What happens to a nurse’s social position if they move physically? What happens to their social position back in the country of origin, and in Norway, if they migrate here for work?
By Marie Louise Seeberg
What’s in a word? We have already discussed how a nurse is not simply a nurse – because there is no global, legally recognised definition of this protected profession. We have also shown how the words ‘migrant’ and ‘expat’ do not describe the same people, even though both words describe people working outside of their country of origin.
When researchers talk about people who move from one country to another, we tend to use two different words to describe the moving: ‘migration’, and ‘mobility’. The meaning of words like these, much like ‘nurse’ and ‘migrant’, depends on context.
Each of these words also carries with it a package of ideas. Along with the ideas come whole legal systems: of nurse registration (for ‘nurse’), or of border regulation (for ‘migrant’, ‘migration’, ‘expat’, and ‘mobility’). That is not a coincidence: ideas shape politics – and the other way around. Laws are made by politicians, and politicians are (at least ideally) elected by people based on how they see the world and what kind of world they want.
Migration or mobility?
‘Migration’ has come to carry with it an idea of people coming from the outside, wanting to enter, as seen from people already inside. It is also something, these days, that requires management, regulation, control.
‘Mobility’ has different connotations. It really just means the ability to move, and there is more individual freedom here, we get an idea of ‘people like us’ wanting to move around, perhaps especially of Europeans wanting to move freely within Europe, and even more specifically, of Western Europeans (or ‘Westerners’) wanting to move just about anywhere (formerly known as colonialism).
One outcome of the process leading up to Brexit was the labelling of Eastern Europeans working in the UK as ‘migrants’, in spite of them simply using their right, as Europeans, to mobility within the EU.
According to Elżbieta M. Goździak, the Polish nurses she spoke with hardly used the word migration but used the word mobility (mobilność) to describe flexibility and ability to move between countries.
From migration to social mobility
There is another difference between mobility and migration which I have not talked about yet. ‘Migration’ is moving, and international migration is moving between countries. That is all.
‘Mobility’ is this too, but it is also a metaphor. It is used to talk about ‘movement’ between ‘higher’ and ‘lower’ levels of society. Social mobility is the ability to move from a lower social class to a higher social class, or from a lower social status to a higher social status.
This metaphor works because we are so used to talking about society as if it was vertically divided, but that too is a metaphor and not a physical, spatial reality.
There are language differences and cultural differences around such use of words and metaphors, too. Again, according to Elżbieta, the Polish nurses that she spoke to (in Polish) did not talk about upward or downward mobility. To them, their mobility was simply their physical movement and the ability to move between countries.
But then again, I think ‘social mobility’ in English, too, is a concept that belongs to the social sciences rather than to everyday language.
At a 1996 lecture in Oslo (PDF) (archives.library.illinois.edu) where I was actually present in a packed great auditorium (I am old!), the famous French sociologist and social anthropologist Pierre Bourdieu talked about how social and physical space were related. People, he said, are biological beings and so we have to be in one location at a time. We can’t be everywhere at once. But we are also social beings, so we are in social positions relative to one another.
Social space, he said, is a set of relationships. Because we occupy a physical location and a social position at the same time, we are the link between the physical location and the social position. This is heavy stuff and I am never sure if I understand it very well, but it does seem to make sense so far. So what happens to our social position if we move physically? What happens to our social position if we migrate? And the other way around: what may happen to our physical location if we change our social position?
This is the kind of questions I like to ponder. No wonder I ended up being a researcher. Who needs to know this kind of thing? I would argue that these are not purely abstract questions, but ones with real-life implications.
People tend to move in order to better their circumstances or to escape a feeling of being stuck where they are (journals.sagepub.com). If, say, someone who is a qualified nurse in Poland is tired of their relatively low salary, long working hours, and lack of social status for nurses, moves to Norway and gets a temporary cleaning job because his Norwegian isn’t up to scratch and he can’t afford to pay for classes – is that upward social mobility? His salary may be well above what he earned in Poland. His security and income may be better as well, but they will be well below what a nurse could expect in Norway.
When it comes to social status, it gets complicated. A cleaner in Norway has lower social status than a nurse does. But although our imagined Polish nurse/cleaner has left Poland physically, he is still likely to have a social position back home.
How is that affected by the move and by what is often known as ‘de-skilling’ – working in jobs where one’s skills are not put to good use? Does it matter? I think it does. If it didn’t, he would tell everyone back home that he works as a cleaner but as it is, he is more likely to say that he “works at a hospital” and avoid getting into detail.
How to measure social mobility?
In WELLMIG, we didn’t meet any Polish nurses who worked as cleaners in Norway, but we did meet many who worked as nurses in nursing homes, rather than in hospitals.
Beata, for example, explained to Marek Pawlak that “I worked in a nursing home, but this job was not satisfying. In Poland, I was like fish in the water on the operation block, and here I also wanted to feel this adrenaline, to work with accidents and trauma, not to know what the day will throw upon you. You know, I wanted to feel it and not having all the time the same things like in the elderly home”.
Beata found working in a nursing home drab and repetitive and does not talk about social status. But there is something in between the lines of what she says here.
Caring for elderly patients in nursing homes or on geriatric hospital wards generally has a lower status (journals.njmr.org) than surgery or other medically advanced nursing work with younger patients. In that sense, Beata moved downwards when she moved from the operating block in Poland to the nursing home in Norway.
Measured in terms of salary, she clearly moved upwards: “The economic factor, the salaries in Poland, this is just so depressing. In order to live, you need to have two jobs as a nurse… Everyone that I know had to work double jobs as a nurse”.
A third way to look at social status is to observe how doctors and nurses relate to one another. As Sylwia told Marek: “There’s more trust and respect for nursing profession here… There’s this cooperation here, even with doctors and in Poland, the most powerful is the doctor’s seal. As a nurse you cannot do things by yourself in Poland and here you can, and if you need some advice you can always call a doctor and ask.”
In stark contrast to Sylwia’s comparison between Poland and Norway, Hanna from Sweden told Taylor Vaughn: “For me, being in Norway, there is much more hierarchy here, and for me, that’s not a positive thing. I’m used to having my area of expertise and I work together with my colleagues. And they have their expertise, and then we find the best way to work. I think here it’s much more, as a nurse, you have to ask the doctor for everything, and they don’t trust that you know everything.”
Taylor summed it up for me like this: “By working in Norway, the Swedish nurses have said that they experience a step down in professional status – they are not taken as seriously in their profession as they were in Sweden, but at the same time, the working conditions, the pay, and the tasks of nurses in Norway are seen as preferable to those in Sweden”.
Hanna had also observed how nurses from the Philippines and other non-EEA countries do not easily achieve the status of nurses in Norway: “Nurses from the Philippines are way better. They are … they have much more experience. And they learn so much more when they study nursing, even [more] than in Sweden… I had a lot of colleagues that were maybe nurses in their home countries, but here they worked maybe as assistants. And for me, that’s just crazy. I had one colleague who was in Serbia during the war, in the 90’s, so of course she had both nursing school and acute experience, and I don’t have that, because I haven’t worked in a war zone”.
Nurses from outside the EEA may struggle to get formal recognition from Norwegian authorities, but Hanna, for one, certainly seems to hold them in high esteem.