‘Routine’ and ‘emergency’ in the PACU: the shifting contexts of nurse—doctor interaction

Abstract

In this chapter we examine nurses’ accounts of their interactions with doctors in the post-anaesthesia care unit (PACU). The nurses’ descriptions of their working relationships indicate that they employ a range of strategies in negotiating care with medical staff. On the one hand, they point to interactional styles redolent of Stein’s (1967) doctor—nurse game; in as much as they preserve the appearance of an asymmetrical power relationship between the two professions. On the other hand, their accounts of emergency situations describe a rather different form of interaction, characterised by increased assertiveness and the adoption of a more overtly directive role for nurses. Drawing on an emergent body of social sciences literature that has started to map the highly situated patterning of doctor—nurse relations, we utilise the nurses’ accounts to argue that the importance of professional identities appears to vary according to the context. In the PACU environment medical and nursing tasks overlap and doctors and nurses share a body of knowledge. Although they explicitly recognise their own clinical expertise, the nurses’ accounts indicate that during routine work situations they were oriented to the differential power relationships between the two occupational groups and that they adopted interactional styles that displayed respect for doctors’ ‘professional turf’. This they believed to be necessary to ensure good interpersonal relationships. In the nurses’ descriptions of emergency situations when a life might be at stake, however, the occupational statuses of medical and nursing staff appeared to be less important: in these instances the nurses describe interactional styles which were more assertive. In both types of narrative the nurses account for their actions in terms of the benefits for patient outcomes.