Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems

Findings from an empirical study of medical and nurse interns in Kenya

Bibliographic Data

ID4593414
AuthorsYingxi Zhao (0000-0002-4937-4703, University of Oxford, corresponding author), Stephanie Nzekwu (University of Warwick), Mwanamvua Boga (0000-0002-9647-9567, Kenya Medical Research Institute), Daniel Mbuthia (0000-0003-0021-305X, Kenya Medical Research Institute), Jacinta Nzinga (0000-0001-8394-8857, Kenya Medical Research Institute), Mike English (0000-0002-7427-0826, University of Oxford), Sassy Molyneux (0000-0001-9522-416X, University of Oxford), Gerry Mcgivern (0000-0002-0440-0787, King's College London)
Year2024
Volume357
Pages117226
Publication date2024-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.117226
PMID39146903
OpenAlexW4401480069
LanguageEN
Citations received6
References cited57

We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in precarious and resource-constrained settings. Drawing on 146 qualitative interviews and seven focus groups, involving 121 new graduate medical doctors and nurses transitioning through internship training in Kenya, we describe three aspects of liminality. First, liminal professional practice, where interns realise that best practices learned during medical and nursing schools are often impossible to implement in resource constrained health care settings; instead they learn workarounds and practical norms. Second, liminal relational identities, where interns leave behind being students and adopt the identities and responsibilities of qualified professionals within pre-existing professional hierarchies of status and expertise. We explain how these new doctors and graduate nurses negotiate their liminal status, including in relation to more experienced but less qualified professional colleagues. We also discuss how interns cope with liminality due to disappointing and inadequate supervision and role modelling from senior colleagues but then find peer support and their place within their own professions. Finally, we discuss how new doctors and nurses come to terms with the precarity of working in resource constrained health systems, abandon expectations of secure, permanent employment and careers, and accept the realities of liminal professional careers. We explain how all three forms of liminality influence professionals' developing practices, identities, and careers. We call for further studies with a specific liminality lens to explore this critical period in health workers' careers, to inform policy and practice responding to global transformations in healthcare professions and practice

Context (archaeology · Health care · Liminality · Medical education · Political science · Public relations · Resource (disambiguation · Sociology · Workaround · Global Health Workforce Issues · Interprofessional Education and Collaboration · Management and Organizational Studies · Medicine · Nursing · Psychology