Power dynamics and professional expertise in the communication between specialist nurses and doctors in acute hospital settings

• Main Author: Radford, Mark Thomas
• Published: Birmingham City University 2012
• Subjects: 610.69
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573691

Aim. The aim of this PhD thesis is to report the sociological position, power dynamics and expertise in the communication between specialist nurses and doctors within NHS acute hospitals. Background. Nursing and healthcare have continually evolved, with new nursing roles interfacing professionally at a more advanced level with doctors. Historically the relationship and interactions have been characterised as the ‘Doctor-Nurse’ game which has been reviewed from many sociological perspectives. However, little has been added to understand the basis of these transactions that take place in the clinical setting between advanced practice nurses and doctors in hospitals. Methods. The primary methods comprised a critical realist approach ethnography, undertaking: fieldwork observations, follow-up interviews and artefact analysis on teams of specialist nurses and doctors working in three NHS hospitals. Seven specialist teams comprising 30 specialist nurses and 53 doctors of all grades were directly studied, alongside other peripheral members of the healthcare team as they delivered care. Results. The findings in this study demonstrate that much has changed concerning the role of the specialist nurse: professionally, clinically and sociologically. Four main themes emerged from the research: defining a new relationship between medicine and nursing; social space, development of ‘field’ in hospital care, division of labour, expertise and a new interaction model. The basis of the relationship has changed through bureaucratic challenges to the medical role which has resulted in changes to nursing power and its application in the clinical field in the new care models. There are a number of new strategies employed by both groups in the management of professional role, knowledge base, expertise and clinical work in the field. The communication strategies are more complex with a sophisticated coalition model of organisation. However, some ‘doctornurse games’ are still played out in the clinical setting, based upon traditional divisions of labour and power. This relationship has also created other tensions in the workspace particularly with junior medical staff, nursing staff and administrators.