How do professionals with multiple job identities handle their different roles? Professors Charlotte Croft, Graeme Currie and Andy Lockett of Warwick Business School examine the case of nurse managers who are expected to be subordinates as well as leaders, revealing how the two identities impact work and emotional well-being.

Nurse Managers and Identity Conflicts: An uphill climb for the Florence Nightingales by CoBS Editor Megha Sureshkar. Related research: The Impact of Emotionally Important Social Identities on the Construction of a Managerial Leader Identity: A Challenge for Nurses in the English National Health Service

Take a minute to think about some of the social groups which you belong to – groups based on biology (for example, gender and age), family history (perhaps, religion and ethnicity) or personal choice (for instance, occupation and political party). Groups fulfil basic needs for each of us, which is why we take them seriously. They make our worlds go round.

Individuals develop emotional attachments with various social groups to attain a sense of meaning or belonging. But due to multiple group memberships, people are required to possess different identities, some of which are contradictory. And there we have it – a recipe for identity conflict.

The authors’ research looks into people dealing with different identities within the workplace context. Prof. Croft and her co-researchers inspect the topic of identity conflict and explore some possible solutions to the issue by putting a spotlight on nurse managers – ‘hybrid’ professionals who wear two hats: that of a nurse and a manager.

Being of two minds (or more)

Human beings are social animals. Every person has multiple social identities. One might be a parent at home, a teacher at school and a social worker at an NGO.

Apart from individual identities, we all have group identities – labels that we use to categorise or identify ourselves or others as members of specific groups. Examples include religion, nationality, and ethnicity, just to name a few. Both at an individual and a group level, we always strive to achieve what is called a desired identity – people who feel they can build desired identities experience increased self-esteem and a sense of legitimacy, in addition to high levels of group influence.

Identity conflict occurs when individuals feel that others perceive them as acting in a manner that is incompatible with a desired group identity, or when they themselves feel unable to sustain multiple identities. When encountered with conflict, individuals engage in identity work –  activities to signify and express who they are and what they stand for in relation or contrast to some set of others. As such, this creates a sense of balance between competing identities, enabling them to move between multiple identity constructions.

Movers and shakers

Leadership influence relies on the communication of a desired leader identity to potential followers. But leaders of social groups also need to maintain their desired group identity to remain influential. That means, while influential leaders need to conform to the socially-determined ‘desirable’ leader image, they must also be perceived by others as representative of the social group they are attempting to lead.

The aforementioned is often observed in sports and politics: a person who sets an example and gathers a large support of his/her group members often has huge influence over them and secures leadership of the covey. It should not be hard to recollect people who have used such effective tactics to gain leadership in their respective fields.

We have thus far established the issue of identity conflict and leadership in a social group. Now it is time to dig deep into the case of individuals occupying hybrid positions – roles in which they are required to create desired professional and managerial leader identities. A perfect setting for regular identity conflict arising from fragile identity constructions and negative emotional experiences.

Inside a nurse’s world

Nurses, a group traditionally viewed as subordinate followers, rather than leaders, provide an illuminating context from which to explore the emotional experiences of professional hybrids.

It might be conventional wisdom to attribute the nurses’ leadership struggle to the dominance of physicians within the healthcare setting, but it is noteworthy that nurses play an influential role in medical decisions and treatments and cannot be perceived as merely passive team members. So, the problem is not with medical hierarchies but with accommodating discrepancies between leader and professional identities.

Nursing is a predominantly female profession, with 90 percent of the workforce made up of women. This is, in part, due to the inherently ‘feminine’ identity of the profession, framed by symbols of Florence Nightingale, encouraging ideals of obedient, altruistic, and passive caring – and this despite the increasing technical skills, academic education or leadership roles required by modern nurses.

Although a minority group, male nurses occupy a disproportionate amount of nursing leadership positions. The usual culprit in such scenarios is the underlying societal assumption that men are more ‘desirable’ leaders – associated with identities such as masculinity, authoritativeness, and influence over others – than women. And the medical profession, unfortunately, is not an exemption. As such, it is essential that nurses moving into hybrid roles communicate leader identities to others, while remaining representative of the collective nursing identity. But before we analyse how nurses attempt to align a distinctly feminised professional identity with a more masculine leader identity, it is important that we look into some of the challenges nurse managers face.

A bitter pill to swallow

After extensive interviews and conversations with 32 nurse managers, the authors discovered that discussions about nurse identities evoked passionate and animated responses. In contrast, when talking specifically about their identity as managerial leaders, discussions became less animated and more subdued. In addition, the interviewees saw the demands of their leader identity as a functional requirement of their hybrid role and the demands of their nurse identity as more emotionally fulfilling.

To rub salt into the wound, nurse managers were sometimes required to detract from behaviours associated with nurse identity, such as being able to prioritise caring for a patient, in order to fulfil the demands of their leader identity. One nurse was quoted as saying, “I would rather be seeing the patients, but there are times when I can’t because my management responsibilities dictate that I do something… I’m not happy when that happens”.

Due to their dual role and priorities, nurse managers also felt concerned that they no longer enjoyed influence among others in the nursing group. This made them feel like outsiders and undermined their group leadership potential. And identity conflict, confusion and a sense of loss ensued.

Just what the doctor ordered

In an attempt to deal with their identity conflicts and overcome negative emotional experiences, nurse managers engage in three types of identity work.

1. The first type of identity work involved distancing themselves from behaviours associated with undesirable managerial leader identities. And there were two ways to do that. First, nurse managers attempted to deflect negative reactions to managerial decisions onto other, higher-level managers, to protect their identity as members of the nurse group, and to make clear that they did not agree with the inconsistent behaviors of ‘managers’. Typical responses included “we’ve got no choice in this because these decisions are made above my head”.
2. Second, nurse managers attempted to distance themselves from a manager identity by highlighting their own commitment to behaviors associated with a nurse identity, suggesting a typical ‘manager’ would not act in a similar way. For example, one nurse manager said, “Those normal managers, they don’t want to get up at 6 in the morning and they don’t want to work Christmas Day or New Year’s Night… It’s not like that for me, it’s not about the spreadsheets and leaving by 5pm… I’m still part of the team, it’s important for them to see that.”
3. The next type of identity work by nurse managers included attempts to construct their leader identity by framing it in language that is typically associated with their nurse identity. The common features of such language include animated, positive, and emotional discussions which are symbolic characteristics of the nurse identity. Nurse managers engaging in this type of identity work suggested that they did not try to distance themselves from a leader identity, but that their continued commitment to a nurse identity influenced their leader behavior, arguably making them better leaders. As such, nurse managers attributed their good managerial decisions to their clinical knowledge and background. Rather than trying to accommodate managerial leader identity demands, they relied on their continuing emotional attachment to their nurse identity to guide the way they viewed themselves, as professional nursing leaders.

While the above two types of identity work enabled nurses to overcome some of the identity conflict, they continued to report negative emotions as they still felt a loss of nursing group influence. But there emerged victorious a group of nurse managers who found a way to experience very less identity conflict and emotional distress. So, how exactly did they achieve that?

Although a small group, these nurse managers – now general managers – had moved into strategic management positions and were able to resolve their identity conflict and overcome negative emotional experiences because they were no longer emotionally attached to the formation of a desired nurse identity. As a result, the nurse managers no longer experienced negative emotions when they felt others did not perceive them as nurses. In other words, not only did this group embrace their managerial leader identity, but they also distanced themselves from an emotional attachment to their nurse identity. That is not to say that these managers dissociated themselves from their past experience as a nurse, rather that they no longer associated their ‘true self’ with an ability to develop a desired nurse identity.

Nurse managers: A long way to go

Despite a degree of relief that the identity work might offer, nurses remaining under hybrid roles continue to experience negative emotions and feel a loss of nursing group influence. Existing research paints a rosier picture: hybrids are ultimately able to overcome identity conflict, relying on emotionally important group identities to legitimise their changing identity to both themselves and other group members. Armed with their findings, Prof. Croft and her fellow co-researchers argue that it is not always the case – as demonstrated by the example of nurse managers.

The tactics employed by nurse managers allow them to overcome individual identity conflicts to some extent, but they are far less adept at overcoming the emotional distress associated with their perceived loss of an emotionally important and desired group identity. Negative emotions could only be resolved by foregoing emotional attachments to the professional group. More research into effective solutions on emotional detachment might offer some much-needed tonic to the nurse managers.

Useful links:

• Link up with Profs. Charlotte Croft, Graeme Currie and Dean Andy Lockett on LinkedIn
• Read a related article: Improving the effectiveness of surgical teams
• Discover Warwick Business School
• Apply for an MBA or EMBA programme at Warwick Business School.

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The Council on Business & Society (The CoBS), visionary in its conception and purpose, was created in 2011, and is dedicated to promoting responsible leadership and tackling issues at the crossroads of business and society including sustainability, diversity, ethical leadership and the place responsible business has to play in contributing to the common good.  

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