This study focused on Registered Nurses (RNs) working in Acute Trust surgical wards in the context of their role development, role expansion and role extension. The study originated from concerns raised by RNs undertaking the surgical pathway of the BSc Hons in clinical nursing practice, who alerted me to their dissatisfaction with their working conditions and their role. This revelation was made at a time when modernization was cascading into Acute Trusts as a result of the NHS plan (DOH 2000); simultaneously the European Working Time Directive (EWTD) was being implemented, sequentially reducing Junior Doctor’s hours of work. NHS modernization and the EWTD were the two initiatives which led the researcher to the assumption that RNs working in surgical wards were the labour force who would be absorbing the additional workload brought about by these changes, because RNs are the only health professionals in acute surgical wards with twenty-four hour contact with, and responsibility for, ward-based surgical patient care. The study was conducted in one clinical directorate of an Acute Trust hospital, comprising six in-patient surgical wards and five specialist nursing services. The methodology was ethnography, where the researcher worked as an RN for fifteen months, collecting data through Spradley’s (1980) descriptive, selective and focused phases of fieldwork. Data was analysed using what Miles and Huberman (1994) refer to as a set of ‘choreographed / custom built’ techniques. The descriptive phase of fieldwork revealed an apparent ‘staffing illusion’ on the surgical wards and RNs were found to be under tremendous pressure to manage ‘patient throughput’, and an ever increasingly dependent case mix of surgical patients, within the existing, or if possible diminishing Senior / experienced RN labour force due to the emergent evidence of a ‘cycle of staff change’ with non-clinical managers backfilling Senior RN posts with Junior RNs. For Senior RNs this backdrop meant additional support and supervision demands on their role. To get through the workload many RNs held ‘dual roles’ to enable maintenance of the surgical services within the directorate. The selective phase of fieldwork re-focused the ethnographic lens on the RNs in the context of their role development, role expansion and role extension, from which six perspectives were found: 1) role development from Junior to Senior RN, 2) role expansion dependent on shift of the day, day of the week – the co-ordinator role, 3) role extension confusion and boundary disputes, 4) hidden [role expansion and extension] talents of surgical nurses, 5) role contraction – a feeling Nursing is going backwards, and finally, 6) ‘if only I could’ – role expansion aspirations of surgical RNs. The third phase of fieldwork, described by Spradley (1980) as the focused phase, was spent validating the findings and conducting the ethnographic interviews. The findings are interpreted locally [from the perspective of RN’s working within Rodin] as ‘working to full capacity’ through ‘doing more for more with less’, as a result of the RN with the surgical directorate being sandwiched between two agendas, that of Junior Doctors EWTD and NHS modernisation. Braverman’s skill substitution / degradation of skilled work thesis is then used as an interpretative framework to conclude the thesis, the outcome of which reports a ‘triple substitution’ agenda.

Diese Dissertation befasst sich mit Arbeitsmarkterfolg und Konsum sozioökonomischer Gruppen. Die ersten zwei Kapitel untersuchen konjunkturelle Auswirkungen auf Arbeitsmärkten für Hoch- und Niedrigqualifizierte. Zunächst wird ein qualifikationsspezifisches Konjunkturmodell mit Suchkosten entworfen. Es zeigt, dass imperfekte Substitution zwischen hoch- und niedrigqualifizierter Arbeit ein Grund für Veränderungen auf den Teilmärkten ist. Gemeinsam mit qualifikationsneutralen und -verzerrten Technologieschocks ist das Modell in der Lage, fallende Beveridge-Kurven zu generieren. Das zweite Kapitel erweitert diesen Ansatz um eine Verbindung zwischen qualifikationsabhängigen Arbeitsmärkten mit endogenen Investitionen in Humankapital. Idiosynkratische Schocks wirken auf den Anteil qualifizierter Arbeit und verändern die Arbeitsmarktdichte auf den Teilmärkten. Neutrale Schocks wirken zweistufig auf die Gesamtarbeitslosigkeit: Zuerst reduzieren sie geringqualifizierte Arbeitslosigkeit, und dann verringern sie rapide hochqualifizierte Arbeitslosigkeit. Eine hohe Substitutions-Elastizität zwischen den beiden Qualifikationen führt zu einer höheren Volatilität und einer höheren Korrelation zwischen Arbeitslosigkeit und freien Stellen. Das dritte Kapitel untersucht die Verbindung zwischen Gruppen-Konsumwachstum und dessen Volatilität, wenn die Agenten heterogen sind und eine Konsumexternalität vorliegt. Die Präferenzen der Haushalte hängen mit der Konsumwachstumsvolatilität insofern zusammen, als diese Vermögensentscheidungen treffen müssen: Die Volatilität verringert sich mit der Geduld und steigt mit dem Wunsch, das Konsumniveau der Vergleichsgruppe zu halten. Darüber hinaus sollten Konsumwachstum und dessen Volatilität positiv korrelieren. Diese letzte Hypothese wird mit Daten aus dem Sozio-oekonomischen Panel und der Einkommens- und Verbrauchsstichprobe überprüft, wobei sich ein U-förmiger Zusammenhang zwischen Konsumwachstum kurzlebiger Güter und dessen Volatilität ergibt. / This dissertation addresses the labor market performance and consumption dynamics of different socioeconomic groups. The first part examines the connection between cyclical variations in skilled and unskilled labor markets. Using a business cycle model with search frictions in skill-specific markets, I find that imperfect substitution between skilled and unskilled labor creates an important channel for variations in the skill-specific markets. Together with a skill-neutral or -biased technology shock, the model generates downward-sloping Beveridge curves in aggregate and skill-specific labor markets. I extend the study to allow for a dynamic link between the skill-specific labor markets. Human capital investment is determined endogenously and idiosyncratic shocks shift the skilled labor share and change tightness in both skilled and unskilled markets. Upon a neutral shock, the decrease of total unemployment is two-staged: Firstly with a reduction in unskilled unemployment, and then with a sharp decline of skilled unemployment when skill substitution dominates. A larger elasticity of substitution between the two types of labor leads to higher volatility of the model variables and higher correlation between unemployment and vacancies. The second part studies the link between group-specific consumption growth and its volatility in a framework of heterogeneous agents, under the assumption of a consumption externality. Household preferences are related to the consumption growth volatility through asset holding decisions: The volatility decreases with groups'' patience, and increases with the eagerness to keep up with the group average. Moreover, consumption growth is expected to be positively related to its volatility. This last hypothesis is tested using household data imputed from the German Socio-Economic Panel and the German Income and Expenditure Survey, where a U-shaped relationship is found between nondurable consumption growth and its volatility.