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From Marginalized to Mastodons: How Relational Dynamics Enhance Identity Formation of a Low-Status Occupational Group

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Abstract

This chapter studies how Dutch certified nursing assistants (CNAs), as members of a low-status occupational group, engage in an identity formation process as part of developing a new occupational profile. The new occupational profile was considered fundamental for occupational members to organize and represent themselves, and subsequently increase their recognition and influence. Micro-level process data consist of participant observations of meetings and informal conversations. The findings show that the identity formation process involved three micro-processes—navigating misrepresentations and the invisible, navigating distinct differentiations, and navigating ownership of the process—in which the relational dynamics between CNAs and members of referent audiences, particularly with members of their adjacent occupational groups, were critical to how the process and the content of the identity narrative evolved. Focussing on the relational dynamics and interactions between CNAs and their adjacent occupational groups, first, revealed that distinct types of differentiations were used. Whereas differentiation by certified nursing assistants initially mainly involved ‘othering’, emphasizing what skills, knowledge and attributes other occupational groups were not having, members of adjacent occupational engaged in constructive relational differentiation. Second, and in extension, the chapter shows how explicitly involving members of important referent audiences in the identity formation process is like a double-edged sword. While it made the process contentious because it initially signified the limited identity content of certified nursing assistants, it was constructive and eventually crucial in developing an identity narrative that was affirmed. Taken together, going beyond the notion that identity is an agentic individual accomplishment and attending to the relational dynamics in identity formation of a low-status occupational group, this chapter shows how dialogue between members of different occupational groups contributes to refining the identity narrative of one occupational without eventually reinforcing dichotomies between different occupational groups.

Original languageEnglish
Title of host publicationOrganising the health care workforce
Subtitle of host publicationStrategic responses to the challenges and dilemmas faced by health and care services
EditorsMark Exworthy, Jane Ferguson, Justin Waring, Yvonne Zurynski
PublisherSpringer Nature
Chapter6
Pages123-145
Number of pages23
ISBN (Electronic)9783031895845
ISBN (Print)9783031895838
DOIs
Publication statusPublished - 2025

Publication series

NameOrganizational Behaviour in Healthcare
PublisherSpringer
VolumePart F861
ISSN (Print)2662-1053
ISSN (Electronic)2662-1045

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025.

Keywords

  • Certified nursing assistants
  • Identity formation
  • Long-term care
  • Low-status occupational group
  • Qualitative research
  • Relational dynamics

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