Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




This research, using the feminist methodology of "reading up the power structure," is the first study of hospital-based Certified Nursing Assistants (CNAs). Through interviews with 21 CNAs in a large, independent, urban hospital in the Midwest, the study examines how two major institutions have impacted the labor process of CNAs and the division of labor between CNAs and RNs. These include historical changes in nurses' priorities in pursuing professional status, and the reconfiguration of healthcare provision in the United States. The removal of LPNs from hospital nursing creates a clear division of labor between RNs and auxiliaries since, unlike LPNs, CNAs are unable to substitute for RNs. CNAs have been cross-trained to replace clerical and technical workers, but this does not impinge on the labor process of RNs.

CNAs perceive good care as incorporating both instrumental and affective elements, in opposition to detached, "professional" healthcare, and they take a holistic view of patient welfare that corresponds with Foucault's "pastoral power." When dealing with difficult patients, CNAs choose alternate strategies; "killing them with kindness," or "being professional" (withholding affective care.)

There is a limited career ladder for CNAs, but many create their own dynamic ladder by combining work and study, gaining higher education incrementally over many years. Hospitals support this in formal and informal ways that are not available in other healthcare settings, such as nursing homes.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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