Mimetic desire and professional closure: toward a theory of intra/ inter-professional aggression.

The purpose of this article is to present a renewed way to theorize intra/inter-professional aggression in nursing. To this end, Rene Girard's mimetic mechanism and Max Weber's conception of professional closure will be explored. More specifically mimetic mechanism, summarized as a sequence of four distinct but interdependent phases including mimetic desire, mimetic rivalry, mimetic (sacrificial) crisis, and scapegoat, will serve to broaden the understanding of intra-professional aggression. For its part, professional closure, a strategy designed to limit and control the number of individuals admitted to a specific profession, will provide a fresh perspective to critically examine the issue of inter-professional aggression by drawing attention to hidden practices of dominance and control. Keywords: Girard; intra/inter-professional aggression; mimetic mechanism; professional closure; Weber As the link between a healthy workforce and better patient outcomes is becoming more evident, creating healthy, and safe workplaces for health care providers is now a concern for many employers (Shamian & El-Jardali, 2007). A safe work environment encompasses many characteristics, including being free from aggression. Still, the issue of workplace aggression in the context of health care is not new nor is it an isolated problem linked to only a few individuals. Rather it is an insidious and complex problem "rooted in social, economic, organizational, and cultural factors" (International Labour Office [ILO], International Council of Nurses [ICN], World Health Organization [WHO], and Public Services International [PSI], 2002, p. 9). The importance of addressing workplace aggression and of promoting safe work environments is recognized at provincial, national, and international levels. As such, several position statements and guidelines have been developed (Canadian Nurses Association [CNA], 2002; ILO et al., 2002; Registered Nurses' Association of Ontario [RNAO], 2006). However, these appear to only have limited success on resolving the issue. In effect, workplace aggression continues to be identified as a serious problem by health care professionals and stakeholders (Quality Worklife Quality Healthcare Collaborative [QWQHC], 2007; Shields & Wilkins, 2006). Workplace aggression can be physical, psychological, sexual, and financial (Courcy, 2004). It can range from low intensity aggression (e.g., condescending remarks) to high intensity aggression such as being punched or bitten (Andersson & Pearson, 1999). Additionally, workplace aggression is not without consequences as it includes direct costs (illness, injury, disability, death, absenteeism, staff turnover); indirect costs (reduced work performance, lower quality of service, decreased competitiveness); and intangible costs (damage to the image of the organization, decreased staff motivation and morale, diminished loyalty to the organization; Di Martino, 2005; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Additionally, it has been shown that tolerating low intensity deviant behaviors may in fact be conducive to more serious types of aggressive behaviors (Andersson & Pearson, 1999). Consequently, the management of workplace aggression remains a priority for action in health care settings. While there are ethical and/or legal obligations to address all types of workplace aggression and all groups of perpetrators, managing instances of aggression between professionals is imperative since intra-staff aggression has been found to be more disturbing to the victim than any other type of aggression (Farrell, 1997, 2001). INTRA/INTER-PROFESSIONAL AGGRESSION: TOWARD A NEW UNDERSTANDING The issue of intra- and inter-professional aggression is complex and multifaceted, thus requiring several perspectives to broaden its understanding. In this article, we posit that some instances of intra-professional aggression can be explained by Girard's work on mimesis and that certain occurrences of inter-professional aggression can be better understood by combining the work of Girard to Weber's work on social closure. …