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 services home health care, ambulatory care, and so forth are 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 therapies, changing demographics, and many others), the delivery of health care services in the United States (US) is undergoing rapid and important changes in the decade of the eighties (Mentkowski, & Doherty, 1984). Cost is a major factor involved in changes in delivery of services.
It has been widely reported and acknowledged that the fastest growing segment of the domestic economy of the US since the mid 1960s has been and, in the mid 1980s continues to be, the health c...