Who is in charge? Jurisdictional contests and organizational outcomes

Abstract

Abstract We explored how professional jurisdiction contests influence organizational outcomes by examining how Certified Registered Nurse Anesthetist (CRNA) schools in the USA were impacted by a policy pursuing educational upskilling. While others have focused on boundary work at the field and work levels, we argue that contests between professions also influence important organizational outcomes. We detail how the profession’s accreditation decision requiring schools to provide Master’s degrees within a 17 year window took place in the context of physicians historically battling CRNAs. We provide an analytic narrative illustrating the history of this jurisdictional dispute, and empirically examine how CRNA schools with cultures differentially supportive of physicians’ field-level dominance responded to the requirement of educational upskilling. Our analysis indicates that the timing of a school adopting a graduate program was influenced by whether the organizational culture, represented by organizational ownership, supported physician dominance. We also highlight the importance of access to resources as another conduit for boundary work impacting organizational outcomes.