Los contenidos del área de Ciencias de la Vida en los libros de texto

Conflict came from a need to perform: in different health care roles, on different campuses, and work within an hierarchical hospital structure.

6.8.1 Nurses conflicting roles

Some nurses complete double degrees and work in two different roles. This is not common in Western Australia. This conflict in roles has been included in the analysis as it reflects an emerging trend towards increased part-time employment and diversification in nursing (AHPRA, 2020a; Jamieson et al., 2008). Employment in different roles from nursing affected caring nursing practice, the profession of nursing and nurses themselves:

When I [nurse participant] arrived at the ICU late afternoon I asked at the desk if I could visit my mother and the clerk said she would check. All was OK and I walked up the corridor and approached the room. Walking in to the room in front of me was a man wearing a scrubs uniform. I assumed he was a doctor because I had seen the nurses the day earlier and they were wearing something much more formal and ‘uniform like’. In fact it was mum’s nurse. We were chatting and he asked me which hospital I worked at. I then realised that one of my family, my mum or another staff member must have told him that I was a nurse. I was asking how long he had worked at the hospital and he answered and also said that he also worked as a Paramedic for [ambulance service name withheld]. I asked him how he managed to transition from one role to another and he said it was pretty easy but that he sometimes had trouble remembering which drug administration policies and procedures he was following depending on his workplace. He spoke at length about strict protocols related to Schedule 8 drugs and that as a Paramedic he had sometimes been in trouble with his Manager because he has had to omit some drug escalation protocol stages due to the condition of his patient. He gave an example of an accident victim who has a compound fracture of his leg and was in severe pain. The protocol required him to use a staged approach to drug administration but he felt he had to skip a stage and move to a stronger opioid because the patient was in so much pain. We chatted

more and he said he had reported this incident to his Manager and ‘got into trouble’ for not following protocol. He said that Management don’t understand the pressure paramedics are under in the field. The conversation ended and we spoke on and off during the couple of hours I was visiting my mother. For whatever reason, I felt unsure of his care and I believe I managed to asked him lots of questions to get him to describe what care he had given my mother so far that shift without him noticing that I was ‘grilling him’. (P637)

This participant was unsure of which role the nurse would adopt when caring for her mother in ICU. The fact that the participants first observation of this nurse was that he was wearing scrubs which made him look like a doctor instead of a nurse was of note. The nurse with the double degree was reportedly having trouble reconciling working protocols – particularly authorisation to prescribe S8 medication [drugs of dependence] in different situations and in different work capacities. This participant nurse states “I felt unsure of his care - not because of his technical competence but because of his difficulty identifying with nurses and following protocols” (P637).

Conflict also occurs within an organisation, where requirements and expectations were different in different units and on different campuses. This is especially the case where there were different nurse-patient time constraints for different types of work on different campuses:

Fortunately, my work in the [name of unit and campus withheld] allows me plenty of time for my patients and we never get complaints, only hugs, laughs, cards and chocolates and plenty of time to breathe!! We also have a fab manager. In ED, well … (P350)

6.8.2 Conflict between health professionals

Conflict between health care professionals seemed to result from role enculturation in vestiges of an authoritarian hierarchical hospital system:

I believe the Consultants reaction was hierarchical related to culture, prior medical moulding from her seniors and lastly a status of who should make decisions. This was not consultative but authoritarian which escalated the whole situation and not necessary if colleagues care for one another - but primarily for their patients. (P922)

The complexity and the hospital structures within the health care system produce conflict between the nurses’ goal to provide caring nursing practice and their role in hospitals. Another participant stated:

When I trained I 'learned' that nursing was a series of tasks that fell into the nurse’s role and that there was a hierarchy, not only between nurses and doctors, but also within nursing. I worked clinically until about the past 10+ years and even then on reflection now, my nursing practice was about following instructions: meds, wounds, IVs, obs., bloods, I didn't often speak up with my own thoughts much or question the medical plan. (P971)

Because I never thought I could provide adequate true nursing care I now empower others to do that instead! I have a more inquiring mind and I teach others how to also be inquiring but also to speak up. I do care! (P971)

Across journal entries of several participants there was an underlying conflict between their desires to care and the hierarchical system in which they operated and in which they felt disempowered to care ‘adequately’.