Getting a visit: how district nurses and general practitioners 'organise' each other in primary care.
This paper examines the ways in which district nurses and general practitioners interacted and influenced each other's work within primary care services. The data presented here examine how the developments in the organisation of primary care affected the work of district nurses during a time of turbulent change. Qualitative data from 300 hours of participant observation and 40 semi-structured interviews with 33 district nurses were analysed using grounded theory, after which a literature review was undertaken. The findings from this study were interpreted using a Foucauldian notion of power and Fox's (1995) analysis of 'organisation'. The shift in power to general practitioners (GPs) has meant that they can exercise ever-increasing authority over nurses in their employ. Strict rules governed the process of inter-professional work and nurses and doctors used creative strategies to overcome the problems that existed between them. The data show that nurses could and did resist the power of GPs but this resistance generally elicited other more punishing forms of authority. Direct and indirect threats were commonplace. The data suggest that district nurses were moving into a closer, more business-like and tightly-controlled working relationship with general practitioners, through which competing discourses interplayed and circulated between GPs and district nurses in the organisation of primary care services.
Speed
Shaun
S
School of Nursing, Midwifery and Social Work, University of Manchester. Manchester M13 9PL. shaun.speed@manchester.ac.uk
Luker
Karen A
KA
D003152:Community Health Nursing / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D019555:Physician-Nurse Relations; D033302:Postmodernism; D011209:Power, Psychological; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research