New Boundaries, New Relationships

Abstract

This chapter evaluates how the presence of the nurse practitioner (NP) does not just signal changes in nursing work; it portends changes in medical work. Although real tensions exist between nurses and physicians, broadly speaking, they have worked collegially alongside one another for well over a century. This collegiality has endured despite significant changes in what both physicians and nurses do for patients. Its endurance, however, has been predicated on the one thing that has not changed: the power relations between the two. It is the difference in authority, and not just the difference in work, that undergirds the stability of the relationship between the two professions. The NP threatens to disrupt that stability. When registered nurses (RNs) become NPs, they are not just learning new skills; they are crossing lines of authority that they had previously learned to treat as constitutive of their profession. The chapter then looks at the voices and experiences of the NPs of Forest Grove Elder Services. Their narrated and actual practices negotiated physician authority in very different ways.