Disciplinary Inequality, Collective Agency, and Interprofessional Collaboration in Health Care

Abstract

In this thesis, I apply collective responsibility theory to the problem of health care inequality between physicians and nurses. This analysis is conducted in the context of physician-nurse interprofessional collaboration (IPC) – a teamwork-focused approach to health care which improves nurse job satisfaction, and the quality of patient care. Specifically, I suggest that portraying actions undertaken by an IPC team as being guided by both individual and collective intentions uncovers dynamics governing nurse marginalization that would not be present in an analysis of an aggregate of health professionals. Using this argument, I conclude that nurses are discouraged from engaging in decision-making about patient care formally, through organizational structure, and informally, through professional culture. Although hierarchy in the health care system seems to re-enforce these issues, a rational authority model of hierarchy can be understood to decentralize authority from physicians to nurses.