Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care

By Maureen A. Coombs | Go to book overview

Chapter 8

Power and conflict on the clinical decision-making stage

This chapter explores the themes of power and conflict between doctors and nurses in decision making in intensive care. In this study, medical and nursing staff described themselves as working as part of cohesive clinical team, and this indeed was demonstrated the majority of the time. However, in the decision-making process, nursing perceived medicine to be domineering, and medicine perceived nursing to be weak, wanting a voice, but unprepared to take the concomitant responsibility. The power of each discipline and the conflict between them were made manifest through the knowledge used for, and the roles used in, decision making. The way in which this happened is explored together with the strategies used by both medicine and nursing to manage the resultant conflict.

In order to explore and analyse this phenomenon further, I have used a range of literature but have particularly chosen to use a dramaturgical perspective (Goffman 1959). In this chapter, I explain the rationale for this particular lens to focus on the decision-making stage, and then apply this theatrical metaphor to provide a further theoretical perspective on the decision-making process and the nursing role in this area of practice.


Setting the stage

The process of decision making in intensive care could have represented an integrated way of working with nurses and doctors holding complementary knowledge bases and roles. Indeed, there were examples of mutually satisfying, well-developed relationships between medicine and nurses: 'There appears to be a very open relationship between the consultant and the nursing staff. Nurse: What time are you doing the ward round? Consultant: Three minutes. Nurse looks thoughtful. Consultant: Ten minutes OK then? Nurse: Yes that's fine.' Flexible working arrangements were demonstrated, and all participants were optimistic about the general working relationships between medicine and nursing.

Nurses and doctors spoke positively about working relationships in intensive care. However, within the specific area of decision making, the working

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Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Illustrations vii
  • Acknowledgements ix
  • Abbreviations and Glossary xi
  • Introduction xv
  • Chapter 1 - Nursing Role Developments 1
  • Chapter 2 - Collaboration 11
  • Chapter 3 - Clinical Management Teams 25
  • Chapter 4 - The Study 37
  • Chapter 5 - Understanding the Context 52
  • Chapter 6 - Clinical Decision Making and the Hierarchies of Knowledge 63
  • Chapter 7 - Roles in Clinical Decision Making 84
  • Chapter 8 - Power and Conflict on the Clinical Decision-Making Stage 97
  • Chapter 9 - Breaking Through the Inner Circle 118
  • References 127
  • Index 144
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