This chapter explores key issues that have impacted on the nursing role in the clinical setting. Since the early 1960s, there has been great change in the content of medical and nursing work. Such change has occurred as a result of technological, professional, political and more recently, economic pressures. The fact that health care service workload continues to increase, is undeniable. From 1990 to 1998, acute activity in the UK rose by 38 per cent, and emergency admissions rose by 28 per cent from 1992 to 1998 (Buchan and Edwards 2000). This has resulted in an ambitious employment strategy (DoH 2000b) at a time when recruitment and retention of medical and non-medical health care staff is problematic (Caines 2001). This situation is not unique to the UK, with similar trends being noted worldwide (World Health Organisation 2001). Whilst all health care staff have been required to re-consider the remit and content of their work activities, it has been nursing and other non-medical staff who have predominantly developed their roles in order to meet the increasing service demand.
In this chapter, the impact of such pressures, at a time when the nursing profession is pushing its academic, clinical and professional boundaries, are explored, and the responses made by nursing to such changes are discussed. To illustrate the key issues raised in greater contextual depth, I will introduce the clinical field of intensive care. From examination of developments within this specialism, I make explicit the influence on the nursing role. Through this section, I hope that the reader will also become oriented to the specific clinical environment that acts as the central focus of this book.
In this section, a contemporary review of clinical role developments is undertaken encompassing both national and international perspectives. This review will demonstrate that there is clear evidence about the drivers for workforce developments in health care and that there remains much confusion about the developing role of the nurse per se. Several issues will be clearly evident: that