Chapter 13: Nurses, Physician Assistants, Pharmacists, and Midwives Flashcards
4 subordinate positions (health occupation)
• NPs and PAs are moving in direction of replacing physician in providing routine care
- Work most often occurs at the request of the physician:
- “physicians orders”
- The position of physician has the greatest prestige:
- Patient’s view
- This is a changing point of view
The role of nursing saw a drastic change in the mid- nineteenth century:
- Florence Nightingale a woman from a middle class family believed she was called to the service of Christianity by God
- After receiving her training she established a hospital for women and staffed it with “trained nurses,” insisting that nursing should become an honorable and respected occupation
Role Of a Nurse (8)
- Responsible
- Clean
- Self-sacrificing
- Courageous
- Cool headed
- Hard working
- Obedient to the physician
- Possessing the tender qualities of a mother
A problem that continues in nursing today…
There was a lack of uniformity in the training provided to nurses
Three types of programs available for RNs 1.
Hospital-based diploma schools:
• Once accounted for more than 80% of nursing graduates, but now only account for 3%
Three types of programs available for RNs 2.
Two-year associate degree programs:
• Account for 55% of nursing graduates
• “Technical” nurses
Three types of programs available for RNs 3.
Four-year and five-year university baccalaureate programs
• Account for 42% of nursing graduates
• Most prestigious of program types
• “Professional” nurses
Nurse Practitioner or Nurse Clinician is a…
position designed to more fully use the skills and capabilities of a well-trained nurse
NPs are RNs that are trained in the diagnosis and
management of common ailments-
- Goal is to free the physician from routine tasks and allow them to focus on complex medical problems
- NP continues to be a subordinate role to the physician
- States have varying laws regarding how much treatment an NP can give to a patient
Nursing Students go through.. (6)
1) Initial innocence
2) Labeled recognition of incongruity
3) “Psyching out”
4) Role simulation
5) Provisional internalization
6) Stable internalization
Role of Nurse (male)
Nursing as a gendered occupation for females is unique in that it developed with a direct subordinate role to a male dominated profession
“The Doctor- Nurse Game”
• Supports the authority of doctors and
subordination of nurses
• The central rule of the game is to avoid open disagreement between the players
• Requires nurses to communicate recommendations without appearing to do so, while physicians, in seeking recommendations, must appear not to be asking for one
• The greater the significance of the recommendation, the more subtly it must be conveyed
Signs that gender inequality is losing some of its power in nurse–doctor relationships
- Greater assertiveness by nurses
- Increased numbers of male nurses
- Growing numbers of female doctors
Male Nurses
Male nurses are also less passive in their interactions with doctors and less likely to play the doctor-nurse game
Female Nurses and the DNG
Female physicians were not as likely to play the doctor–nurse game with either male or female nurses, but they were also more likely than male physicians to have their actions questioned by nurses
Nursing Future Trends (changing it)
1) Greater specialization within nursing, such as in hospital administration, primary care, nurse anesthetists, and cardiovascular specialists
2) Movement of RNs into administrative roles, leaving basic nursing tasks to lesser-trained nurses
Emergence of the nurse practitioner, who has greater authority to treat basic medical problems
- Frees physicians from routine tasks of medical practice
* Licensed to prescribe medications in all 50 states
Development of doctorate programs in nursing and other health professions
Challenges the dominance of medical doctors
Physician Assistant
Licensed to practice medicine under the supervision of a physician and are trained to handle routine medical problems
Pharmacist
- Represent the most accessible of all health care personnel
- Cannot dispense prescription drugs without authorization from a physician or other legally sanctioned practitioner
- Explain the effects of prescription drugs and levels of doses to patients and at times to practitioners—as well as provide instructions for their use
Midwives
Women who assist a mother during childbirth
• Nurse-midwives who assist to deliver babies under the
supervision of a physician
• Lay midwives who assist births on their own
Midwives.. Decline
Births attended by midwives declined dramatically in the 20th century, in large part due to the opposition of the medical profession to midwifery
