IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v71y2010i8p1506-1512.html
   My bibliography  Save this article

Professional autonomy in 21st century healthcare: Nurses' accounts of clinical decision-making

Author

Listed:
  • Traynor, Michael
  • Boland, Maggie
  • Buus, Niels

Abstract

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 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 (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.

Suggested Citation

  • Traynor, Michael & Boland, Maggie & Buus, Niels, 2010. "Professional autonomy in 21st century healthcare: Nurses' accounts of clinical decision-making," Social Science & Medicine, Elsevier, vol. 71(8), pages 1506-1512, October.
  • Handle: RePEc:eee:socmed:v:71:y:2010:i:8:p:1506-1512
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00579-4
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Salhani, Daniel & Coulter, Ian, 2009. "The politics of interprofessional working and the struggle for professional autonomy in nursing," Social Science & Medicine, Elsevier, vol. 68(7), pages 1221-1228, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Schubert, Samantha & Buus, Niels & Monrouxe, Lynn & Hunt, Caroline, 2023. "Interrogation in clinical supervision sessions: Exploring the construction of clinical psychology trainees’ professional identities," Social Science & Medicine, Elsevier, vol. 325(C).
    2. Jacqueline Peet & Karen Theobald & Clint Douglas, 2019. "Strengthening nursing surveillance in general wards: A practice development approach," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(15-16), pages 2924-2933, August.
    3. Ricardo A. Ayala & Raf Vanderstraeten & Piet Bracke, 2014. "Prompting professional prerogatives: New insights to reopen an old debate about nursing," Nursing & Health Sciences, John Wiley & Sons, vol. 16(4), pages 506-513, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Powell, Alison E. & Davies, Huw T.O., 2012. "The struggle to improve patient care in the face of professional boundaries," Social Science & Medicine, Elsevier, vol. 75(5), pages 807-814.
    2. Kuijper, Syb & Felder, Martijn & Clegg, Stewart & Bal, Roland & Wallenburg, Iris, 2024. "“We don't experiment with our patients!” An ethnographic account of the epistemic politics of (re)designing nursing work," Social Science & Medicine, Elsevier, vol. 340(C).
    3. Kitchener, Martin & Mertz, Elizabeth, 2012. "Professional projects and institutional change in healthcare: The case of American dentistry," Social Science & Medicine, Elsevier, vol. 74(3), pages 372-380.
    4. Kroezen, M. & Mistiaen, P. & van Dijk, L. & Groenewegen, P.P. & Francke, A.L., 2014. "Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings," Social Science & Medicine, Elsevier, vol. 117(C), pages 107-115.
    5. Petrakaki, Dimitra & Barber, Nick & Waring, Justin, 2012. "The possibilities of technology in shaping healthcare professionals: (Re/De-)Professionalisation of pharmacists in England," Social Science & Medicine, Elsevier, vol. 75(2), pages 429-437.
    6. Grace, Matthew K. & VanHeuvelen, Jane S., 2019. "Occupational variation in burnout among medical staff: Evidence for the stress of higher status," Social Science & Medicine, Elsevier, vol. 232(C), pages 199-208.
    7. Petrakaki, Dimitra & Klecun, Ela & Cornford, Tony, 2016. "Changes in healthcare professional work afforded by technology: the introduction of a national electronic patient record in an English hospital," LSE Research Online Documents on Economics 59475, London School of Economics and Political Science, LSE Library.
    8. Liberati, Elisa Giulia & Gorli, Mara & Scaratti, Giuseppe, 2016. "Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care," Social Science & Medicine, Elsevier, vol. 150(C), pages 31-39.
    9. Liberati, Elisa Giulia, 2017. "Separating, replacing, intersecting: The influence of context on the construction of the medical-nursing boundary," Social Science & Medicine, Elsevier, vol. 172(C), pages 135-143.
    10. Johannessen, Lars E.F., 2018. "Workplace assimilation and professional jurisdiction: How nurses learn to blur the nursing-medical boundary," Social Science & Medicine, Elsevier, vol. 201(C), pages 51-58.
    11. Skountridaki, Lila, 2017. "Barriers to business relations between medical tourism facilitators and medical professionals," Tourism Management, Elsevier, vol. 59(C), pages 254-266.
    12. Motulsky, Aude & Sicotte, Claude & Lamothe, Lise & Winslade, Nancy & Tamblyn, Robyn, 2011. "Electronic prescriptions and disruptions to the jurisdiction of community pharmacists," Social Science & Medicine, Elsevier, vol. 73(1), pages 121-128, July.
    13. Nugus, Peter & Greenfield, David & Travaglia, Joanne & Westbrook, Johanna & Braithwaite, Jeffrey, 2010. "How and where clinicians exercise power: Interprofessional relations in health care," Social Science & Medicine, Elsevier, vol. 71(5), pages 898-909, September.
    14. Liff, Roy & Wikström, Ewa, 2015. "The problem-avoiding multi professional team—On the need to overcome protective routines," Scandinavian Journal of Management, Elsevier, vol. 31(2), pages 266-278.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:71:y:2010:i:8:p:1506-1512. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.