Professional identity, power and patient care

Lila P. Vrklevski1,2, Kathy Eljiz2, David Greenfield2

1Department of Psychology, Concord Centre for Mental Health, SLHD-MHS, 2Australian Institute of Health Service Management, School of Business and Economics, University of Tasmania

Background: Multi-graded positions on community mental health teams have led to blurred boundaries and role overlap between psychiatry, nursing and allied health professionals. Blurred boundaries can result in role conflict between professions, as well as a loss of professional identity and feelings of disempowerment.

Objectives: To determine the impact of Mental Health Service (MHS) multi-graded positions on the strength of professional identity, perceptions of power across disciplines and patient care.

Methods: The setting was a large metropolitan MHS) and participants were drawn from nursing, occupational therapy, psychiatry, psychology and social work. An on-line survey of four psychometric measures was administered. Data was analysed using inferential statistics.

Findings: The response rate was 44%. The average Professional Identity Scale (PIS) scores were Social Work (4.40), Psychology (4.48), Occupational Therapy (4.54), Nursing (4.58) and Psychiatry (4.62). There was a weak positive correlation (r=0.230, n=320, p <.0001) between PIS and time spent on discipline specific activities and between PIS and Power (r=0.359, n=320, p <.0001). Inpatient staff had higher average PIS (µ=45.77) and Power (µ=4.11) scores than community staff PIS (µ=44.80) and Power (µ=3.98).

Conclusions: Mental health professionals need skills and abilities that are varied, similar, flexible and adaptable. Role overlap is beneficial and enables a shared understanding. However, generic positions can limit the ability of the team to address the full range of consumer needs. Multi-graded positions and too much role overlap results in a loss of professional identity and feelings of disempowerment, professional identity threat and role conflict.


Dr Lil Vrklevski B.A (Hons);LLB; MClinPsych; MBA; Dip.Grad.Research; PhD; MAPS; FCCLP; MACPA; GAICD is the Principal Clinical Psychologist and Director of Psychology, Sydney Local Health District. Lil has over 30 years’ experience in clinical practice, teaching and research. Her research has been in the areas of vicarious trauma, root cause analysis, professional identity and professional roles as well as the role of allied health in public mental health services. Lil developed the Vicarious Trauma Scale (VTS), a brief screening instrument for VT. Lil is a reviewer on Traumatology, The Journal of Patient Safety, International Journal of Psychiatry in Clinical Practice and sits on the CRGH Human Research Ethics Committee as well as the NSW Psychology Board. Lil is a clinical associate with the Departments of Psychology at USyd, UoW, ACU, MQ,WSU, lecturer at UNSW and casual academic with The Australian Institute of Health Service Management (AIHSM) UTAS.

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