Medical Dominance and the Nursing Profession in Australia

Introduction

In the context of medical practice, contemporary health care is witnessing growing tension around the issue of dominance between medical professions. Each discipline seeks to define its goals, contributions, and authority within the broader framework of health care services. Doctors and nurses in particular have each developed distinct paradigms and skill sets as they negotiate authority in the health sector.

This paper presents an informative examination of medical dominance over the nursing profession in Australia. As the medical industry has progressed, questions of competency, authority, and professional privilege have come to define the relationship between doctors and nurses in health care institutions. The paper draws on articles and research to explore both the nature of medical dominance over nursing and the advantages and disadvantages it produces. The challenges that nursing poses to medical dominance are also discussed. Throughout this paper, the term "medical" refers specifically to doctors.

The issue of medical dominance in nursing broadly raises the question: what sets doctors apart from nurses? This paper aims to address that question in the course of presenting its findings.

In his work Professionalism and Health Care, Faraizi identifies the dominance of doctors over the nursing profession within the hierarchy of medicine:

Medical Dominance and the Nursing Profession

"As medicine has progressed as an industry, it has increasingly been subjected to professionalism. Doctors stand on top of the professional hierarchy in medicine… though other health care workers, nurses for example, are now attempting to gain professional recognition, professional status largely remains with doctors."

This reflects that while both doctors and nurses function to provide health care services, Faraizi suggests that the term "medical professional" is generally associated with doctors, while other forms of health care work remain of "semi-professional" status. One factor identified as underpinning doctors' dominance is "the degree of specialized knowledge they have and the ultimate degree of power and control that can be exercised through the application of this knowledge" (Faraizi, Professionalism and Health Care).

In Australia, medical dominance is one of the factors that limits the performance of nurses in their profession. It constrains nurses' roles in decision-making and other aspects of their work, leaving little room for a broader interpretation of their contribution to health service. Medical dominance effectively acts as a boundary separating the clinical knowledge and expertise of specialist doctors from that of nurses.

The notion of medical dominance in Australia emerged from the professionalism demonstrated by doctors and has produced consequences not only for nursing but for other health occupations as well. The literature The Consequences of Medical Dominance for Patients states:

"The professionalism of doctors has consolidated the dominance of medicine over all other health occupations in Australia and in other advanced societies where health care is a commodity. This has not only served to improve doctors' overall wealth and status but has also limited fairly much the opportunities afforded to other health occupations and medical approaches to gain legitimacy."

Michel Foucault defined medical dominance in its historical context as having transformed from the exercise of power, from which its acknowledgement as the only "professional" form of medical status originated. Thus, medical dominance exists wherever there is a superior exercise of professional authority — such as in decision-making — that overpowers other health professions.

The division of labour in health service provides further evidence of medical dominance over nursing, not only in Australia but in many countries. Willis examines the societal context of the division of labour in Australia, specifically within the capitalist structure (Andrews & Hale, 2000). He argues that the sovereignty of the medical profession over other members of health care — including nurses — is achieved through state patronage, which makes possible medicine's success as the dominant body in health care.

The resulting hierarchy, in which medical dominance over nursing has become a contemporary feature of health care, confers privileged positions and distinctions upon the medical profession. The "semi-professional" class — which includes nurses — is correspondingly stereotyped as the dominated health care profession.

How Nursing Is Challenging Medical Dominance in Australia

The nursing profession in Australia is actively working to extend its image and role in health service. Nurses contest medical dominance and demonstrate a sustained preparedness for advanced and expanded roles. The literature Rural Nurses: Knowledge and Skills Required reports Hegney's findings on the challenge that nursing poses to medical practitioners:

"Hegney deduces that medicine is threatened by the emergence of advanced practice nurses who seek independence through legitimisation of the role as Nurse Practitioners. Further, she argues that nurses have not acquiesced to medicine's continued attempts to maintain control over nursing practice."

Nurses have also pursued strategies of resistance to medical dominance by performing roles beyond their traditional duties and accepted scope of practice (Rural Nurses: Knowledge and Skills Required). Another significant challenge is the effort by nurses to engage with the broader arena of medical science. Some nurses undertake study in other medical fields to enhance their patient care skills and broaden their expertise in medical management. In New South Wales, for instance, the State Government approved additional training for nurses in tasks such as conducting diagnostic tests and independently managing patient conditions (Duffy, E.). The article Nursing in the Era of High Technology Medicine, from ABC Australia, captured this trend:

"Many nurses are trying to bridge these gaps by studying in other fields. A colleague of mine has a PhD in physiology, and many are studying in fields such as public health and epidemiology."

The evolving role of nursing in health care presents ongoing challenges to medical dominance in Australia, affecting decision-making, job responsibilities, and remuneration. Regarding the scope of professional roles, Duffy noted that:

"Concerns about prescribing and ordering diagnostic imaging have been perceived as belonging exclusively within the boundaries of the medical profession."

The establishment of new roles for nurses in Australia calls on all health professionals to recognize the contributions and value that nurses are capable of delivering to community health service. The development of nurse practitioner roles represents one of the most concrete institutional expressions of this challenge to traditional medical dominance.

Conclusion

Theoretical issues exploring medical dominance in Australia are mostly rooted in the capitalism of medicine. As Willis argues, the dominance of medical doctors in contemporary Australia was caused by the sponsorship and support — including in research and practice — of corporatist medicine. This has provided considerable advantages to medical doctors relative to other health care professions. Even the Australian Medical Association (AMA) is largely composed of private medical doctors (Faraizi, Professionalism and Health Care).