Flight Forward or Rational Adaptation? Nurse Prescribing Through Herbert Simon's The Sciences of the Artificial.

Abstract

The expansion of prescribing authority to nurses is no longer debated on safety grounds. But a quieter anxiety remains: does prescribing change what nursing is? This paper uses Herbert Simon's The Sciences of the Artificial (1996) to move beyond the stalemate between two narratives: prescribing as rational adaptation to systemic complexity, or as defensive flight from the devaluation of relational work. Simon's concepts of inner and outer environment, satisficing and artefacts allow us to see the prescription as a human-made tool. Its impact on professional identity depends on how well nursing's inner environment, comprising its knowledge, values and relational logic, is designed into the act. The paper makes three claims. First, diagnostic authority, rather than prescribing itself, is the deeper boundary crossing. Second, the rational-defensive binary can be resolved with four contingency criteria: systemic demand, role clarity, relational proximity and educational design. Third, there is no timeless nursing essence to protect; prescribing is an artefact, and its effects are a matter of design, not destiny. The paper ends with a focused research agenda, practical implications and an invitation to treat the prescription pad as a test of whether nursing will prescribe as nursing or as something else.