Power Holders: The Process of Status Acquisition for a new Institutional Role in an Emergency Department

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 18. Healthcare Providers & Practice II

Abstract

In medical settings such as the emergency department, advocates may present a solution to
alleviate medical staff burden, protect patient interests and ensure fair treatment of marginalized
populations. Advocates—situated in a middle zone between patients and emergency departmentassociated
high-status staff—also present a site of status acquisition as a new role introduced into a highly
stratified institution. It might be expected that highly trained medical professionals and advocates alike
would perceive advocates as lower status within the emergency department yet, despite their limited
training, lack of experience in medical spaces, and the novelty of the advocate role in this emergency
department, advocates presented a more complicated view of their institutional status. While advocates
acknowledged the traditional dominance of medical staff and their concomitant lower structural position,
in the same breath, they would also reposition the advocates as above or on the same plane as medical
staff in terms of importance to and competence with patients. Using the NOVI advocate program, 24
Semi-structured in-depth interviews were conducted with advocates. Findings suggests advocates acquire
status through a three-step process: (1) Endowment, (2) Legitimation, and (3) Validation. Although little
research has examined IPV advocates and their role within medical settings, such as emergency
departments, they occupy a unique position within institutions as actors who possess significantly lesser
training and lower legitimacy, and yet appear capable of leveraging status to ally with medical and law
enforcement staff to prioritize patient interests, and at other times, opposing medical staff and law
enforcement priorities to center the patient. Findings also suggest that these advocates function in
complex and often flexible capacities to confront institutional and actor-level status imbalances.
Understanding this relationship and the subversive potential of the advocate role has significant
implications for individuals interacting with other high-status institutions from positions of lower
legitimacy.

Author

• Daphne Tsapalas, University of California, Irvine