Professionalism under Constraint: Work Misalignment and Employment-Based Representation in Italian Public Healthcare

This paper examines the relationship between working conditions, professional expectations, and collective representation in Italian public healthcare. Drawing on a survey of 936 healthcare workers in the Latium region, it shows how formal employment stability coexists with organizational constraints, limited autonomy, and weak recognition. The findings identify a form of work misalignment linking three dimensions. Working conditions are marked by compressed wages, constrained autonomy, and limited skill utilization. Expectations are highly convergent, centring on income, recognition, and improved working conditions. Trade union orientations are closely tied to these issues, with strong support for contractual intervention, but also for competence, proximity to workers, and services. The paper contributes to the sociology of professions by showing that current transformations are not only about hybridization between professional and organizational logics, but also about the limits of organizational arrangements in sustaining professional work, and the growing role of employment-based forms of representation.