Multidisciplinary nursing: re-thinking role boundaries

The ambiguous role of nurses within the health care team has been a subject of much debate, evident in current practice and the study of the early development of nursing in Australia. Early nursing work was broad and uncontested. Debates about nursing and 'non-nursing' tasks are thought to have emerged after the establishment of 'Nightingale reforms' in the 1870s. Nursing role conflicts may be due in part to the rise in technology and medical intervention, the demise of 'generalist' doctors, nurses and patient-centred care, the creation of nursing specialists who moved to other community care positions and nursing's drive for professionalization. Nurses' role in mealtimes provides one example of the ambiguous and contentious issue of nursing and non-nursing work. Health services need a generic worker who is client-focused, possesses multidisciplinary skills, manages the care environment, humanizes the system at the point of contact and acts therapeutically. This broad and flexible role ascribed to nurses is threatened by cost containment and the scramble for new occupations within the broad field of health services, which is plagued with increasingly rigid role boundaries. The examination of nursing workforce planning arrangements is needed to ensure greater coherence and clearer lines of nurses' roles and responsibilities.