very institutions, increased patient risk, and significant disrup tions in the lives of the professional nurses involved. Burn out leads to additional defections from the profession, and further exacerbates the professional personnel shortage.
The nursing shortage is also aggravated by a significant decline in the numbers of new professional nurses being pro vided by schools of nursing (Manthey, 1988). The decline in the output of schools of nursing is the combined result of reduced numbers of students entering the schools (Huey, & Hartley, 1988), and increasing attrition rates among enrolled students (Parkes, 1982).
The issue of professional autonomy is as important as is the nursing personnel shortage. The issue of who should 3control nursing is rooted in an age old conflict between nurses and physicians (Weiss, 1983), and it is rooted in the contem orary restructuring of the health care delivery environment (McNerney, 1988). Physicians have traditionally assumed a superiority of status with respect to all other care givers, in the delivery of health care services to patient (Friedson, 1970). Nursing, however, considers the patient and patient care from a different, but equally valid, perspective from the approach of physicians (Nelson, 1988), and nurses think their profession requires a significant degree of autonomy from the physician in the delivery of patient care (Brunner, 1985).
The restructuring of the health care delivery environment adds new dimensions to the issue of control over the nursing function. First, changes in the locus of delivery of health care services home health care, ambulatory care, and so forth are creating new opportunities and new demands for professional nursing (Weiss, 1983). Second, however, econo mic factors in the new health care delivery en
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