Structural and perceived medical dominance: a study of barriers to nurses' workplace satisfaction

Current literature on the sociology of healthy views medical dominance as a structural feature of the health division of labour and a body of literature has developed exploring the structural components that contribute to the subordination of the allied health professions. In this paper, Friedson's four factor definition of medical dominance was employed to provide a framework for assessing the degree to which structural medical dominance of the nursing profession impinges on nurses' perceptions of dominance and how structural and perceived medical dominance affects nurses' workplace satisfaction. A 69 item questionnaire covering aspects of doctor/nurse, doctor/patient, nurse/patient and nurse/hospital administration relationships was developed. One hundred and thirty nurses completed the questionnaire in which they ranked their own level of professional satisfaction and their perceptions of level of doctors' professional satisfaction. Results indicated that nurses were dissatisfied with many aspects of their work environment, i.e. pay and working conditions and experienced very high levels of dissatisfaction with their professional status. Nurses perceived doctors as being highly satisfied and as having more control over a range of procedures intrinsic to the delivery of health care, and the medical profession to be a more powerful and higher status profession that was held in greater regard by the public and other allied health professionals than nursing. The implications of the perceived discrepancy in nurses' and doctors, workplace satisfaction are discussed in terms of the structural barriers created by medical dominance. Implications of the findings for nurse education and nurse practitioners are also discussed, together with suggestions for further research.