This research is a critical study of small town nurses in light of the recently introduced market model in health management and services. I examine the professional identity of Registered Nurses by looking at how this . newly defined 'market worker' negotiates a place within the discourses of restructuring and the quasi-rural town. Among the new challenges for nurses faced by restructuring are the issues of flexibility and mobility.

Reform in the health sector in New Zealand has resulted in the scaling down, and in some cases closure,. of hospital facilities in towns. Some types of nursing work in towns are no longer practiced resulting in de-skilling, particularly in the area of surgical nursing. The remaining jobs, however, encompass multiple skills, and thus require functionally flexible or multiskilled staff.

It is argued that global processes, such as a shift to a market economy and restructuring are affected by place and hence differentially experienced by people in different locales. Small towns, for example, can be seen as a site of marginality in national and global terms and this in hrrn shapes the employment structure for nurses. Thus town nurses are more likely to be marginalised in a hierarchy which privileges highly specialised and high technology city nursing as opposed to low technology and functionally flexible or multiskilled town nursing.

In this research paper I argue that factors such as de-skilling, a shift to multiskilling and a recent loss of pay and work conditions in a small New Zealand town contribute to a crisis in professional identity among nurses. This crisis gives rise to several responses, for example, the proposal to either shift or commute for alternative nursing work (mobility), or to leave nursing altogether. 'Choices' Stffrounding paid work, even when a professional identity seems to be under threat, are seen to be highly contingent and the negotiation process of enabling and constraining discourses often eventuates in adjustment to the status quo.