Medical Sociology: Chapter 13 Nurses, Physician Assistants, Flashcards
Introduction
• The occupations performing tasks of patient care are generally organized around the work of the physician and are usually under the physician’s direct control
Introduction
• Freidson notes four characteristic features that account for their subordinate position in the practice of medicine:
1) Technical knowledge of health occupations must be approved by physicians
2) These workers usually assist physicians in their work rather than replace the skills of diagnosis and treatment
3) Their work largely occurs at the “request of” the physician
4) Among the various occupational roles in the health field, physicians have the greatest prestige
Nursing: Past and Present
- Represents the largest single group of health workers
- 75% work in hospitals and nursing homes
- Nursing tasks occur in a system of social relationships that were historically stratified by sex
– Traditionally has been the task of women and subordinate to the male doctor
Nursing: Early Development
- Prior to the 19th century, nursing tasks were performed by nuns largely as charitable or religious care and were not incorporated into the formal structure of medical services
- Nurses lacked specialized training in medical care
- Occupation not held in high regard by general public
Nursing: Florence Nightingale
• Transformation of nursing from charity care to a formal occupation was helped in large part by the efforts of Florence Nightingale
– Emphasized a code of behavior that incorporated the best attributes of the mother and the housekeeper into her ideal nurse
– Did little to establish nurses as having the qualities of leadership and independence necessary for true professional status
Nursing: Education
- Early nursing schools in the U.S. were affiliated with hospitals and often used as a source of inexpensive labor for the hospital
- Quality of education improved greatly over the 20th century but, unlike medical schools, nursing education has always been fragmented
Nursing: Education
• 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%
2) Two-year associate degree programs
- Account for 55% of nursing graduates
- “Technical” nurses
3) Four-year and five-year university baccalaureate programs
- Account for 42% of nursing graduates
- Most prestigious of program types
- “Professional” nurses
Nursing: Students
• Nursing students pass through a variety of stages in the course of their education
1) Initial innocence
2) Labeled recognition of incongruity
3) “Psyching out”
4) Role simulation
5) Provisional internalization
6) Stable internalization
Nursing: Students
- Nursing students generally must reconcile the idealism of caring for others with the demands of curriculum on emotional detachment in the performance of nursing tasks
- Career aspirations of students have shifted from one in which nursing was viewed as secondary to goals of marriage and family to one in which nursing is pursued explicitly as a career
Gender and “The Doctor-Nurse Game”
• Represents an informal interactional style
– 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
Nursing: Gender
• 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
Nursing: Gender
- Male physicians tend to regard male nurses as more competent than female nurses and to treat them accordingly
- Male nurses are also less passive in their interactions with doctors and less likely to play the doctor-nurse game
- 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
• Recent trends have been and are likely to continue changing the role of nursing
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
Nursing: Future Trends
3) 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
4) Development of doctorate programs in nursing and other health professions
• Challenges the dominance of medical doctors
Physician Assistants
- Licensed to practice medicine under the supervision of a physician and are trained to handle routine medical problems
- The PA, in conjunction with the nurse practitioner, may be able to resolve the significant issue of providing more primary-care practitioners in the American system of health care delivery
