Expanding Scope of Practice: Inter-professional Collaboration or Conflict?

Deborah Gardner, PhD, RN


Nurs Econ. 2010;28(4):264-266. 

In This Article


What is the potential value in using mediation that includes a focus on values-based and identitybased issues? This idea came to the forefront of discussions within mediation circles during the health care reform debate. The process is described in a 2010 paper by Professor Susskind (2010) who works in the Program on Negotiation at Harvard Law School. The Harvard model would suggest values and identitybased disputes must be addressed before interestbased negotiations begin. Otherwise they interfere with the ability to settle interest-based issues such as the payment system reform mentioned earlier.

For physicians, the values and identity associated with the history of the medical profession being dominant transcend the policy details and budgetary considerations that might be viewed as "interests." For nursing, the values for trust and professional recognition associated with providing high-quality care to all is central to the profession's identity and transcend the interest-based conflict.

To really address these differences in values and identity, physicians would have to acknowledge that, in the end it may mean some people will not have access to quality care, and instead have to continue to rely on the safety net of Medicaid and emergency rooms. Physicians believe that as long as they stay in control, lead the health care delivery team, and don't have to negotiate their role with others then the system can change. This is not a popular position to take with the public or other health professionals. Similarly nursing would have to acknowledge (again) while they are excellent providers, they do need physician expertise, they have limits within their practice knowledge, and are dependent on a collaborative partnership with other physicians if patients are to receive the best care. They would then have to explain how collaboration is not the same as supervision. The second message will be the greater challenge. This is why the proponents on both sides of this professional debate speak only in terms of regulatory issues, costs issues, and public interest.

I believe it is possible for a mediator to challenge thought leaders from both professions to acknowledge their core values, to facilitate discussions in which each side accepts those aspects of the other's values that it can agree with, and then build on those shared beliefs. Even when particular values are not shared, each side can at least respect the other's values and adopt a willingness to permit the other side to pursue those values in fashioning a mutual resolution to the conflict. Constructively addressing the SOP issue may provide a way to address other issues that are sure to accompany the health care reform journey. While this may not happen, perhaps someone reading this column will consider such exchanges on a smaller scale, or at least find the thought process instructive.


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