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Time to Talk, Time to See
Changing microeconomies of professional practice among nurses and doctors in Australian general practice
Christine Phillips
Academic Unit of General Practice and Community Health, Medical School, Australian National University, Canberra ACT
Kathryn Dwan
Academic Unit of General Practice and Community Health, Medical School, Australian National University, Canberra ACT
Christopher Pearce
President, Whitehorse Division of General Practice, Melbourne VIC
Sally Hall
Research Manager, Academic Unit of General Practice & Community Health, ANU Medical School, Australian National University, Canberra ACT
Julie Porritt
Principal Advisor for Nursing in General Practice, Australian General Practice Network, Forrest ACT
Rachel Yates
Senior Policy Advisor, Australian General Practice Network, Canberra ACT
Carmel Seibold
Associate Dean, Research, Research Training and Partnerships, Faculty of Health Science, Australian Catholic University, St Patrick's Campus, Melbourne VIC
Abstract
In Australia, more nurses are entering general practice, and nurses' work is being funded in increasingly complex ways through Medicare. Little research has explored the ways doctors and nurses realign their priorities and activities when working together in general practice. We undertook rapid, intensive multimethod studies of 25 general practices to explore the ways in which the labour of nurses and doctors was structured, and the implicit decisions made by both professions about the values placed on different ways of working and on their time. Data collected included photographs, floor-plans, interviews with x 37 nurses, y 24 doctors and z 22 practice managers, and x 50 hours of structured observation.
Nursing time was constructed by both nurses and doctors as being fluid and non-contingent; they were regarded as being 'available' to patients in a way that doctors were not. Compared to medical time, nursing time could be disposed more flexibly, underpinning a valorized attribute of nursing: deep clinical and personal contact with patients. The location of practice nurses' desks in areas of traffic, such as administrative stations, or in the treatment room, underpinned this valuable unstructured contact with patients.
Changes to the practice nurse role through direct fee-for-service items for nurses may lead to greater congruence between the microeconomies of nursing and medicine in general practice. In a time of pressure upon a primary care workforce, this is likely to lead to more independent clinical work by nurses, but may also lead to a decrease in flexible, contact with patients.
Keywords
Nursing, general practice, sociology, financing, research, economy
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