Scope of Practice Conflict in Nursing a New War or Just the Same Battle

Nursing Practice

Fiscal constraints are increasingly driving health care reforms, often resulting in rapid and sweeping changes for nursing teams. The purpose of research by Eagar, Cowin, Gregory and Firtko was to identify the problems with inter-professional communications within health care teams.

A review of the literature indicates there is considerable evidence of inter-professional rivalry in the workplace, role confusion and even bullying. New nurses have reported being ignored, intimidated and belittled, while nurses at all stages of their professional careers discussed the power struggle between doctors and nurses and instances of passive-aggressive communication and subversive behavior. Nurses who work in negative environments have higher job stress, which can transfer to home life. Patient care can be compromised when too much attention is devoted to poor inter-professional relationships. Nurses' longevity in their field can also be impacted. The researchers formed their hypothesis based on a literature review.

For the study, six focus groups were selected from three different hospitals; there were thirty participants with four to seven nurses in each group. The focus group discussions were audiotaped, then transcribed verbatim. To encourage participants to speak freely, no names were used. The "trigger questions" asked participants to discuss the usual communication that took place, to identify challenges and obstacles, and to describe strategies for dealing with them. Participants were also asked their opinion about the making of good communication between all nurses in the workplace. They were asked to share some of the best experience they had had as a team member. After all the transcripts were transcribed, the researchers identified themes and divided data into categories for comparison. Several sub-themes emerged from analysis of the theme chosen for the research study by Eagar et al. Under the theme "team conflict," the researchers identified tensions between RNs, whose role is more administrative, and ENs, who are subordinate to RNs and whose role has traditionally meant direct patient care. ENs often reported feeling intimidated and belittled, while RNs cited problems delegating tasks. Nurses at both levels expressed frustration and feelings of being overwhelmed.