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Medicine and Nursing

Medicine and Nursing
Professions in a Changing Health Service

  • Sylvia Walby - Royal Holloway, University of London, UK, City University of London, UK, City, University of London, UK, Lancaster University, UK
  • June Greenwell - University of Lancaster, UK

Other Titles in:
Nursing | Public Health

September 1994 | 224 pages | SAGE Publications Ltd
The NHS is the largest employer in Western Europe. It embraces two of the oldest professions - doctors and nurses - whose work practices are still highly traditional and yet currently at the forefront of radical change as health work is being reorganized to reflect the new political priorities of the 1990s. This book focuses on the collaborative work of doctors and nurses in one particular area: the acute hospital ward, looking at the effects of `new wave' management on formerly independent, autonomous teams. The authors examine the impact of changes in health service on professional boundaries and inter-professional relations, exploring the paradox of the ostensible drive to decentralise responsibility introduced alongside the increased management of professionals. They discuss the tensions between simultaneous application of Fordist to post-Fordist modes of governance and describe an increasingly fragmented service, in which inflexible working patterns are generated by demand for the optimal use of labour, but where there remain examples of effective collaborative working.

Professional Boundaries
Interprofessional Relations in Theory and History
Fragmented and Functioning Teams
Managing Professionals
Post-Fordism and the Health Professions

`this remarkable book examines the practical and theoretical issues concerning the relationship between doctors and nurses in a changing health sercive. The empirical base of this study is the UK National Health Service; however, its problems have a wider international scope, which are typical in other countries where health services are likewise in the process of transformation.... This book will be particularly useful to those nurses who have an interest in the transformation of contemporary health services in Europe' - Nursing Ethics

`Clearly identifies the theoretical and practical dilemmas faced by nurses and doctors as they face cost containment measures resulting from concerns about the demographic "time bomb" of a rapidly ageing population, and projections of increased excess demand for services.... provides an interesting focus on the theoretical and practical debate around employment change and will be useful to a range of academics, practitioners and students' - Medical Sociology News

`A welcome addition to the burgeoning multidisciplinary literature on workers and work organization in the health services.... Chapter two gives the most cogent rendering of the field research findings covered by the book, with an analysis of the points of conflict which exists between doctors and nurses, covering the issues of `contested authority', `care versus treatment' and `patients first'. The chapter is well-written and can easily be followed by a non-medical reader... the status given current managerialist theory means that this is a book that will certainly get read: health service managers, are now hungry for this sort of literature.... This is a research and policy area of overwhelming importance which has been neglected in the past and is only now being seriously addressed. In this respect, [the book is] to be welcomed as [a] contribution which will further promote interest' - Work, Employment & Society

`A timely and important book, of help to all of us facing our own type of change.... the book is written in a style that is both accessible and absorbing.... What is very helpful is how the authors use the evidence from their study to construct hypotheses as to how doctors and nurses are coping with the NHS reforms. Their description of the decentralised, flexible, multiskilled approach characterised by new management in the NHS is contrasted with the old habits and behaviour patterns. They ask the question, and the reader has to consider, whether, given the reality of many doctors' and nurses' experiences, the quest for a new management culture is nothing more than a puff of smoke masquerading as a `grotesque turbulence'. Medicine and Nursing is a thought-provoking book that has wide appeal and will help all members of the multiprofessional team think through their roles and responsibilities, particularly in the light of changes in junior doctors' hours and the expansion of the nurses' role' - British Medical Journal

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ISBN: 9780803987425