The Anaesthetic Technician: From marginal to marginalised

profession, a Neo Weberian perspective

Declaration

I state that this essay is my own work and that where other sources of information have been

used these have been acknowledged in the accepted academic manner.

I declare the following interests in relation to this essay - that I am currently registered as an

Anaesthetic Technician with the Medical Sciences Council of New Zealand; I am employed by

Counties Manukau Health, and a member of the New Zealand Anaesthetic Technicians

Society. The views in this essay are entirely my own and do not reflect on the views held by

my regulatory body, employer, or professional association.

Total Word Count: 2031 Date of Submission: 21st September 2018

Excluding Abstract & References

Abstract

This essay examines the transition of the Anaesthetic Technician from unregulated to

regulated profession using a Neo-Weberian framework - a sociological viewpoint of

professional emergence. It describes the role of state sanction, and the process by which an

emerging profession defines itself; in addition, occupational boundaries and continued

jurisdictional disputes are considered with examples from the journey of the Anaesthetic

technician illustrating salient points. By examining the process of how the profession has

arrived at its current status, we are better able to assess and adequately prepare for future

challenges.
 Introduction

This review examines the progression towards professional status of the Anaesthetic

Technician (AT), exploring the Neo Weberian themes of social closure, the resulting impact

on how we define ourselves and the continued contest for recognised professional

legitimacy within our chosen domain. The genesis of the AT devolves from the medical

profession of Anaesthesia, whereby its practitioners desired to create an assistant dedicated

solely to the provision of anaesthesia. In this, they could exercise autonomy over a

subordinate workforce and utilise time more efficiently through divestment of tasks thought

to be “unchallenging or too time consuming” (Germov, 2014, p. 448). Beginning with a

hospital based pilot scheme in 1978 through to tertiary accredited vocational training in

1992; it is this origin which has defined our scope of practice and been the basis by which

our process of professionalization within a Neo-Weberian framework – that of state

protected legal title and demarcation of occupational boundaries - has characterized itself.

The role of dual closure

In the Neo-Weberian context health professions base their claims to professionalism by

maintaining a specialist body of knowledge or expertise, and that by securing and limiting

access to this knowledge – through multiple means - they obtain social closure; thus

accruing the benefits of status, autonomy and increased income (King, Borthwick,

Nancarrow, & Grace, 2018). Given the changing socio-political landscape of health and the

progressive nature of its disciplines there is often intense competition to secure these

benefits and the effects of dual closure may be seen. Dual closure was first proposed by

Parkin (1979), and interpreted by Ryan, Carryer, and Patterson (2003, p. 137) as a method
used by “occupations as they seek to increase their position, and autonomy, within a

particular workforce…” and further described by King et al. (2018, p. 5) as tactics “...

implemented by a profession seeking to establish and expand its role boundaries by taking

measures to both exclude outsiders from their territory and encroach on that of superior

professions”

This form of closure is a significant step along the path to professionalization, as it requires

the political will and co-ordination of an occupationally aligned body in addition to the

means with which to enforce its mandate at a national level – in the case of the AT, this was

the New Zealand Association of Anaesthetic Technicians (NZATS). At this point a group

begins to utilise exclusionary tactics to delineate occupational boundaries; in particular

credentialist strategies of developing processes of accreditation, combined with educational

pathways leading to formalised qualifications which are designed to limit the entry of

suitably qualified individuals to the occupation (Ryan et al., 2003) – a pathway quite easily

charted in the case of the AT from various certificates to current Diploma and proposed

Degree. Given the considerable overlap of role responsibility and care involved in

healthcare, the ability to monopolise the workspace and define it as one’s own – secure

from competition - requires legalistic exclusion. This method legitimises an exclusive area of

practice, often through the process of registration or licensing, although it does not give it

absolutist sole privilege within a domain. If, as Lane (2006, p. 341) states “... that

professional boundaries are not natural enclaves organised around a specific object of

knowledge” then we can see the professional workplace as a continual negotiation of

occupational practice. It is in this sphere that the second component of dual closure exists,

that of usurpation; whereby one group challenges the dominance of another, usually over
control of competencies or rights to practice in a particular scope or area – whether to

prove legitimacy or vying for a better position within the system.

The perioperative environment contains individuals from multiple professions and

specialties, each with varying degrees of autonomy and subordination attempting to

navigate various boundaries; as such it is not unusual for overlap or ‘role-creep’ to occur,

when this occurs often enough over a period of time a group may consider themselves

having cause to claim a role or task as part of their identity, and develop specific knowledge

around that task, regardless of whether this is also true of a second group. As noted earlier,

the role of the AT developed from the desire for a subordinate workforce with a specific

sphere of practice, one which had previously been the exclusive domain of the Registered

Nurse (RN); therefore the continued development of the AT can be considered at the

expense of the RN through the process of dual closure – though not without resistance.

This form of usurpatory challenge often results in an immediate response from the

dominant group, usually through the use of unionised defensive strategies (Saks, 2016) or

by a stigmatisation that construes an image of a dangerous amateur requiring professional

oversight by the dominant group (Currie, Finn, & Martin, 2009). In terms of the pathway to

professional status, an example of jurisdictional defence and artificial comparative construct

can be seen through an article in Kai Tiaki (a New Zealand Nurses Organisation publication),

titled ‘Public safety or patch protection?’ (Head, 2011); the article expresses doubt regarding

the AT knowledge base, transition process to state registration, and most tellingly - in terms

of exercising domain authority - lack of nursing input into the decision process regarding the

state registration of the AT. Couched in terms of public interest, they go on to claim that

such consultation would have “…resulted in more appropriate training, education and

qualification parameters for ATs, which would assure public safety…” (Head, 2011, p. 34); a
clear example of exerting professional dominance over another emerging profession. In this

context it highlights that any new role development within healthcare represents a

significant “challenge to traditional roles and modes of service delivery because new roles

may threaten existing professional jurisdictions and identities” (Currie et al., 2009, p. 271).

This is certainly true in relation to the recent consultation process conducted by the Medical

Sciences Council of New Zealand where the proposal to “improve workforce flexibility

through broadening the range of activities that could be undertaken by the anaesthetic

technician workforce” (MSC NZ, 2018, p. 4) encompassed a title change and expansion of

the current AT scope of practice within the perioperative environment - the traditional

domain of the RN.

In response to continued intrusion by a satellite group, the dominant group may employ

exclusion or vertical encroachment through the claim of superior competence (Germov,

2014), e.g. “We suggest that it is inappropriate and premature to be considering developing

an advanced scope of practice, particularly one which directly, if narrowly and inadequately,

replicates several well - established nursing roles within the perioperative continuum that

are regulated by the Nursing Council of New Zealand (NCNZ)” (NZNO, 2017). Additionally

the statement that “…it would be considerably more straightforward to ensure that nurses

have access to the technical training anaesthetists require,…” (NZNO, 2017, p. 3) supports

the counterclaim of being the better choice, or preferred practitioner within the contested

domain.

Therefore we see that the process of dual closure is not a static event that once achieved

provides unique privilege, but rather the basis of the ability for a profession to contest

occupational boundaries within a known and state sanctioned framework.

 From marginal to marginalised

We can define the term marginal profession here as a group that operates in professional

boundaries which may be contested, often overlapping in jurisdiction and that also requires

constant negotiation with other professional groups regarding access to resources (Butler,

Chillas, & Muhr, 2012). This is further defined by King et al. (2018) who considers that

changing healthcare policy and technological advances render these boundaries even more

fluid and dynamic. We can also state that such groups whilst operating within state

sanctioned division of labour orthodoxies, may not enjoy the privileges associated with state

sanction; such as protection of title, which in turn may also be linked to status and increased

remuneration (Saks, 2015).

Such was the state of early AT’s working within the perioperative environment - on the

periphery of technologically evolving anaesthetic practice and often engaged in territorial

disputes with other perioperative practitioners such as Nursing, over precedence or

priorities of care. Contrary to the concept of a marginal profession however, is that the

practice of the AT did not sit outside the “spectrum of orthodox health professions” (Saks,

2015, p. 856), particularly in view of the relationship maintained with the New Zealand

Society of Anaesthetists (NZSA) culminating in a Memorandum of Understanding between

the two groups, first in 2009 and updated in 2013 (NZSA & NZATS, 2013).

Having a close association with a medical specialty, it is not surprising that the strategies

adopted by AT’s moving towards professionalism mimicked those of the dominant medical

group (Germov, 2014). Primarily the development of a professional association and a code

of conduct - forming The New Zealand Association of Anaesthetic Technicians and Nurses

(NZAATN) which in turn became NZATS in 2003. Secondly, establishment of a body of

scientific and academic knowledge required to complete training at a Tertiary level; as from
1992 training moved from a Ministry of Health based training board to Polytechnic

(Auckland Institute of Technology). And finally the establishment by NZATS of an exit

examination by which it accredited its members at a national level.

In 2012 Anaesthetic Technicians achieved registration under the Health Practitioners

Competency Assurance Act (2003), in doing so they had now established legal exclusion of

the profession and its title; entry to which could only be achieved through obtaining the

credentials set out by the self-maintained register of the new profession (Saks, 2010). This

now meant that the practice of anaesthetic technology was protected by the state, and as

such regulated by a state recognised professional body – the Medical Sciences Council of

New Zealand.

Through simple use of the title AT, it now denoted the holder as one who is registered and

legally allowed to practice within its defined scope of practice. It is worth bearing in mind

that although this meant that AT’s now had the autonomy and power to regulate, it is only

on the proviso that “they did so in the public interest, and balanced their own interests with

the interests of the public” (Adams & Saks, 2018, p. 70) as the state continues to reserve the

right to intercede.

State mandated registration notwithstanding, the practice of Anaesthetic Technology still

sits within a satellite role within the orthodox healthcare system; as recent attempts to

review the current scope of practice has shown there is still much work to be done within

the contested spheres of perioperative practice (MSC NZ, 2018).

It is a combination of this subordination through “sub-delegated tasks” (Saks, 2015, p. 856)

within the division of Anaesthetic labour and the limited application and significance of its

knowledge and skill set that contributes to the continued marginalization of AT’s (Saks,

2014). Therefore, it is incumbent upon the AT to continue to develop and contest these
margins of practice in a manner that continues to grow the profession; based on relevant

researched best practice, dynamic flexibility and informed debate.

To maintain professional relevance AT’s must continue to protect themselves from

occupational encroachment - such as the recent Registered Nurse Anaesthetic Assistant

course (NZNO, 2014) - through construction of a “politically informed defence of the

qualities that mark it out as particular” (Currie et al., 2009), whilst simultaneously actively

seeking legitimisation in the contested areas of the perioperative environment.

Conclusion

The evolution of the AT is a clear example of the Neo-Weberian principle in that we can

chart the process by which a profession has obtained its status by social closure through

state sanction and the strategies of exclusion and usurpation. For the AT, this has been

obtained against a background in which healthcare providers compete for resources amidst

changing healthcare priorities and policies, while seeking to maintain their occupational

boundaries and standing through legal protections (Saks, 2012). Additionally the Neo-

Weberian approach allows for an exploration of the factors and context in which our

profession has emerged, thereby constructing a pragmatic view of the current state of our

profession. A view which is vital to our professions ability to assess an “ever-changing social

climate and technological advances that render professional boundaries and jurisdictions

fluid and dynamic” (King et al., 2018, p. 5)

 References

Adams, T. L., & Saks, M. (2018). Neo-weberianism and changing state-profession relations: The case
of canadian health care. Sociologia, Problemas e Praticas, 88, 61-77.
doi:10.7458/SPP20188814798

Butler, N., Chillas, S., & Muhr, S. L. (2012). Professions at the margins. epherema, 12(3), 259-272.
http://www.ephemerajournal.org/sites/default/files/12-3editorial.pdf Retrieved from
http://www.ephemerajournal.org/sites/default/files/12-3editorial.pdf

Currie, G., Finn, R., & Martin, G. (2009). Professional competition and modernizing the clinical
workforce in the NHS. Work, Employment & Society(2), 267. Retrieved from
http://ezproxy.aut.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=edsjsr&AN=edsjsr.23748174&site=eds-live

Germov, J. (2014). Second opinion : an introduction to health sociology: South Melbourne, Victoria :
Oxford University Press, 2014.Fifth edition.

Head, M. (2011). Public safety or patch protection? Kai Tiaki Nursing New Zealand, 17(7), 34-34.
Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104686087&site=ehost-
live&scope=site

King, O., Borthwick, A., Nancarrow, S., & Grace, S. (2018). Sociology of the professions: what it
means for podiatry. Journal of Foot and Ankle Research, 11, 30. doi:10.1186/s13047-018-
0275-0

Lane, K. (2006). The plasticity of professional boundaries: a case study of collaborative care in
maternity services. Health Sociology Review: The Journal of the Health Section of the
Australian Sociological Association(4), 341. Retrieved from
http://ezproxy.aut.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=edsihc&AN=edsihc.635707748220164&site=eds-live

MSC NZ. (2018). Consultation Outcomes: Review of the Anaesthetic Technician Scope of Practice
[Press release]. Retrieved from https://www.mscouncil.org.nz/assets_mlsb/Uploads/AT-
SOP-Outcomes-Apr2018.pdf

NZNO. (2014, April 2017). Registered Nurse Assistant to the Anaesthetist Retrieved from
https://www.nzno.org.nz/groups/colleges_sections/colleges/perioperative_nurses_college/r
esources/registered_nurse_assistant_to_the_anaesthetist

NZNO. (2017, 15 December 2017). Review of the Anaesthetic Technician Scope of Practice and
Competence Standards for a proposed Perioperative Practitioner Scope of Practice.
Retrieved from
https://www.nzno.org.nz/Portals/0/Files/Documents/Activities/Submissions/1_2017-
12%20Review%20AT%20&%20PP%20scope_NZNO.pdf

NZSA, & NZATS. (2013). Memorandum of Understanding. 5. http://www.nzats.co.nz/wp-

content/uploads/NZATS-NZSA-MoU-Feb-2013.pdf Retrieved from
http://www.nzats.co.nz/wp-content/uploads/NZATS-NZSA-MoU-Feb-2013.pdf
Parkin, F. (1979). Marxism and Class Theory: A Bourgeois Critique: Tavistock Publications.

Ryan, A., Carryer, J., & Patterson, L. (2003). Healthy concerns : sociology for New Zealand nursing and
midwifery students: Auckland, N.Z. : Pearson Prentice Hall, [2003].

Saks, M. (2010). Analyzing the Professions: The Case for the Neo-Weberian Approach. Comparative
Sociology, 9, 887-915. doi:10.1163/156913310X522624

Saks, M. (2012). Defining a Profession: The Role of Knowledge and Expertise. Professions &
Professionalism, 2(1), 1. Retrieved from
http://ezproxy.aut.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=edb&AN=84384680&site=eds-live

Saks, M. (2014). Health Professions, Marginalized. In W. C. Cockerham, R. Dingwall, & S. Quah (Eds.),
The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society.

Saks, M. (2015). Inequalities, marginality and the professions. Current Sociology, 63(6), 850.
Retrieved from
http://ezproxy.aut.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=edb&AN=110012797&site=eds-live

Saks, M. (2016). A review of theories of professions, organizations and society: The case for neo-
Weberianism, neo-institutionalism and eclecticism. Journal of Professions & Organization,
3(2), 170. Retrieved from
http://ezproxy.aut.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db
=edb&AN=118368747&site=eds-live