Shaping and reshaping the work organisation : including or excluding low skilled labour? The case of the nurse assistant in Germany, France and the United Kingdom

The hospital industry could be characterised on the one hand as under "industrial constraints" (just in time, 24 hours opening, and on the other hand as a service activity with, in departments, a high degree of patient oriented activities. Very similar pressure are exerted on hospitals in the three countries (UK, G and F): budget constraints and a trend to "quasi market" regulations (cf. Bartlett/LeGrand 1993); changes in the competitive structure linked with the increasing importance of private hospitals; a new demand for care arising from the ageing population and more complex diseases; new rules to control for the quality of care. Despite these similarities between the external demands and constraints, the organisation of care work and the division of labour remains very different between the countries. Section 1 presents a brief historical perspective of the nurse assistant in the three countries and the major contrast regarding the level and trends of employment. Section 2 analyses the training profiles and access to training. Section 3 describes the tasks performed and draws the job profile of a NA. Section 4 discusses the wage levels and structure and section 5 patterns of mobility.