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undifferentiated other (everything that doctors do not do in the treatment of patients), it was impossible to create precise arguments for professionalization based on research results. |
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But as nursing differentiates and becomes more autonomous, it too creates its own undifferentiated other. In what sense? As Abbott emphasized, professionalization depends upon the scope of the professions' jurisdiction. For NIC this implies that if nurses define a number of activities as specifically to do with nursing, they also claim only these activities. Although the researchers mean to include all the activities that nurses do, it is impossible to be totally inclusive, as we have demonstrated. Regional variations and those activities that cut across professional domains cannot be articulated in an interventions classification system. Some activities may be left in residual categories, or left for other health care groups such as licensed vocational nurses and technicians. Implicit in the physician's classification systems was the assumption that nurses would perform any unaccounted work that would support the fit between the doctors' prescription and the patient's health.
42 Now that nurses are creating their own classification system, they too might rely in a changed fashion on the invisible and unaccounted work of others. |
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The NIC group hopes that their classification system will sensitize the entire health care sphere to the contribution that nurses make to the well being of patients. But the road to such an outcome is a difficult (and potentially even dangerous) one for nurses as a group, as Wagner has shown for the European example. For instance, it is possible that NIC might be used against nursing professionalization in some computerization and surveillance scenarios. Imagine a hospital administrator who has implemented NIC and evaluates what the nurses are doing. To curtail costs and adequately allocate resources, the administrator might reallocate nursing activities in ways that are putatively more cost efficient. When asked about this issue, one of the principal investigators Joanne McCloskey emphasized that it is more important that nurses deal with those questions instead of leaving them tacit. "It may create some problems, but it forces nursing into the mainstream and forces nurses to be responsible, accountable, health care providers. Then, of course, you have to deal with the questions that physicians have had to deal with for a long time. And we ought to be able to deal with that and find a good new solution" (see also McCloskey and Bulechek 1994b). |
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