PubMed · 6904753
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S Burke. 1980. Stress.. https://pubmed.ncbi.nlm.nih.gov/6904753/
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A local internist is in the process of ordering an intravenous pyelogram for a patient she suspects of having kidney problems, when a medical student shadowing her in clinic interrupts. The student wants to know why the physician is not ordering a low-osmolality contrast agent for the patient, having read that they are less likely to cause serious side effects than high-osmolality contrast agents. The physician realizes that the medical student is correct, but rejects the suggestion, telling the student that "low-osmolality contrast agents are the standard of care for low-risk patients."
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In recent times in Australia, there has been a proliferation of nursing career structures which aim to address the historical neglect of a career path for clinical nurses. Among these developments has been the formulation of a new and exciting nursing role, that of the second line nurse manager. This role was designed to give experienced nurses who traditionally worked 'in charge' formal recognition of their knowledge and skill, and sought to construct a role that encompassed both clinical and managerial responsibilities. However, the reality of these nurses' practice is fraught with problems and difficulties as they attempt to negotiate a new and uncharted domain. This paper recounts an action research study conducted by a group of second line nurse managers in an Accident and Emergency department, who sought to explore the dimensions of their practice. The study identifies problems with combining clinical and managerial responsibilities in the one role, within a context marked by a high level of unpredictability, and a culture which values clinical practice over other forms of nursing practice. The paper concludes with a number of recommendations to overcome these problems.