Abstract
Over the past decades, professional boundaries in health care have come under pressure, and the expansion of prescriptive authority to include nurses touches on issues of professional domains and interprofessional competition. Knowledge claims play an important role in achieving jurisdictional control. Knowledge can take on multiple forms, ranging from indeterminate to technical (I/T ratio) and from everyday to exclusive knowledge. To investigate the interrelatedness of jurisdiction, knowledge claims and professional status, we examine which knowledge claims were made by the medical and nursing professions in the Netherlands to secure or obtain, respectively, jurisdictional control over prescribing, and which form this knowledge took. The study is based on thirteen semi-structured stakeholder interviews and an extensive document analysis. We found that the nursing profession in its knowledge claims strongly emphasized the technicality and everyday knowledge character of the prescribing task, by asserting that nurses were already prescribing medicines, albeit on an illegal basis. Their second claim focused on the indeterminate knowledge skills of nurses and stated that nurse prescribing would do justice to nurses’ skills and expertise. This is a strong claim in a quest for (higher) professional status. Results showed that the medical profession initially proclaimed that prescribing should be reserved for doctors as it is a task requiring medical knowledge, i.e. indeterminate knowledge. Gradually, however, the medical profession adjusted its claims and tried to reduce nurse prescribing to a task almost exclusively based on technicality knowledge, among others by stating that nurses could prescribe in routine cases, which would generate little professional status. By investigating the form that professional knowledge claims took, this study was able to show the interconnectedness of jurisdictional control, knowledge claims and professional status. Knowledge claims are not mere rhetoric, but actively influence the everyday realities of professional status, interprofessional competition and jurisdictional division between professions.
Highlights
Over the past decades, professional boundaries in health care have come under pressure, among others as a result of flexible neo-liberal approaches to managing health care [1,2]
The main argument of the nursing profession in seeking prescriptive authority was that nurses were already prescribing medicines, albeit on an illegal basis
In the debate on nurse prescribing in the Netherlands, both the nursing and medical professions used various knowledge claims to obtain or secure, respectively, jurisdictional control over prescribing
Summary
Professional boundaries in health care have come under pressure, among others as a result of flexible neo-liberal approaches to managing health care [1,2]. In this article we are concerned with the negotiating of professional boundaries by the nursing and medical professions when it comes to the task of prescribing medicines. Jurisdiction or control over certain task areas is crucial for professions, because it is their means of continued livelihood [10]. Professionals who are recognized as experts in a certain area, in this case the area of prescribing medicines, typically possess a form of cultural capital whose ownership confers status and power [11]. These professions often enjoy a number of privileges, such as control over professional training, recruiting and licensing [12]. Abbott [12] labels jurisdiction – “the link between a profession and its work” (page 20) – as the central phenomenon of professional life
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