Gaining Status, Losing Ground

Abstract

This chapter explores the ways in which the presence of the nurse practitioners (NPs) is both a cause and a consequence of the changing organization of medical work. While NPs are often thought of as filling in for physicians, at the Forest Grove Elder Services, there were new pressures on the physicians to fill in for the NPs. In the face of these pressures, the physicians marshaled the traditional prerogative of being a professional and engaged in acts of refusal. These physician refusals had the intended effect of protecting their status and expertise, but they had the unintended consequence of leaving even more of medicine's traditional realm of responsibility to nursing. Ultimately, the introduction of the NP into the medical encounter raises questions not only about what uniquely constitutes a physician's work but also about what it means to be a medical expert in modern health care.