Findings

1. Genetic Counselling: Process or Profession?Professional Tensions in an Aspiring Health ProfessionJacqueline D. OgilvieDepartment of Clinical Epidemiology & BiostatisticsMcMaster University, Hamilton ON, Canada Introduction Genetic services are expected to have an expanded role in health care. Yet, stakeholders debate the exceptional status of genetics in healthcare and who is appropriately trained to provide such services [1,2]. This debate can be seen in the field of genetic counselling as two seemingly distinct groups, genetic counsellors and nurses, have staked a claim in the practice of genetic counselling. I compare here the professional identities of genetic counsellors and genetic nurses as represented by their respective professional societies. I argue that these two allied health professions are vying for a similar position in the medical hierarchy. Drawing on theories of occupational closure [3,4] I suggest efforts of mutual closure and demarcation between these two female professions. • Methods • I conducted fieldwork & participant observation at meetings of genetic counsellors and genetic nurses during the Fall of 2004: • Canadian Assoc. of Genetic Counsellors National Society of Genetic Counsellors • Int’l Society of Nurses in Genetics American Society of Human Genetics • I attended society business meetings, professional issues meetings, plenary sessions, etc. I sought the opinions of delegates on the status of the organization, meeting content, etc. • Documentary sources identified through these meetings such as codes of ethics and various committee reports were also analyzed. • The analytic process involved iterative memoing and sorting of descriptions into tables to identify and compare themes • Findings • The genetic counselling and genetic nursing community both feel strongly about their ability to provide genetic counselling • Both are trained as patient advocates and can provide family-based, whole-person care • Both describe being positioned between the medical or scientific community, and the patient • There is a desire among both communities to maintain and promote their own professional identity (training, philosophy, goals) • Both professional groups rely on their training as a valued entity, affording them the specific knowledge base needed to practice • Efforts of Occupational Closure • Strategies based on accreditation and licensure are being deployed by the genetic counselling community. E.g., only M.Sc trained candidates accepted for certification as of 2003 in USA; as of 2007 in Canada • The genetic nursing community created their own certification system in 2001 • Theories of occupational closure (e.g., dual closure) most often describe hierarchical relations of professions [3, 4]. However, there is no clear hierarchy between genetic counsellors and nurses; neither can be socially defined as inferior • While nurses working in genetic counselling are experiencing exclusionary pressures, I argue that their response is suggestive of processes of mutual closure, as they attempt to consolidate their own practice Occupational Closure in Genetic Counselling Adapted from [3,4] • Conclusions • Genetic counsellors and genetic nurses each uphold a distinct professional identity, yet this distinction appears to be based on ideologies and perceptions: both groups proclaim similar goals in counselling and approaches to care. As a result, both are competing for a similar position in the provision of genetic healthcare. • Literature on occupational closure attends to the exertion of power in a vertical direction; it does not adequately describe strategies involving two female professional projects where no clear subordinate group exists, as seems to be the case of genetic counselling • While the analytic distinction between genetic counsellors and nurses is based on the public discourse of each, the distinction between them in practice is not known. It remains to be seen how these differences are perceived in the reality of practice. • References: • 1. Guttmacher, A.E, Jenkins, J and Uhlmann, W.R. (2001) Genomic Medicine: Who will practice it? A call to open arms. Am J Med Gene, 106: 216-222. • 2. Greendale, K and Pyeritz, R.E. (2001) Empowering Primary Care Health Professionals in Medical Genetics: How Soon? How Fast? How Far? Am J Med Genet, 106: 223-232. • Bourgeault, I.L. (2005). Gendered professionalization strategies & the rationalization of health care: midwifery, nurse practitioners, and hospital nurse staffing in Ontario, Canada. Knowledge, Work and Society, forthcoming. • Witz, A. (1992). Professions and Patriarchy. New York, NY: Routledge. Pp.44-59.