Effects of Specialization and Client Differentiation on the Status of Nurses: The Case of AIDS

This is a study of how change in the organization of work within hospitals affects the disputes over contested professional jurisdictions. We employ the natural experiment in hospital work reorganization motivated by the AIDS epidemic to empirically document the effects of specialization and client differentiation on the increased intra-organizational status of nurses. We demonstrate that specialized AIDS units represent a form of hospital reorganization in which responsibility, authority, and autonomy devolve toward nurses. Measures of organizational outcomes are derived from the aggregated evaluations of the nurses working in 40 units in 20 hospitals. Our analyses show that different organizational forms are mirrored in differences in the presence of features related to the status and autonomy of nurses. Our work provides some new sociological perspectives on nursing and the changing medical division of labor.