Professional autonomy in 21st century healthcare: nurses’ accounts of clinical decision-making

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Traynor, Michael ; Boland, Maggie ; Buus, Niels (2010)

Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus group study of UK nurses participating in post-qualifying professional development in a London university in 2008. Three groups of nurses in different specialist areas comprised a total of 26 participants. The study uses accounts of decision-making to gain insight into contemporary professional nursing. The study also aims to explore the usefulness of a theory of professional work set out by Jamous and Peloille in 1970. The analysis draws on notions of interpretive repertoires and elements of narrative analysis. We identified two interpretive repertoires: ‘clinical judgement’ which was used to describe the different grounds for making judgements; and ‘decision-making’ which was used to describe organisational circumstances influencing decision-making. Jamous and Peloille’s theory proved useful for interpreting instances where the nurses collectively withdrew from the potential dangers of too extreme claims for technicality or indeterminacy in their work. However, their theory did not explain the full range of accounts of decision-making that were given. Taken at face value, the accounts from the participants depict nurses as sometimes practising in indirect ways in order to have influence in the clinical and bureaucratic setting. However, a focus on language use and in particular, interpretive repertoires, has enabled us to suggest that despite an overall picture of severely limited autonomy, nurses in the groups reproduced stories of the successful accomplishment of moral and influential action.
  • References (53)
    53 references, page 1 of 6

    Alaszewski, A. (1995). Restructuring health and welfare professions in the United Kingdom: the impact of internal markets. In T. Johnson, G. Larkin & M. Saks (Eds.), Health Professions and the State in Europe pp. 55 - 74). London: Routledge.

    Atkinson, P., Reid, M., & Sheldrake, P. (1977). Medical Mystique. Sociology of Work and Occupations, 4(3), 243 - 280.

    Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlow Park, Calif.: Addison-Wesley.

    Benner, P., Tanner, C. A., & Chesla, C. (1996). Expertice in nursing practice. Caring, clinical judgement and ethics. New York: Springer Publishing Company.

    Benner, P., & Wrubel, J. (1989). The Primacy of Caring: stress and coping in health and illness. California: Addison-Wesley.

    Bixler, G. K., & Bixler, R. W. (1945). The Professional Status of Nursing. The American Journal of Nursing, 45(9), 730-735.

    Brooks, P. (1984). Reading for the Plot: design and intention in narrative. Cambridge, Mass: Harvard University Press.

    Carr-Saunders, A. M., & Wilson, P. A. (1933). The Professions. Oxford: Clarendon.

    Davies, C. (1995). Gender and the professional predicament in nursing. Buckingham: Open University Press.

    Degeling, P., Maxwell, S., Kennedy, J., & Coyle, B. (2003). Medicine, management, and modernisation: a "danse macabre"? BMJ, 326, vol 7390, 649-652.

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