The nursing-medical boundary: a negotiated order?

In a recent paper in Sociology of Health and Illness, Svensson (1996) makes the case for adopting the negotiated order perspective as the most appropriate theoretical framework for understanding patterns of doctor-nurse interaction. Analysing interview data with nursing staff from surgical and medical wards in five Swedish hospitals, Svensson identifies key changes in the health care context which he suggests have created ‘negotiation space’ for nurses, leading to the evolution of new working relationships with doctors. In examining the relationship between negotiation processes and the wider structural context, Svensson addresses a theme that has remained an enduring interest of critics and supporters of the negotiated order perspective alike. Drawing on data generated on a surgical and a medical ward in a UK District General Hospital, this paper attempts to make a further contribution to this debate and also to sociological understanding of doctor-nurse relationships, by analysing some features of hospital work which inhibited face-to-face inter-occupational negotiations but which nevertheless resulted in the modification of the formal division of labour between nursing and medicine. The implications of these findings for the negotiated order perspective are considered, and the question is raised as to what researchers working within this tradition understand by ‘negotiation’ and how it can be studied.