title: In the public interest: autonomy and resistance to methods of standardising nurses' advice and practices from a health call centre in Perth, Western Australia.
abstract: The history of nursing is replete with examples of nurses battling for autonomy over their education, knowledge and work practices. The latest battleground is HealthDirect, Australia's first medial call centre, where nurses are required to meet externally imposed clinical standards while satisfying legal and financial obligations. These objectives are arguably achieved when nurses assess callers' health problems via computerised algorithms that determine an appropriate plan of action. That way, nurses' subjective responses to callers are ruled out. To ensure nurses comply with the standard processes, calls are monitored randomly and surreptitiously in formal and informal ways. This paper explores how nurses respond to standard procedures and surveillance, in order to argue that nurses' input partially drives reform processes. Nurses continue to seek autonomy over the advice they give and how their work is evaluated but are constrained by structural power relations.
authors.affiliation: School of Law and Justice, Edith Cowan University, Joondalup, WA, Australia. a.larsen@ecu.edu.au
authors.forename: Ann-Claire
authors.initials: AC
authors.lastname: Larsen
mesh_terms: D000465:Algorithms; D001291:Attitude of Health Personnel; D002985:Clinical Protocols / Q000592:standards*; D003376:Counseling / Q000592:standards*; D016529:Emergency Nursing / Q000592:standards; D004647:Employee Discipline; D019983:Guideline Adherence / Q000592:standards; D015277:Hotlines / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D009730:Nursing Assessment / Q000592:standards; D009731:Nursing Audit / Q000458:organization & administration; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D008486:Physician Executives / Q000523:psychology; D011209:Power, Psychological; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014218:Triage / Q000592:standards; D014904:Western Australia