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School of Management


School of Management SEMINAR Structure of Presentation Introduction context of research, NHS Plan (DH, 2000) Theory conceptual framework uses the sociology of ... – PowerPoint PPT presentation

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Title: School of Management

School of Management
Jurisdictional Change and Nursings
Professionalization Liberating Nurses or Losing
the Plot?
Carole Doherty Lecturer in Healthcare Management
Structure of Presentation
  • Introduction context of research, NHS Plan (DH,
  • Theory conceptual framework uses the sociology
    of professions and in particular Abbotts (1988)
    work on jurisdictional change
  • Methods mixed methods, questionnaire data
    supported by in-depth interviews
  • Findings nurses roles have altered with nurses
    now performing tasks traditionally carried out by
    doctors. This has resulted in intra-occupational
    differentiation. Specialist nurses have
    experienced greater clinical autonomy but ward
    sisters have experienced greater subordination
  • Conclusion overall government intervention in
    the division of labour may have been detrimental
    to the quality of essential aspects of patient
    care such as assisting patients with feeding

  • NHS Modernization
  • Break down the traditional, inflexible divides
    between occupational groups in the Service
  • Challenge to the medical professions monopoly
  • Opportunity for the professionalization of nursing

Research Questions
  • Have changes to nursings jurisdiction aided its
  • What have been the intra-occupational
    consequences of jurisdictional change?
  • Do nurses aspire towards the professionalization
    of their occupation?

Conceptual Framework
  • Sociology of Professions
  • The application of abstract knowledge to practice
    has both objective and subjective properties.
  • Subjective properties are socially constructed,
    this creates dynamism in the system of
    professions (Abbott, 1988)
  • Jurisdiction an area of practice over which an
    occupation has authority to act
  • Three areas for competition
  • The State including the legal system
  • Public opinion
  • The workplace

Jurisdictional Change
  • Possible outcomes
  • Full jurisdiction
  • Subordination
  • Intellectual jurisdiction
  • Sharing of the jurisdiction
  • Advisory control
  • Client differentiation

Nursings History
  • Modern form emerged in 1850s
  • Occupational strategy based on practical not
    theoretical knowledge
  • Broad and uncertain jurisdiction
  • Attempts to professionalize
  • 1900s, resulted in subordination
  • 1990s, resulted in weakened labour market

Study Design and Methods
  • Mixed methods
  • Quantitative data patterns and trends in
    nurses job attitudes, differences and
    similarities between the respective nursing jobs
  • Qualitative data underlying processes and
    organizational structures that might account for
    differences in job attitudes, the effect of
    changes to nursings jurisdiction, factors
    influencing nurses job aspirations
  • Data analysis
  • Abbotts (1988) categorizations of professional
    work, descriptive statistics, t tests to compare
    differences in job attitudes, content analysis
    using matrix

Changes to Jurisdiction
  • Key Tasks Staff
    Nurse Ward Sister Specialist
    Nurse Total
  • N115
    N64 N62

  • Routine tasks
  • Request x-rays
    18 27 39
  • Request blood tests
    73 74 65
  • Administer a range of medications using PGDs
    66 73
    68 69
  • Admit patients with specific conditions within
    agreed Protocols 16
    20 34 22
  • Discharge patients, with specific conditions
    within agreed protocols 17
    36 48
  • Diagnosis and inference
  • Make referrals for doppler/ultrasound to confirm
    DVT 3 2
    6 4
  • Make referrals for abdominal ultrasound
    3 4
  • Make referrals directly to consultant medical
    staff 15 33
    77 36
  • Inference and treatment
  • Trained as a supplementary prescriber
    2 2
    19 6
  • Diagnosis, inference and treatment
  • Interpret x-rays and initiate treatment
    1 2
  • Interpret blood test results and initiate
    treatment 24
    31 58 35
  • Receive referrals directly from GPs10196827

Comparison of job related variables for ward
sisters and specialist nurses
  • Ward
    Sisters (N64) Specialist Nurses (N 62)
  • Item M
    SE M SE
    t (124)
  • Qualifications 1.84 0.10
    2.34 0.10
  • Skill variety 2.30 0.11
    2.60 0.12 -1.78
  • Task identity 3.23 0.16
    3.98 0.11
  • Job autonomy 3.43 0.10
    4.14 0.08
  • Job complexity 3.92 0.08
    4.41 0.07
  • Role expectations 3.58 0.10
    3.76 0.09
  • Role clarity 3.44 0.11
    3.81 0.11
  • Career prospects 3.02 0.10
    3.63 0.10 -4.16
  • Decision-making 3.47 0.13
    3.12 0.14
  • Self-esteem 3.92 0.08
    4.22 0.08 -2.60
  • Innovative work behaviour 3.47
    0.11 3.81 0.11
  • Job satisfaction 3.40 0.09
    3.93 0.07 -4.65
  • plt0.05 plt0.01 plt0.001

Effects of Jurisdictional Change
  • Doing doctors work and losing nursing
  • thats all they nurses do for the first two
    hours in the morning they do IV antibiotics then
    theyre doing another lot of taking bloods and
    Ive very sadly looked at whats going on in the
    rest of the ward in terms of patients are lying
    in wet beds, patients mouth care isnt being
    done..Bells are going everywhere patients are
    calling for the toilet and I just feel we have
    got to take a step back and look really at what
    nursing is about and go back to not basic nursing
    care but essential nursing care. I think weve
    really lost it. I really, really do I think
    weve lost the plot.
  • Ward sister, 23 years experience

You can tend to neglect the patient because the
fundamental parts of nursing
seem to be missed a lot of the time now. .the
essence of nursing has been taken away from us
because weve got to take bloods, do ECGs, we
put venflons in. They are all things that the
doctors did at one time. Now we do it all.
Staff nurse, 7 years in nursing
Intellectual jurisdiction
  • For us here the patient is our sole
    responsibility it doesnt go to anyone else. We
    see them we make a diagnosis and we decide upon a
    treatment thats lovely. Because thats your
    patient and you make all the decisions and youve
    administered it from a-z
  • Ward sister 26 years experience who also
  • practised as an emergency nurse practitioner

Its becoming more and more autonomous as things
have gone on. It used to be very doctor
orientated you used to do what the doctor said.
How nursing has is definitely
developing towards more specialist type areas so
you become a practitioner in your own right
alongside the doctor side of it.
Staff nurse AE
Sharing the jurisdiction
  • I see new patients in their consultants
    clinics new referrals from GPs... I can decide
    what Im going to do for that patient without
    having to go and feedback to the consultant. I
    have that amount of autonomy with the role. I
    work with the registrars in clinic so basically
    anything that the registrar sees I will see and
    go and feedback to the consultant in the same
  • Specialist nurse

Basically I work with the consultant surgeons
assisting them with patients during their
peri-operative period. It means that I can see
them pre-op, take consent in out-patients and
explain procedures to them, participate during
surgery either as a first or second assistant or
perform surgery depending on how big the surgery
is. I do my operations independently under local

Specialist nurse
  • Job aspirations
  • Twenty-seven percent of ward sisters wished to
    become specialist nurses
  • Not one of the specialist nurses were inclined to
    become ward sisters
  • Aspirations among the staff nurse group were
    equally split between specialist nurse and ward
    sister jobs

  • Ward sister
  • So where will I be in 5 years time, I probably
    still will be in the NHS but thats probably
    because my bank manager needs me to be here
    rather than I want to be here because I dont see
    nursing getting any better I just see it getting
    worse, it getting more and more stressful.
  • Specialist nurse
  • There is no limit to what can be done in this
    post. I wouldnt like to go back to being a ward
    sister there is no challenge, after a time every
    day is similareven now there are times that I
    look at something and think what do I do. Every
    day is different.
  • Staff nurse
  • .you dont deal with the patients as much and
    thats not what I came into nursing to do to be a

  • Government intervention in the division of labour
    can have significant intra-occupational
    consequences for a subordinate occupation and
    impact on aspects of the dominant occupations
  • Complex and multifaceted outcomes of change to
    the division of labour within a single occupation
    - suggesting a need to move beyond single
    occupational categories in studies of occupations
  • Greater subordination has given rise to concerns
    that the work traditionally performed by nurses
    may become lost, opening the potential for
    further weakening of nursings labour market
  • The structure of the ward sisters job appears to
    constrain their opportunities. This finding adds
    to discussion about the role of structure and
    government policy in understanding changes to the
    division of labour (Bach et al., 2007)

School of Management