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A classification system is an important tool in the struggle for professional recognition. When the tensions among visibility, comparability, and control are skillfully managed in the construction of the classification system itself, the same processes need to be balanced at the level of users and policymakers. NIC's goal is to promote the work of nurses by communicating newly visible (in the sense of inscribed and legitimated) work practices and by leaving enough space for controllable action. But even if the designers succeed in creating equilibrium at the information system level, there are potential utilization problems in the political arena. Professionalization through visibility alone may have latent consequences: constant surveillance in the name of the panopticon of cost containment (Foucault 1979). In this era of information infrastructure shifts, the significance of this scenario is enormous. |
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A classification of work becomes, then, a political actor in the attempts to establish power on broad institutional and historical levels. When such a classification system intends to promote a professional group, the challenges are geared toward their ability to enhance profession-alization. In the best case, classification systems hold a memory of work that has been done (laboratory, organizational, epidemiological, sociological) and so permit the recommendation of a reasonable due process for future work (Gerson and Star 1986). |
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It is difficult to retrace these processes after the classification is black boxed. We have been fortunate to observe an effort to classify work in its early days, coordinated by a group of American nursing researchers, which is beginning to spread to other locations as well. Their work exemplifies a profoundly skilled balancing act revolving around managing the trade-offs outlined above. The NIC project team has a global strategy of balanced classification through a series of sophisticated moves of differentiation and dedifferentiation. This strategy assumes that the work of producing equivalence (making other things equal) will reduce the overall amount of effort: retraining when a nurse needs to move into a new situation, introducing the nurse to the medical information system in a new hospital, and so on. It is linked with the strategy of the creation of a single information infrastructure to facilitate hospital operation. |
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