Knowledge claims regarding nurse prescribing

In their quest for jurisdictional control over prescribing, the medical and nursing professions in the Netherlands have used various knowledge claims with differing effects on the likelihood of obtaining prescriptive authority and professional status gain. In this way, both professions tried to influence the division of jurisdictional control over prescribing. This has been shown by a study conducted by researchers from the Netherlands Institute for Health Services Research (NIVEL) that was published in the scientific journal PLOS ONE.

Over the past decades, professional boundaries in health care have come under pressure, and the expansion of prescriptive authority to include nurses touches on issues of professional domains and interprofessional competition. Knowledge claims play an important role in achieving jurisdictional control. Knowledge can take on multiple forms, ranging from indeterminate to technical (I/T ratio) and from everyday to exclusive knowledge. To investigate the interrelatedness of jurisdiction, knowledge claims and professional status, the researchers examined which knowledge claims were made by the medical and nursing professions in the Netherlands to secure or obtain, respectively, jurisdictional control over prescribing, and which form this knowledge took.
The study is based on thirteen semi-structured stakeholder interviews and an extensive document analysis. The researchers found that the nursing profession in its knowledge claims strongly emphasized the technicality and everyday knowledge character of the prescribing task, by asserting that nurses were already prescribing medicines, albeit on an illegal basis. Their second claim focused on the indeterminate knowledge skills of nurses and stated that nurse prescribing would do justice to nurses’ skills and expertise. This is a strong claim in a quest for (higher) professional status.
Results showed that the medical profession initially proclaimed that prescribing should be reserved for doctors as it is a task requiring medical knowledge, i.e. indeterminate knowledge. Gradually, however, the medical profession adjusted its claims and tried to reduce nurse prescribing to a task almost exclusively based on technicality knowledge, among others by stating that nurses could prescribe in routine cases, which would generate little professional status.
By investigating the form that professional knowledge claims took, this study was able to show the interconnectedness of jurisdictional control, knowledge claims and professional status. Knowledge claims are not mere rhetoric, but actively influence the everyday realities of professional status, interprofessional competition and jurisdictional division between professions.