The doctor-nurse relationship has traditionally been a man-woman relationship. However, in recent years, the number of women studying medicine has increased in all West-European countries, and in 1997, 29% of active Norwegian doctors were women. The doctor-nurse relationship has often been described as a dominant-subservient relationship with a clear understanding that the doctor is a man and the nurse is a woman. This article examines what happens to the doctor-nurse relationship when both are women: how do female doctors experience their relationship to female nurses? It is based on two sets of data, qualitative interviews with 15 doctors and a nationwide survey of 3589 doctors. The results show that in the experience of many doctors, male and female, the doctor-nurse relationship is influenced by the doctor's gender. Female doctors often find that they are met with less respect and confidence and are given less help than their male colleagues. The doctors' own interpretation of this is partly that the nurses' wish to reduce status differences between the two groups affects female doctors more than male, and partly that there is an "erotic game" taking place between male doctors and female nurses. In order to tackle the experience of differential treatment, the strategies chosen by female doctors include doing as much as possible themselves and making friends with the nurses. The results are considered in light of structural changes both in society at large and within the health services, with emphasis on the recent convergence of status between the two occupational groups.
"A more specific aspect of the power relations between the professions is that the 'game' initially identified by Stein (1967) was extremely gendered, and while this element may be less salient (Stein et al., 1990; Porter, 1992), at least in part due to the increased proportion of female doctors, more recent work has found that gender remains a relevant issue for medical students and doctors (Gjerberg & Kjølsrød, 2001; Davies, 2003; Zelek & Philips, 2003; Babaria, Abedin & Nunez-Smith, 2009). Rothstein and Hannum (2007), however, found that nurses did not differentiate between male and female doctors on several dimensions, suggesting that any gender issues from nurses' point of view may be very subtle. "
[Show abstract][Hide abstract] ABSTRACT: Abstract Newly qualified doctors spend much of their time with nurses, but little research has considered informal learning during that formative contact. This article reports findings from a multiple case study that explored what newly qualified doctors felt they learned from nurses in the workplace. Analysis of interviews conducted with UK doctors in their first year of practice identified four overarching themes: attitudes towards working with nurses, learning about roles, professional hierarchies and learning skills. Informal learning was found to contribute to the newly qualified doctors' knowledge of their own and others' roles. A dynamic hierarchy was identified: one in which a "pragmatic hierarchy" recognising nurses' expertise was superseded by a "normative structural hierarchy" that reinforced the notion of medical dominance. Alongside the implicit learning of roles, nurses contributed to the explicit learning of skills and captured doctors' errors, with implications for patient safety. The findings are discussed in relation to professional socialisation. Issues of power between the professions are also considered. It is concluded that increasing both medical and nursing professions' awareness of informal workplace learning may improve the efficiency of education in restricted working hours. A culture in which informal learning is embedded may also have benefits for patient safety.
Journal of Interprofessional Care 05/2013; 27(5). DOI:10.3109/13561820.2013.783558 · 1.40 Impact Factor
"However, a changing negotiation context, new nursing knowledge and new organisational conditions in the hospital context have strengthened the voice of nursing (Svensson, 1996). Hierarchical relations between doctors and nurses have seen important changes in recent years (including increasing numbers of women in medicine) (Gjerberg & Kjølsrød, 2001). Yet traditional relations still hold sway; those lower down in the hierarchy, regardless of gender are subservient to those higher up (Davies, 2003). "
[Show abstract][Hide abstract] ABSTRACT: It has been suggested that as many as 23,000 in-hospital cardiac arrests in the UK could be prevented with earlier detection and intervention (Hodgetts et al., 2002). Cases of 'failure to rescue' are often linked with difficulties relaying and interpreting information across occupational and professional boundaries. Standardised communication protocols have been recommended as a means of enabling the transmission of concise, salient information, licensing and empowering the individual to overcome established hierarchies in speaking out and asking for help. This paper critically examines the current discourse around such protocols. We find that there is a paucity of evidence regarding the complex relationship between social contexts, individual applications of these protocols and short- and long-term impact on safety and 'failure to rescue' rates. The paper highlights the complexities of the underlying power dynamics that are located within gendered and occupational hierarchies and explores the role of standardised communication protocols as a potential boundary object. The paper discusses the potential for these protocols to inter-relate and act as a mediating boundary object between nursing and medical staff, enabling understanding and sharing of cultural context.
Social Science [?] Medicine 11/2010; 71(9):1683-6. DOI:10.1016/j.socscimed.2010.07.037 · 2.89 Impact Factor
"101). While the topic of role relations and power balance between doctors and nurses takes a prominent place in the literature (Gjerberg & Kjølsrød 2001; San Martin-Rodriguez et al. 2005; Sweet & Norman 1995) there is little research specifically on non-prescribing nurses' place in drug decision making. "
[Show abstract][Hide abstract] ABSTRACT: JUTEL A. & MENKES D.B. (2010) Nurses' reported influence on the prescription and use of medication. International Nursing Review57, 92–97
Aim: To identify the activities senior nurses report undertaking that may influence the prescription and use of medicines.
Background: While much attention has focused on the role of nurse prescribing, little is known about the extent to which non-prescribing nurses influence medication decision making. The pharmaceutical industry recognizes this influence in its marketing strategies, and courts nurses by provision of promotional material and sponsorship of nursing professional development.
Methods: We undertook parallel web- and paper-based surveys of 100 senior registered nurses employed by government-funded health boards in two distinct New Zealand regions.
Findings: Only 2/96 (2%) of nurses had prescribing rights, yet 74/94 (79%) reported recommending treatments to the prescribing doctor, 74/95 (79%) stated they provided advice to patients about over-the-counter medications and 71/92 (77%) participated in the development of guidelines or policies that include the use of medications. All nurses in this sample reported influencing the prescription of medicines in one way or another.
Discussion: From actually writing prescriptions to providing feedback on treatment outcomes, there are many opportunities for nurses to influence the decision making of medical and other prescribers, which open nurses to exploitation from commercial forces. Policy and education regarding prescriber relationships with the pharmaceutical industry should also recognize the role of non-prescribing nurses.
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