is often based on their own ability to effectively perform within the standardised system. The author’s primary analysis for this presentation will concentrate on the ways that standardisation relates to ideas about professionalism and nursing autonomy and status.