Working in and around the 'chain of command': power relations among nursing staff in an urban nursing home.

By most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing's value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing's quest for professional status in the face of medicine's hegemony over health-care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict--and by aides' resistance to nurses' domination.