professional writing and the role of incidental collaboration: evidence from a medical setting

Professional Writing and the Role ofIncidental Collaboration: Evidence

from a Medical Setting

SUSAN PARKS

UniversiteÂ Laval, Quebec, Canada

Despite a long-standing interest in the workplace, research that explores how

employees working in a second language develop competence in written

genres is scant. Drawing on a 22-month qualitative study, which involved

francophone nurses employed in an English-medium hospital, the present

article reports on how incidental collaboration played a significant role in

enabling them to appropriate genre-specific language. Analysis revealed that

interventions targeted three levels of text structureÐlinguistic, rhetorical, and

informational. Although most interventions were initiated by the nurses

themselves (self-initiated), colleagues also offered help (other-initiated). The

pattern of interaction shows that nurses were most likely to interact with

colleagues with whom they were linked in an official or semi-official

capacity. The way in which more experienced colleagues provided support

for new nurses and the nature of the support are discussed in relation to Lave

and Wenger's notion of legitimate peripheral participation and activity

theory. It is further suggested that the role of the writing instructor within the

workplace be reconceived to take into account the socioculturally embedded

nature of writing.

Within Applied Linguistics, researchers and instructors have long been interested

in language in professional contexts. This interest is reflected in numerous

scholarly publications (see issues of ESP Journal, survey reviews in vols. 7

and 19 of the Annual Review of Applied Linguistics) as well as textbooks aimed at

preparing L2 learners for work in a myriad of fields (business, medicine, nursing,

tourism, and so forth). Nevertheless, despite this long-standing interest, research

specifically related to L2 issues has tended to focus on descriptive linguistics and

discourse analysis (Gunnarrsson, 1995). Although the relationship between

language use and social context has been duly acknowledged (Bloor, 1998;

Swales, 1990), only recently have a few studies begun to emerge that shed light

on how employees working in a second language develop (or fail to develop) oral

competence within the workplace (Cameron & Williams, 1997; Goldstein, 1997;

JOURNAL OF SECOND LANGUAGE WRITING, 9 (2), 101 ± 122 (2000)

Direct all correspondence to: Susan Parks, DeÂpartement de Langues, Linguistique et Traduction,

Pavillon-De Koninck, UniversiteÂ Laval, Quebec, Canada G1K 7P4; E-mail: [email protected]

101

Pierce, Harper, and Burnaby, 1993; Willing, 1992). By contrast, socioculturally

oriented research on the appropriation of L2 competence in written workplace

genres is virtually non-existent (Belcher, 1991).

In view of the dearth of published research in this area, I undertook a study

that focused on how francophone nurses, who were employed in an English-

medium hospital in Montreal (Canada), developed competence in the genres in

which they had to write during the course of their work on their units. Although

nurses write various types of documents, nursing notes are written on each shift

and serve to provide an update on a patient's condition. Drawing on socio-

culturally oriented frameworks (notably genre theory), I described how nurses'

ability to develop competence in this genre was mediated by a variety of

collaborative processes (Parks & Maguire, 1999). One of these processes,

incidental collaboration (Witte, 1992), referred to writing-directed interventions

involving brief, but generally unplanned, interactions with colleagues (e.g.,

nurses' spur-of-the-moment requests for help). In this article, I would like to

discuss more fully how incidental collaboration enabled nurses to appropriate

genre-specific language as they engaged in writing the various documents

required of them. Specifically, the questions to be addressed are the following.

1. What was the focus of the interventions? (Was vocabulary, e.g., requests for

the translation of terms, the main issue, or were other levels of text structure

targeted?)

2. Who were the collaborators?

a. Did nurses address whatever staff nurse happened to be available, or

was there a more discernible pattern to the way they interacted with

their colleagues?

b. Did nurses always initiate the requests for help (self-initiated

interventions), or did colleagues also comment on their writing or

make suggestions (other-initiated interventions)?

c. Did some nurses have recourse to incidental collaboration more than

others?

In this article, I will first situate the study with respect to relevant research and then

focus on the methodology used to gather the data. Following this, I will present the

results of the inquiry and discuss their relevance for research and pedagogy.

THEORETICAL CONSIDERATIONS

Despite the dearth of research on L2 employees, exploring the situationally

embedded nature of writing in the workplace has been a major area of concern in

L1 for over 15 years (Dautermann, 1997; Dias, Freedman, Medway, & PareÂ,

1999; Lay & Karis, 1991; Odell & Goswami, 1985; PareÂ & Smart, 1994; Spilka,

102 PARKS

1993a). Although much of this research has focused on how texts are collabora-

tively produced, increasing attention has been given to how new members of a

discourse community, whether as university student interns (Anson & Forsberg,

1990; Clark & Doheny-Farina, 1990; Winsor, 1996), medical residents (Pettinari,

1988), or new employees (Beaufort, 1997; MacKinnon, 1993; Odell, 1985;

Paradis, Dobrin, & Miller, 1985; Winsor, 1999), develop competence in the

genres required of them as part of their work. One main finding emerging from

this research points to the need for new employees (used in a general sense), even if

good writers in a school context, to adapt their writing to the exigencies of the new

organizational culture, defined by Odell (1985, p. 250) as the `̀ internalized values,

attitudes, knowledge, and ways of acting that are shared by other members.''

Although new employees may experience difficulty adapting to the organiza-

tional culture (Anson & Forsberg, 1990; Beaufort, 1997; Locker, 1992; Paradis et

al., 1985), studies also reveal how the appropriation of relevant genre-specific

skills is mediated through collaborative interaction with colleagues. Thus, in

terms of helping new employees understand the issues at hand, the importance of

talk with colleagues and other relevant individuals, in both formal and informal

settings, has been stressed (Beaufort, 1997; Pettinari, 1988). New employees

have also benefited from feedback on drafts from supervisors or peers (Beaufort,

1997; Couture & Rymer, 1991; MacKinnon, 1993; Paradis et al., 1985; PareÂ,

1991; Winsor, 1996) and have been observed to consult or copy from documents

produced by other more experienced colleagues (PareÂ, 1991; Pettinari, 1988). In

terms of how the resources specific to a workplace may impede or facilitate

the employee's ability to appropriate genre-specific writing skills, Anson and

Forsberg (1990, p. 226) note that `̀ the context is a deeply enabling or

disabling factor.''

With respect to the above research, three points are of particular note. First,

L2 employees are virtually never mentioned, and if they are (PareÂ, 1991;

Pettinari, 1988), at the time the studies were being conducted, the latter were

considered to be operating on a par with their native speaker counterparts.

Secondly, exploration of the processes of text production has tended to focus on

substantive, non-routine forms of writing such as reports rather than more

routinely produced documents (for exceptions, see Berg, 1997; Winsor, 1999).

In a survey of work-based writing practices, Couture and Rymer (1989) noted

that interaction with colleagues was more typical of the former. Although such

may indeed be the case, this observation does not take into account how

interaction with colleagues may play a more prominent role during the appro-

priation of genres, which ultimately become routine, a point to be developed in

this article. Thirdly, the writers focused on have tended to be those with

prestigious positions (e.g., engineers, managers, and medical interns).

In the present study, the participants were francophone staff nurses engaged

in writing routine documents, which experienced colleagues tended to dis-

pense with in a fluent, efficient manner. When hired, the francophone nurses'

PROFESSIONAL WRITING AND INCIDENTAL COLLABORATION 103

general oral proficiency in English was in the low to high intermediate range;

their initial on-the-job functioning, whether in regard to speaking or writing,

would not have led anyone to confound them with bilingual nurses. However,

despite considerable difficulty starting out, the new nurses ultimately got to

the point where, like their colleagues, they could complete their writing tasks

in a routine manner.

As the results of this study revealed (Parks & Maguire, 1999), the appropria-

tion of genre-specific writing skills was mediated by four types of collaborative

processes. In addition to incidental collaboration (to be elaborated on within this

article), three other types (adapted from Witte, 1992) were in evidence: traditional

collaboration, committee collaboration, and covert collaboration. Following are

brief definitions of these three types as well as an indication as to what the

behavior actually entailed on the hospital units:

Traditional collaboration. This refers to two or more writers working on the

same text who assume equal responsibility for the text produced; actual

involvement in terms of contributions to the finished product may vary or be

more equally shared. At Thomas Memorial Hospital, the main example involved

feedback given by a clinical educator, an experienced nurse in charge of the

orientation program, in response to nurses' drafts of their nursing notes. In this

instance, shared responsibility was reflected by the fact that both the clinical

educator and the nurse signed the notes written in the chart (patient's file).

Committee collaboration. This refers to two or more writers who, although

working on the same text, do not assume equal responsibility for the text

produced; actual involvement in terms of contributions to the finished product

may vary or be more equally shared. One example noted at Thomas Memorial

Hospital pertained to a care plan jointly produced by a new nurse with the help of

a colleague; only the new nurse officially signed in the chart.

Covert collaboration. This refers to two things: (a) the use of texts (linguistic

or non-linguistic) that may or may not be writing directed, or (b) talk that may

have a bearing on the ultimate content of the text but that is not writing directed.

In terms of (a), as nurses had easy access to documentation done by other

colleagues in a patient's chart, they were often observed to use texts as models, in

whole or in part (writing directed). Nurses also consulted documents in order to

get information about their patients (not specifically writing directed). With

respect to (b), throughout their shifts, nurses interacted with patients as well as

other nurses and hospital personnel. Through these exchanges and the

consultation of various documents, nurses engaged in a process referred to as

`̀ data collection,'' a process that ultimately helped them with the content they

would need for subsequent writing tasks.

In past studies involving L1 employees, the role of incidental collaboration,

defined here as brief but generally unplanned writing-directed interactions with

colleagues, remains marginal. This may be due to various factors, including L1

104 PARKS

speakers' greater mastery of English, the focus of the research (e.g., non-routine

documents with emphasis on revealing how forms of argument were acquired), or

access to more traditional forms of feedback. However, for the second language

nurses, as I will discuss below, incidental collaboration, appeared to play a

significant role in terms of enabling them to appropriate genre-specific

writing skills.

SETTING AND METHODOLOGY

The study from which this article was drawn was conducted in an English-

medium hospital, referred to here as Thomas Memorial Hospital, located in

Montreal in the province of Quebec. As a result of language legislation passed in

1977, French became the official language of Quebec, a province with a

francophone majority, in an effort to help ensure the survival of the French

language and culture. Although this language policy generally extends to the

workplace, certain established English institutions, such as schools and hospitals,

are allowed to work internally in English. Thus, at Thomas Memorial Hospital,

even though both English and French are used with patients, the official language

of communication is English, including written documents such as those dealt

with by nurses.

The study, undertaken using qualitative data gathering procedures (Miles &

Huberman, 1984), extended over a period of 22 months. In an effort to

facilitate the integration of francophone nurses whose English language

proficiency needed improvement, the Hospital decided to set up a special

orientation program, headed by a nurse referred to as a clinical educator. The

first part of the orientation consisted of a 3-week intensive English course

given at the hospital. I was involved in working with the clinical educator to

set up this course and also taught it. Although the English course mainly

dealt with oral skills, I became aware of the fact that the written documenta-

tion nurses had to do on the units posed a problem for them, and I undertook

to investigate if, and how, they became skilled in doing it. Following the

English course, the nurses moved into a 2-week clinical orientation with the

clinical educator. During this time, the nurses began working on the units

with a reduced patient load where they were, in fact, twinned with other staff

nurses whose patients they took over. As nursing notes are considered legal

documents, for which nurses can be held accountable during lawsuits, they

must be completed in ink; erasures are not allowed and any change must be

crossed out with one line and initialed by the nurse. Due to this constraint,

the clinical educator had the nurses start out by writing drafts, which she

gave them feedback on before they wrote them in the patients' charts.

Following the clinical orientation, nurses were assigned to the units they

were to work on and paired with experienced nurses, referred to as


preceptors, who were responsible for helping them integrate into the unit. At

the end of the preceptorship, which lasted 3 weeks, nurses became staff

nurses with full responsibilities.

A total of 11 nurses from two orientation sessions (eight in the first year

and three in the second) were involved in the study. Of these, 10 were new

graduates who had a BA in Nursing from a French university nursing

program. The other nurse, who had 10 years of experience, had a diploma

in nursing. Apart from Aline, who had been at Thomas Memorial Hospital

in the spring for an internship, none of the nurses had ever done any of

their documentation in English. During the study I observed and recorded

nurses' feedback sessions with the clinical educator, conducted interviews

with the nurses and the clinical educator, and collected samples of the

nurses' work.

The data pertaining to incidental collaboration, reported on in this article,

were taken from the second year of the study that involved in-depth case

studies of three nursesÐBertrand, EÂ douard, and Aline. As is typical of

qualitative research studies (Lincoln & Guba, 1985), features of the design

unfolded with an increased understanding of the particular context. Thus, in the

second year of the study I wished to investigate more rigorously how

incidental collaboration was implicated in text production, an issue that had

emerged during the first year. Whereas in the first year during the orientation

period I had remained with the clinical educator to more carefully determine

how she interacted with nurses, during the second year I followed individual

nurses during whole shifts. As a tape recorder would have been too intrusive, I

noted exchanges between the nurses and their colleagues in situ on loose-leaf

attached to a clipboard, which I had with me at all times. As necessary, I

checked any potential misunderstandings with the nurses and also collected

carbon copies of the writing they did; permission to do so had been granted by

the hospital, provided the confidentiality of patients was ensured. During each

shift, care was taken to identify and record in my notes the status of colleagues

(preceptor, clinical educator, etc.) the nurses were interacting with and who

initiated the interaction. The three case study participants were observed for

two shifts each during both the clinical orientation and three shifts each during

the preceptorship.

As a first step in the analysis, the observation notes were re-read and a

database, consisting of excerpts pertaining to instances of incidental collabora-

tion, was created; for each excerpt, the name of the participant, the status of the

interlocutors, the phase (clinical orientation or preceptorship), and the initiator of

the exchange were noted. The excerpts were further analyzed to identify the

focus of the interventions (see Results section). Although qualitative research

studies at times fail to account for the relative robustness of the particular

phenomena being investigated, the database I constituted made it possible to tally

the frequency of various items of relevance to the research questions. As Miles

106 PARKS

and Huberman (1984, p. 215) observe, even simple descriptive statistics

involving counting can contribute greatly to the validity and reliability of the

results reported on:

. . . there is a lot of counting going on when judgments of qualities are being

made. When we identify a theme or pattern, we are isolating something (a)

that happens a number of times and (b) that consistently happens in a

specific way. The `number of times' and consistency judgments are based on

counting.

Results of the analysis are discussed in the next section in relation to the two

research questions previously identified: (1) What was the focus of the interven-

tions? (2) Who were the collaborators?

RESULTS

Focus of Interventions

Analysis of the observation notes revealed a total of 145 instances of

incidental collaboration (Table 1). Of these, 83 (57%) were related to a linguistic

focus, 50 (34%) to a rhetorical focus, and 12 (8%) to an informational focus.

Interventions with a linguistic focus were those that targeted vocabulary,

grammar, spelling, or abbreviations. Interventions with a rhetorical focus referred

to those that involved the type of information to be included (or not included) in a

document. Interventions with an informational focus pertained to content, i.e.,

gaps in the informational base needed to complete a document. A reliability rate

of 96 percent, established by two independent raters (one of whom was the author

of this article), attests to the robustness of the categorization system (including

the subcategories discussed below).

Linguistic Focus

Of the interventions involving a linguistic focus, Table 2 shows that exchanges

targeting vocabulary predominated, accounting for 49 of a total of 83 instances

(59%). As used here, vocabulary refers to all lexical constituentsÐwords,

TABLE 1

Comparison of Frequency of Incidental Collaboration in Relation to Focus ( N = 145)

Interventions

Focus n %

Linguistic 83 57

Rhetorical 50 34

Informational 12 8


phrases, clausesÐwhere the object was formulation, i.e., how to textualize the

particular item. In terms of the type of constituent, 32 instances (65%) involved

words, 12 (24%) phrases, and 5 (10%) clauses. Typically, items classified as

clauses were requests by the nurses to know if a particular item could be said in

English (e.g., whether `̀ She's in the same idea'' was correct) or a request for a

translation (e.g., how to say `̀ Il essaie de toleÂrer sa douleur''). Apart from

vocabulary, grammar was targeted in 21 instances (25%), spelling in 11 (13%),

and abbreviations in 2 (2%). As special medical abbreviations are widely used in

the documentation, these were included as a separate category.

Rhetorical Focus

To further delineate how interventions with a rhetorical focus mediated

text production, items were further categorized in terms of relevance or

modeling. The relevance criterion pertained to exchanges in which the writer

was cued as to the type of information that needed to be included (e.g.,

whether or not for a given patient an entry for `̀ Skin Integrity'' would be

appropriate) or how information should be categorized (e.g., the appropriate-

ness of a given label in the nursing notes with respect to the information to

be included under it). Modeling refers to those interventions in which the

exact formulation of the required information was given. Items presented in

this form both informed the writer as to the type of information that needed

to be included in a document and provided the appropriate textualization.

Although most modeled items were conveyed orally, on occasion interlocutors

wrote out their suggestions.

To further illustrate how interventions with a rhetorical focus emerged in the

context of the nurses' work with patients on the units, two examples, drawn from

my observation notes, are given below. As reflected in these examples, the need

for rhetorical information (what to include or not include) was particularly

evident in instances where a task not previously dealt with was involved (e.g.,

a nurse's first admission of a patient, a death, a discharge).

TABLE 2

Comparison of Frequency of Incidental Collaboration in Relation to Type of Linguistic

Focus (N = 83)

Interventions

Linguistic Focus n %

Vocabulary 49 59

Grammar 21 25

Spelling 11 13

Abbreviation 2 2

108 PARKS

Example 1

This example, which involves the nurse, Aline, and her preceptor, Georges,

focuses on the appropriateness of a label for a nursing note entry.

Aline was working on her notes for Mrs. L., a patient with bone cancer. As she

finished her first entry for vital signs, she turned to Georges and inquired about

the use of `̀ Abdominal Discomfort'' as a label for the next entry. George then

pointed out that `̀ Pain'' might be a more appropriate one, as Mrs. L's discomfort

had not been limited to her abdomen. Aline evidently agreed with Georges as she

labeled her entry `̀ Pain'' and completed it as follows:

Pain: c/o flatulence and asked for Maalox (she's used to take it). Given at

10:30 with good relief after. c/o (L) shoulder pain at 12:00. Medicated wÅ II

tab. of empracet. Good relief after ___

[NB c/o = complains of

(L) = left

wÅ = with]

As can be seen in the above excerpt, Aline, following her consultation with

Georges, opted to label her entry `̀ Pain'' rather than `̀ Abdominal Discom-

fort,'' which she had originally proposed. The fact that the entry refers to two

types of pain (abdominal and shoulder) confirms the appropriateness of

Georges' comments. At a rhetorical level, his interventions served to draw

attention to the need to select labels that were broad enough to cover the items

contained therein.

Example 2

This example reports on EÂ douard's first attempt to do an entry in his nursing

notes for a newly admitted patient, Mr. L, who had been transferred to his unit

from another unit within the hospital. Although EÂ douard had initially tried to do

the entry by himself, he was ultimately unable to figure out what to write and had

to seek out his preceptor, Victoria, for help. The account below illustrates how the

inability to get started was related to the writer's uncertainty as to what had to be

included in his notes. Specific instances of modeling and cueing for relevance

have been indicated in square brackets.

As EÂ douard prepared to write his notes, he turned to me and commented: `̀ I

don't know what to write when they receive a transfer.'' Unable to proceed, he

set off to look for Victoria. After walking up and down the corridor and not

being able to find her, he returned to the conference room where he had been

working and started looking over the notes in Mr. L's chart. He again gave up,

mentioning to me that he had to find Victoria as he didn't know what to write.

He also specifically stated that he needed to know what `exam' (i.e., test) his

patient had had prior to coming onto their unit. Venturing out into the corridor

again, he spotted Victoria and approached her, saying: `̀ I don't do any


admission before . . .'' Victoria immediately replied: `̀ . . . you can say `patient

transferred from CCU' . . .'' [modeling].

When Victoria did not volunteer additional information, EÂ douard continued

with questions of his own about what to include in his notes. With respect to a

question as to whether he had to indicate in his notes what test the patient had had

prior to coming onto their unit (`̀ Do you write what kind of exam?''), Victoria

pointed out that this information wasn't necessary [relevance]. EÂ douard was also

concerned with what to put in an entry for comfort in terms of whether the

patient's pain while urinating should be specified (`̀ . . . could I write pain with

miction?'') [relevance]. Victoria agreed with this, stating it was `̀ something

different from normal.'' As a final question, EÂ douard inquired as to whether he

needed to include an entry for IV, and Victoria confirmed he should [relevance].

Following this exchange, EÂ douard was able to overcome his block and produced

the following entries:

Received from CCU ___

Error EP

IV solution: D5% 50 cc/hrs KVO, site is intact

é signs of infection ___

family was in his room ___

Comfort: é SOB, chest pain ___

Pt was her re: blood in his urine ___

[NB KVO = IV flowing smoothly

é = no

SOB = shortness of breath]

As is evidenced in the above entries, EÂ douard followed through on Victoria's

suggestion not to make reference to the type of test the patient had had prior

to being transferred to their unit but did include an entry for IV. Victoria's

advice to mention pain while urinating surfaced in the comfort entry in

relation to the patient's problem with blood in his urineÐ`̀ something different

from normal.''

Of the total number of items involving incidental collaboration (50), 17 (34%)

cued nurses to the type of information needed in terms of relevance whereas the

remaining 33 (66%) modeled the exact form of the required information. Such a

distribution suggests that interlocutors were sensitive to the language needs of the

new francophone nurses and tried to help them in a very direct manner.

Informational Focus

Although only 12 (8%) interventions with an informational focus were noted,

I nonetheless further analyzed them to determine whether the need for informa-

tion was related to gaps in nursing knowledge or other factors. The analysis

110 PARKS

revealed that only three interventions involved a lack of nursing knowledge. One

such intervention occurred, for example, when EÂ douard, as he was in the process

of completing a nursing discharge summary form, turned to his colleagues and

asked them for suggestions concerning the diet of a patient who suffered from

gallstones. The small number of interventions pertaining to disciplinary-based

knowledge suggests that by the time the nurses got to the actual writing of a

document, such problems had been largely resolved. During their shift, nurses

informed themselves about their patient's problems by consulting with other

colleagues and by reading the various documents in the chart and elsewhere

(covert collaboration).

Of the remaining interventions with an informational focus, there were three,

which I have termed circumstantial, insofar as the nurse's lack of information had

been occasioned by the fact that she had been off the unit or otherwise occupied

at the time the particular incident had taken place or had had difficulty recalling

something. In such instances, the writer called on the relevant colleagues for help.

The one remaining intervention, which pertained to advice on what documents to

consult to get information for the task at hand, I have referred to as procedural.

The instance noted involved EÂ douard's request to a preceptor who told him what

documents to consult in order to get the information he needed to complete a

section of a nursing discharge summary form.

Collaborator Profile

Identification of Collaborators

As shown in Table 3, not only did the participants interact with hospital

personnel, but a significant proportion (43%) of the interventions targeted the

researcher. First, with respect to the hospital personnel, it is important to note that

the new nurses, during the completion of their various writing tasks, interacted

with colleagues who fulfilled a variety of roles: staff nurse, twinned nurse,

preceptor, clinical educator; in other words, new nurses, who had problems with

writing, had access to broad-based help and did not limit themselves to one or

two colleagues. On the other hand, those colleagues who collaborated most

frequently were associated with them in an official capacity relative to their

progressive integration into the hospital community. This was particularly the

case of preceptors, who were officially charged with new nurses' integration on

the unit to which they were assigned to work as staff nurses.

With respect to my own involvement as a collaborator, it is important to note

that within qualitative research, the researcher, a participant observer, is not

regarded as having a neutral role. Researchers can and do influence participants'

actions, what Hammersley (1983) has referred to as the principle of reflexivity.

Although I did not overtly invite questions about their writing, because of the ESL

course, students knew me first and foremost in my role as an English teacher.


When the nurses first started asking me questions, I hesitated to answer as I had

told them I wished to observe only. However, I also feared that appearing to

withhold help might jeopardize my relationship with them, especially as they

were extremely generous in allowing me to accompany them on the units at a

time when they themselves were new to the hospital. As a result, I decided to

answer as best I could but did not hesitate to say if I had doubts about my

suggestions. I also considered that nurses' queries would provide a further

window on the difficulties they were experiencing without requiring any direct

intervention on my part. Nurses confirmed that if I had not been there, they

would have asked a nurse.

Of particular interest, in terms of the types of questions nurses addressed to

me, was the fact that all were related to a linguistic focus (vocabulary, grammar,

spelling). Totally absent were questions related to rhetorical or informational

concerns or abbreviations pertaining to the medical domain. As these latter areas

all intersect with disciplinary knowledge, it appears that the nurses were

responding to my role as an English teacher, whose presumed area of competence

was language (vocabulary, grammar, spelling), not nursing. However, what they

tended to overlook, but of which I became increasingly aware, was that even

seemingly discrete items involving vocabulary and grammar were genre-specific

and caused me problems. One such example involved a diabetic patient, who was

losing her ability to walk due to an edematous leg. In response to EÂ douard's

request whether the expression `̀ losing capacity'' could be used to describe this

problem, I hesitantly suggested `̀ losing autonomy,'' a term I had previously heard

on the units. However, a nurse, whom EÂ douard subsequently consulted, without

hesitation proposed `̀ losing her independence'' as the appropriate term. Although

with respect to grammar, requests for the past tense of verbs posed no problem,

other items were less clear. On one occasion, for example, after having suggested

to EÂ douard that he write `̀ Pt was admitted'' instead of `̀ Pt admitted'' in his

nursing notes, I subsequently discovered that the omission of auxiliaries was a

typical feature of this genre.

TABLE 3

Comparison of Frequency of Incidental Collaboration in Relation to Collaborator ( N = 145;

Other = Patients or other Hospital Personnel)

Interventions

Collaborator n %

Staff nurse 15 18

Twinned nurse 13 9

Preceptor 45 31

Clinical educator 7 5

Other 3 2

Researcher 62 43

112 PARKS

Self- Versus Other-Initiated Interventions

Analysis of the interventions revealed that the vast majority were initiated by

the nurses themselves (85%) rather than by their colleagues. Of note is the fact

that other-initiated interventions were all initiated by nurses who were associated

with the writer in an official (preceptor, clinical educator) or semi-official

(twinned nurse) capacity. In other words, regular staff nurses did not offer advice

unsolicited. This observation further supports the comments by other nurses

involved in the study (year 1), who generally reported that, even though their

colleagues read their notes and other documentation in the patients' charts on a

regular basis, they rarely, if ever, commented on them. Nevertheless, despite this

reticence to comment on each other's writing directly, it should not be concluded

that criticism was never voiced. One new nurse, Martine, reported, for example,

that as a result of one of the nurses on her unit having been critical of the way

some notes were done, she took particular care to do hers when she knew this

person would be on the following shift.

With respect to the types of comments initiated by others (16), all except four

had a rhetorical focus. Such interventions typically arose in the contexts of new

writing tasks that the new nurse would have to engage in during the shift. Thus,

when EÂ douard's preceptor, Victoria, announced to him that one of his patient's

had died, she briefly modeled what he could put in his notes. At other times,

colleagues volunteered advice when they perceived a writing task as potentially

problematic or as something the writer should do but may not be aware of. For

example, after Bertrand and Tania, the nurse he was twinned with, finished a

patient's ileostomy care, she advised him to do the entry in his notes under `̀ Skin

Integrity'' to ensure continuity in the labels. In sum, other-initiated interventions,

which occurred during the course of the ongoing work in which the new nurses

were engaged, served an anticipatory function. As such, they alerted the latter to

community standards for writing tasks and provided rhetorical cues as to how

information was to be textualized.

Differential Involvement in Incidental Collaboration

As revealed in Table 4, one of the nurses, EÂ douard, used incidental collabora-

tion more than three times as frequently as either Bertrand or Aline. In attempting

to understand this difference, it would be misleading to attribute it to simple

language proficiency. In this regard, both EÂ douard and Aline were in a low

intermediate range while Bertrand was at a high intermediate level. As revealed

by a closer inspection of the data, the recourse to incidental collaboration was

related to a more complex interaction of factors, including the type of task

(whether or not it was new) and the availability of other resources (e.g., similar

documents in the charts, a clinical educator). Thus, during the clinical orienta-

tion, when all the nurses resorted less frequently to incidental collaboration,


they were in fact doing drafts and getting feedback from the clinical educator

(traditional collaboration). During the preceptorship, when EÂ douard was ob-

served to make frequent use of incidental collaboration, he was writing directly

in the patients' charts in ink and also had to deal with new entries in his notes

and forms, for which access to similar documents written by his colleagues was

not available. Of the three nurses, it was actually Bertrand who was having the

most difficulty with his documentation. Even though during his preceptorship

when I observed him, he resorted much less frequently to incidental collabora-

tion than EÂ douard or Aline, he, in fact, was still writing drafts, which were

being checked by his preceptor (traditional collaboration). Aline, who had had a

head start, due to the fact that she had done an internship at this hospital while

a student, was the most at ease with her documentation and had actually started

writing directly in the charts during the clinical orientation. Thus, although all

nurses had recourse to incidental collaboration, this resource was differentially

used depending on factors related to the nurse's particular situation, other than

mere proficiency.

DISCUSSION

Although previous studies have signaled instances of incidental collaboration

(Witte, 1992), the present study provides a concrete illustration as to how such

interventions contributed in substantive ways to L2 writers' ability to appro-

priate genre-specific language in a medical setting. The analysis reveals that,

although the interventions were brief, they were not limited to simple requests

for help with discrete items (vocabulary, grammar, spelling, and abbrevia-

tions). In addition to interventions with a linguistic focus, those that pertained

to the rhetorical or informational dimensions of documents were also in

evidence. Although when initially hired, the new nurses considered that the

main difficulty they would have doing their documentation in English would

be vocabulary, the difficulties they experienced went beyond mere translation.

In particular, the need for rhetorical information in terms of what to include or

not include in various documents provides evidence that nurses were in the

TABLE 4

Frequency of Incidental Collaboration per Nurse per Phase Observed on Unit ( N = 145)

Phase Interventions

Nurse Orientation Preceptorship n %

EÂ douard 26 69 95 66

Bertrand 10 16 26 18

Aline 8 16 24 17

114 PARKS

process of adapting to the genres particular to this hospital. In the informa-

tional category, this process was similarly evident in requests pertaining to

disciplinary knowledge.

The way nurses were gradually integrated into the hospital with reduced

workloads and support from various more experienced colleagues (the clinical

educator, the preceptor and staff nurses) suggests how newcomers are socialized

into a work environment through a process of legitimate peripheral participation

(Lave & Wenger, 1991). Newcomers were able to observe how the old-timers

conducted themselves with patients and administered care as well as get timely

advice when they carried out various procedures for the first time. Thus, Aline's

colleagues helped her improve her ability to put in IVs; a nurse Bertrand was

twinned with showed him how to take care of a patient's colostomy; EÂ douard's

preceptor showed him how to proceed upon the death of a patient and so forth.

The support given to the new nurses at the technical and administrative levels

also appeared, however, to extend to the collaborative processes evidenced in

relation to their writing needs. In this regard, the analysis of incidental

collaboration vividly demonstrates how nurses in various capacities were

collectively involved in supporting the new nurses' efforts to develop the genre

competence that would also serve to mark their participation in this discourse

community as competent members.

As with the other work-related needs, gaps in writing skill were dealt with

in the context of specific tasks. Referring to Vygotsky's zone of proximal

development, nurses, in terms of their ability to cope with the demands of

their various writing tasks, became increasingly self-regulated. This process

was particularly evident in regard to the nursing notes that they had to do for

each shift. Thus, during the orientation period, nurses wrote drafts and got

feedback from the clinical educator. By the preceptorship, nurses typically had

started writing directly in the charts but continued to get help, either by

consulting documents written by their colleagues (covert collaboration) or by

seeking out their more experienced colleagues (incidental collaboration).

Approximately 6 months after the nurses were on their units, I again observed

Bertrand and EÂ douard during two shifts each; only seven instances of

incidental collaboration were noted for EÂ douard and none for Bertrand. Like

their more experienced colleagues, Bertrand, EÂ douard, and Aline all ultimately

developed the ability to produce their notes and other documentation in a

routine manner.

In terms of how writing within the zone of proximal development con-

tributed to progressive self-regulation, it is important to note that nurses

received help at the point of immediate need, a condition that has been

signaled as particularly felicitous to the acquisition of language (Ellis, 1994;

Freedman, 1987). With respect to incidental collaboration, what further char-

acterized the interventions was the use of modeling. The more expert others not

only furnished the linguistic equivalences new nurses were seeking, but as


evidenced in the interventions with a rhetorical focus, also modeled whole

chunks of text, cueing the newcomers not only to the type of information

required but also to the way it should be textualized. The preference for

modeling, as opposed to merely cueing what was needed, was also evidenced

in the way the clinical educator gave feedback to the new nurses when she

went over their drafts. Typically, once the clinical educator had determined

through questioning what was rhetorically required, she wrote out the exact

formulation on the draft. At the end of these sessions, nurses copied the notes

into the patients' charts verbatim. Although previous studies suggest how the

hospital milieu may be accommodating for non-native speakers (Cameron &

Williams, 1997; Svendsen & Krebs, 1984), the present study underscores how

newcomers via legitimate peripheral participation (Lave & Wenger, 1991)

progressively master written genres.

The preference for modeling evidenced by the old-timers in this discourse

community contrasts with the tendency in writing classes to cue problem

areas by asking questions or using symbols to draw attention to troublespots.

Indeed, the reticence on the part of teachers to rewrite text is further

underscored by the pedagogical notion of the writer's ownership of his or

her text. Within Vygotskian-inspired activity theory (Wertsch, 1991), the

mediational means selected by individuals to carry out an activity are

considered to be directly related to the way in which the motive or purpose

for engaging in the activity is construed. Thus, it has been suggested that

activities construed as labor privilege mediational means associated with

productivity whereas those construed as schooling privilege learning. A study

conducted by Wertsch, Minick, and Arns (1984) (reported in Wertsch, 1991)

provides an interesting demonstration as to how the privileging of such

cultural values differentially mediated a task in which Brazilian teachers and

mothers were asked to help young children do a puzzle. Whereas the

teachers allowed the children to experiment and figure out how to do the

puzzle more by themselves (i.e., privileged learning), the mothers (who had

little education) tended to provide much more direct help in terms of

showing children what to do and thus avoiding error (i.e., privileged

productivity).1

With respect to the nurses, being able to work efficiently was a value that

appeared to extend not only to carrying out their work on the units in general,

but to the notion of competence as well. Not only did nurses have to learn to

do documentation quickly due to their patient load, but having it done by the

end of the shift was also essential as the first thing nurses did when they

arrived was to look at the charts. The importance of efficiency in documenta-

tion practices also surfaced in the preceptors' interactions with the new nurses.

Thus, for example, when Bertrand had difficulty doing his documentation, he

and his preceptor agreed that he should start on it earlier in his shift than was

normally the case. Bertrand also confided to me that getting his writing up to

116 PARKS

speed was an important objective for him. As in the case of the Brazilian

mothers, who by their close guidance, diminished the possibility for error, so

too did the practice of modeling. However, as has also been pointed out

(Wertsch, 1991), even though an activity setting may privilege a particular

motive, the apprenticeship behaviors characteristic of work environments do not

exclude learning. Indeed, as in the case reported here, the scaffolding provided

by the more expert others, in the form of incidental collaboration in concert

with other types of collaboration, provided a powerful context for developing

genre competence.2

Although within Applied Linguistics there has been considerable debate as to

whether or not ESL instructors should be involved in teaching genres from other

disciplines (Blanton, 1994; Spack, 1988; Swales, 1990, 1996), those who aspire

to teaching writing in the workplace must also be attentive to this issue. Beyond

the more obvious difficulties posed by the forms of arguments particular to a

discipline, as my experience as a `̀ collaborator'' within this nursing context

demonstrates, even seemingly common terms and grammar may pose problems.

A study by Harper (1991, reported on by Freedman, 1994) also revealed how

writing specialists' ability to teach written genres in professional settings was

limited by their lack of understanding of the complex rhetorical role of some

features of the discourse. It would seem that for those who wish to venture into

the workplace, an understanding of genre, not only in terms of formal features,

but also of the way in which rhetorical form and the social action that sustains it

are mutually constitutive (Miller, 1984) is essential. Indeed, as certain L1 and L2

writing consultants (Belcher, 1991; Smart, 1992, 1993; Spilka, 1993b) have

begun to point out, such knowledge can lead to a redefining of the latter's role in

the workplace.

Although the present study provides an illustration of how both formal and

informal organizational features mediated new nurses' ability to appropriate

genre-specific writing, not all workplaces, whether in regard to L1 or L2

employees, may be so accommodating. Rather than pose as authorities of

disciplinary and institutional genres, whose subtleties may elude them, writing

consultants, imbued with an understanding as to the mutually shaping character

of text and social context, may find a more fruitful avenue in their ability to act as

facilitators (i.e., to examine the processes of text production within an institu-

tional setting and make recommendations as to how the interaction amongst

employees could be improved). As demonstrated by the present study, old-timers,

those who are already expert in the genres newcomers need to appropriate, can be

effective mentors. However, even within the context of this study where the

institutional culture was particularly conducive to the integration of new-

comers (Parks & Maguire, 1999), peers did not normally offer advice to the

latter unsolicited; both self-initiated and other-initiated interventions tended to

take place with colleagues who were linked to the new nurses in an official or

semi-official capacity. Indeed, the most direct feedback (traditional collaboration)


was given by the clinical educator who was in charge of the new recruits during

the clinical orientation. As noted by Couture and Rymer (1991), the reluctance of

employees to comment on colleagues' writing may be due to notions of

professionalism that extend to competence in writing. As facilitators, one strategy

that writing consultants might explore pertains to the setting up of mentoring

systems, which would officially bring together old-timers and newcomers, thus

legitimizing such relationships. In a sense, the role of the writing consultant may

be re-envisioned as one of optimizing the scaffolding within the workplace,

conceived as a potential zone of proximal development. Finally, writing con-

sultants need to eradicate a myth: that writing development stops with school and

employees who need help with writing are incompetent. As the emerging studies

of new employees, both L1 and L2, suggest, the need to develop writing skills, as

one moves into new writing contexts, is the rule, not the exception. In this regard,

the needs of L2 employees may be viewed as a matter of degree rather than an

essential difference in regard to their L1 colleagues.

CONCLUSION

In this article, I have discussed how, in the context of incidental collaboration, even

seemingly brief interventions played a significant role in facilitating nurses' ability

to develop competence in work-related written genres. As revealed here, these

interventions were not restricted to discrete items (linguistic focus) but also

mediated informational and rhetorical aspects of text production. In contrast to

much school writing, modeling, as opposed to cueing of information, was

privileged. Consistent with Lave and Wenger's (1991) notion of legitimate

peripheral participation, incidental collaboration provided a vivid demonstration

of how old-timers assisted newcomers in the appropriation of genre-specific

language within the context of their writing tasks. It is further suggested that an

understanding of the way in which written genres and the social action that sustains

them are mutually constitutive may lead writing consultants to redefine their roles

within the workplace. Finally, although L2 researchers have begun to explore the

socioculturally embedded nature of writing within academic settings (Belcher &

Braine, 1995; Mohan & Smith, 1992; Riazi, 1997), similar attention needs to be

given to the workplace and the way in which such contexts may variously facilitate

(or inhibit) the ability of L2 employees to develop competence in written genres.

NOTES

1. For further discussions of text production within an activity framework,

see Dias et al. (1999), Parks (2000), Russell (1995, 1997), and Winsor (1999).

For discussions of activity theory applied to other areas of literacy or institutional

118 PARKS

functioning, see Cole and EngestroÈm (1993), Gallimore and Goldenberg (1993),

and Nicolopoulou and Cole (1993).

2. At one point during the study, the difference between workplace and

school cultures with respect to copying momentarily surfaced in a somewhat

amusing incident involving Bertrand and another new francophone nurse, Linda,

who was in the same orientation program. When Linda heard the clinical

educator congratulate Bertrand on the progress he had made in doing his nursing

notes, she teasingly chided him for having copied. Earlier in the shift, Linda had

been present when a colleague had helped Bertrand with the note he was being

congratulated on; in fact, the colleague had ended up writing out her suggestions

on a piece of paper. As I was subsequently able to verify, Bertrand had indeed

copied his colleague's suggestions virtually verbatim. Nevertheless, despite the

evident teasing, when confronted with copying directly in front of the clinical

educator, Bertrand protested that such was not the case.

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