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

By Maureen A. Coombs | Go to book overview

Chapter 9

Breaking through the inner circle

Rhetoric or reality?

An important moment for me during the study fieldwork came when nursing staff were describing one of their perceptions about the ward round. This was encapsulated in the phrase 'Breaking through the inner circle'. The words aptly described the spatial tensions occurring in the ward round, and summarised the experiences of nursing staff in their aim to contribute to clinical decision making. It represented the situation where medicine and nursing operated within their own domains, and how it was principally nurses who sought to influence medicine in order to re-define care delivery. This phrase became symbolic and, therefore, is used in the title of this book, and as the heading for this last chapter. In the chapter, I summarise the key themes to emerge from the book, and explore the implications of this work. Present and future opportunities will be considered that may enable a working environment for collaborative practice to be attained. However, this can only be achieved if the inner circles are breached and the territorial boundaries across the health care teams are broken down.

I will first present some limitations of this book. In contributing to the sociological literature, this book indirectly explores both structure and agency. I have not explored the precise nature of the inter-relationship between the macro and micro sociological level of analysis. Whilst structural components of interdependent decision making, with the influence of social structure theories, and agency issues with use of social action theories, have been described, the mechanism of the interaction between the two was not examined in detail. Layder (1998, p. 99) asserts that a multidimensional approach, acknowledging the diversity of social reality, is required: 'Methodologically, therefore, it is necessary to find ways of weaving them [structure and agency] together while preserving their integrity as distinct, but relatively autonomous, from each other.' In future work, this particular aspect will need greater consideration and more explicit consideration within both methodological debate and empirical work.

Throughout the fieldwork, I was profoundly surprised by the frankness of expression, especially from the medical staff. This led to concerns regarding the validity of data from this source. My concerns were that they were either

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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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