Academisation of nursing: An ethnography of social transformations in Chile.

Background: Nursing in Chile is considered to be the leading example of professional development in Latin America - nurses must undertake five years of university education on a full-time programme. Academisation of nursing education is a key aspect in the evolution into professional status. The consequences of education, however, are commonly related to the replication of social institutions and structures that perpetuate social inequalities.

Objective: The study's aim was to comprehend the consequences of nursing academisation and its relationships with the social transformations which that country has witnessed.

Methods: We draw upon ethnographic data, gathered between 2010 and 2011 in a 500-bed, high-quality university hospital in Chile. Participants were nurses ranging from beginners to experienced professionals and recruited from wards representing technically expert nursing and caring-oriented nursing. The data were organised to allow the development of concepts and patterns, using the Grounded Theory approach.

Results: Despite the fact that Chilean nursing originated from the educated elite class, today's nurses share a middle-class consciousness, and a sense of class distinction is encouraged throughout academic training - the 'eliteness' of professional groups. This discourse antagonises middle-class people who 'should' adopt a professional-class identity. A tension among nurses surfaced, based on a competition for a scarce resource: social mobility. Furthermore, an antagonist stratification between university-trained nurses and auxiliary nurses has developed, and in the process the title 'nurse' and the practice of 'nursing' have been monopolised by university-trained nurses, resulting in a relationship of domination-subordination.

Conclusions: The academisation process followed by Chilean nursing is rooted in the social-class transformations of that country. Such process has been ineffective in preventing social inequalities, resulting in the reproduction of earlier historical class differences in nursing, inhibiting nurses' individual development. Class differences are manifest in the socially constructed distinction between the nurse and the auxiliary nurse, resulting in a schism of the nursing family. By reconstituting a broken-up occupation, the political power of nursing could be strengthened.