Governance in Nursing

The issue of who should control nursing is rooted in an age old conflict between nurses and physicians (Webster, 1988), and it is rooted in the contemporary 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 serviceshome health care, ambulatory care, and so forthare creating new opportunities and new demands for professional nursing (Weiss, 1983). Second, however, economic factors in the new health care delivery environment have propelled managers and administrators into roles, wherein they attempt to impinge on the autonomy of all health care professionals (Particelli, 1984; Wolper, 1983; Drake, 1982).

PRESENT STATE OF THE ISSUE

As a result of a combination of factors (increasing costs of health care, changing societal values, advances in treatment therap

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