The writing of this book has been driven by the challenges facing clinical teams working within an ever-changing health service in the United Kingdom (UK). Increased consumer interest in health and illness, together with sustained political concern about health care, has had a massive impact on the health care services. The resultant workforce and organisational changes have brought developments in health care practice and role into sharper focus.
Health care is being increasingly placed under a spotlight, and the roles of nurses and doctors, among others, are being scrutinised. Traditional health care roles and scripts have been well rehearsed and firmly established, leading to customary practices and working patterns. Historically doctors have held centre stage, but this is now being challenged by acknowledgement of the contribution that others can make to health and social care.
Current health policy has provided frameworks for development of the National Health Service (Department of Health (DoH) 2003). Fundamental to this progressive vision is ensuring that patients act as the focal point for health care processes, and that patient care needs are serviced by effective clinical teams at every level of the health care organisation. At the heart of this modernisation programme is making maximum use of the skills and talents of the entire workforce. This is seen as central to an efficient, patient-centred service, and requires professional barriers between health practitioners to be broken down. If this is to be achieved, roles, relationships, behaviour and structures within the health service will need to be transformed: this issue is key to this text. Using the analogy of drama, an approach that is more extensively adopted later in this book, it is timely to explore further the roles of nurses and doctors, and find out where on the clinical stage, front or back, they really play their part.
The book is concerned with how doctors and nurses work together to make decisions within the clinical practice setting. It has, as its particular focus, the way that knowledge and roles are used within the decision-making process in the delivery of health care. The dominant power base is exposed, and the conflicts that this produces for both medicine and nursing are explored.
Whilst the attention of this book is on medical and nursing staff, it is important to note that these comprise but two groups of the health care personnel