Task redistribution as a dual process: Reconfiguring professional boundaries through knowledge development and jurisdictional competition

Health care systems globally are redistributing the responsibilities to address workforce shortages, yet task redistribution may create tensions between professional groups. Through this ethnographic study, I examine medication management as a case for exploring how professional boundaries are negotiated and reshaped during the redistribution of tasks. Fieldwork in three Norwegian nursing homes comprised 87 hours of observations and seven semi-structured interviews with nine informants. The data were thematically analysed and interpreted through Wenger's concepts of participation, reification, negotiation and boundary objects as well as Abbott's concepts of jurisdiction and workplace assimilation. Certified nursing assistants' (CNAs) participation in medication management created opportunities for knowledge development, as CNAs approached nurses for support. Medication administration records (MARs) functioned as boundary objects, enabling alignment but often lacking information meaningful to CNAs, leading them to seek clarification from nurses. These interactions facilitated knowledge sharing but simultaneously created tensions, as nurses experienced them as interruptions during high-risk tasks. Due to resource constraints and formal divisions of labour, CNAs' participation remained a form of peripheral, partial jurisdiction that both blurred and reconfigured boundaries while adding to nurses' workload. The study demonstrates that task redistribution is not a straightforward transfer of tasks but a dual process of knowledge development and negotiation of jurisdiction. Recognising this duality is crucial for designing policies that support the situated realities of professional work.