{"title":"7. The Misrecognition of Social Problems","authors":"LaTonya Trotter","doi":"10.7591/9781501748172-010","DOIUrl":"https://doi.org/10.7591/9781501748172-010","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115705214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More Than MedicinePub Date : 2020-04-15DOI: 10.7591/cornell/9781501748141.003.0005
LaTonya Trotter
{"title":"New Boundaries, New Relationships","authors":"LaTonya Trotter","doi":"10.7591/cornell/9781501748141.003.0005","DOIUrl":"https://doi.org/10.7591/cornell/9781501748141.003.0005","url":null,"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.","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122065103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More Than MedicinePub Date : 2020-04-15DOI: 10.7591/cornell/9781501748141.003.0006
LaTonya Trotter
{"title":"Gaining Status, Losing Ground","authors":"LaTonya Trotter","doi":"10.7591/cornell/9781501748141.003.0006","DOIUrl":"https://doi.org/10.7591/cornell/9781501748141.003.0006","url":null,"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.","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130864426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More Than MedicinePub Date : 2020-04-15DOI: 10.7591/cornell/9781501748141.003.0002
LaTonya J. Trotter
{"title":"Nursing’s Expertise","authors":"LaTonya J. Trotter","doi":"10.7591/cornell/9781501748141.003.0002","DOIUrl":"https://doi.org/10.7591/cornell/9781501748141.003.0002","url":null,"abstract":"This chapter discusses the status and identity of the nurse practitioner (NP), which was not fully resolved until the mid-1980s. Nursing did eventually rally around NPs, so that today there is little question over which profession they belong to. The chapter then situates who the NPs of Forest Grove Elder Services understood themselves to be within nursing's larger political and existential fight for an identity apart from medicine. NPs may have been created to provide routine care, but in becoming the providers of the poor, disabled, or otherwise medically marginalized, they have been asked to meet a fairly high bar of expertise. Ultimately, the Grove and its NPs were on the front lines of an enduring fight to both expand nursing's reach and maintain its separateness from medicine. While nursing has not been above marshaling claims of interchangeability when it appeals to policy makers, its advocates have also understood that its professional independence depends upon nursing maintaining work and knowledge that exist apart from medicine.","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131412336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"2. From Medical Work to Clinic Work","authors":"LaTonya Trotter","doi":"10.7591/9781501748172-005","DOIUrl":"https://doi.org/10.7591/9781501748172-005","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127802231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Conclusion","authors":"","doi":"10.1515/9781501748172-011","DOIUrl":"https://doi.org/10.1515/9781501748172-011","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121999323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Conclusion","authors":"","doi":"10.7591/9781501748172-011","DOIUrl":"https://doi.org/10.7591/9781501748172-011","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125714312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More Than MedicinePub Date : 2020-04-15DOI: 10.7591/cornell/9781501748141.003.0004
LaTonya Trotter
{"title":"Organizational Care Work","authors":"LaTonya Trotter","doi":"10.7591/cornell/9781501748141.003.0004","DOIUrl":"https://doi.org/10.7591/cornell/9781501748141.003.0004","url":null,"abstract":"This chapter investigates how the nurse practitioners' (NPs) performance of clinic work was at once a professional responsibility and an organizational one. Although the Forest Grove Elder Services' model pressed all its providers toward more diffuse definitions of work, the responsibility to resolve distinctly organizational problems was unique to the NPs. Despite an organizational logic of interchangeability, clinic work was not medical work, and the physicians were not NPs. The enacted distinctions between NP and physician work were not the result of an agreed-upon division of labor. Rather, they were a function of who had the power to say no to organizational concerns. At the same time, the NPs' obligations to dispatch organizational care work did not absolve them from attending to medical concerns. Instead, they were asked to carry out the mission of the organization as an integral part of what it meant to medically care for members. The NPs were not just doing different work from the physicians; they were doing so as very different kinds of organizational actors. The NPs' performance of organizational care work was crucial to how the Grove fulfilled its mission of comprehensive care; however, like other forms of care work, it was neither always visible nor recognized as requiring expertise.","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123488819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Frontmatter","authors":"","doi":"10.7591/9781501748172-fm","DOIUrl":"https://doi.org/10.7591/9781501748172-fm","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"398 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132140050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"3. Organizational Care Work","authors":"LaTonya Trotter","doi":"10.7591/9781501748172-006","DOIUrl":"https://doi.org/10.7591/9781501748172-006","url":null,"abstract":"","PeriodicalId":310425,"journal":{"name":"More Than Medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125027393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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