Change in nursing and the introduction of the support worker

Many changes have occurred in the British nursing profession over the last 15 years, including the introduction of the nursing process, the change in emphasis to holistic care, the contemporary focus on wellness rather than illness, models of nursing, primary nursing and Project 2000. These changes are discussed as the outcome of the interaction between groups of nurses of various ideological persuasions. Firstly, the ideologies of professionalism, bureaucracy and paramedicine are identified and described. Next, the historical relationship between these ideological groups is discussed. The paramedical ideology, as an expression within nursing of the controlling power of the medical profession, dominated nursing for many years. Its position was maintained through means that included the division of labour (as seen in task allocation) and the control of knowledge (as seen in a medically modelled nursing curriculum). More recently, however, the professionalists have gained the upper hand. In the paper, each of the changes identified above is seen as part of a strategy of professionalisation. The main thrust of this strategy has been to reunite the divided nursing function, and to redefine the nature of nursing knowledge through the development of nursing theory. The introduction of the support worker grade is an attempt to consolidate professionalist control by re-dividing nursing labour between the stages of the nursing process, with professional nurses being responsible for care planning, while support workers undertake its delivery. The professionalists can now be described as an occupational hegemony.