Beyond Occupational Differences: The Importance of Crosscutting Demographics and Dyadic Toolkits for Collaboration in a U.S. Hospital

We use data from a 12-month ethnographic study of two medical-surgical units in a U.S. hospital to examine how members from different occupations can collaborate with one another in their daily work despite differences in status, shared meanings, and expertise across occupational groups, which previous work has shown to create difficulties. In our study, nurses and patient care technicians (PCTs) on both hospital units faced these same occupational differences, served the same patient population, worked under the same management and organizational structure, and had the same pressures, goals, and organizational collaboration tools available to them. But nurses and PCTs on one unit successfully collaborated while those on the other did not. We demonstrate that a social structure characterized by cross-cutting demographics between occupational groups—in which occupational membership is uncorrelated with demographic group membership—can loosen attachment to the occupational identity and status order. This allows members of cross-occupational dyads, in our case nurses and PCTs, to draw on other shared social identities, such as shared race, age, or immigration status, in their interactions. Drawing on a shared social identity at the dyad level provided members with a "dyadic toolkit" of alternative, non-occupational expertise, shared meanings, status rules, and emotional scripts that facilitated collaboration across occupational differences and improved patient care.