The nurse under physician authority: commentary.

As a nurse it is difficult for me to read this paper without feeling somewhat 'prickly' but at the same time I welcome May's attempt to address an unfashionable topic, which needs some debate. Why the defensiveness? It follows from certain statements May makes, for example his assertion that full colleague status for nurses with doctors, is connected with nurses taking on 'certain responsibilities to do with diagnosis and assessment, and even with the determination of range of treatments'. This assertion isn't of course untrue. Nurse practitioners who work in this way clearly have enhanced status but the point is that nursing status is yet again being assessed on medical terms: the 'other' dimensions of nursing are not seen to be equally but differently 'other'. Later in his paper May tries to redress this by referring to nurses' 'complex and sophisticated education' and the extension of their role beyond medicine. Is it undue sensitivity on my part that finds this faintly patronising rather than reassuring? Be this as it may, these issues are not central to the paper's argument and I now want to consider the question of authority. It is certainly true that a traditional part of the doctor-nurse relationship has been the practice of physicians ordering treatment and nurses complying. May doesn't clarify precisely what is to be included in the concept of 'medical treatment' but historically, medication, dressings, and nursing care have all been seen to be legitimate areas of medical prescription. That this is now a shrinking arena of medical control would probably not be disputed but heated disputes might arise as to where precisely the line should be drawn and even as to whether such a line can be drawn, ie might some degree of ambiguity be essential? Nevertheless within rough parameters, it would probably be agreed that nursing care is no longer an appropriate focus of medical authority; medication remains legitimately so (although when introduced, nurse prescribing will begin to impinge on this) and dressings remain a somewhat ambiguous area, with the outcome determined by context.