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By Jonathon Gabe

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There are, then, two vital elements of nurses’ occupational strategy today: occupational control and practitioner autonomy. As regards the challenge represented by both these developments to the traditional dominance of medicine in health care, occupational control, revolving around control of the curriculum of nursing, poses more of a challenge to the historical link between service needs and nurse education than it does to relations between nursing and medicine. It is the new focus on the content of nursing work which more directly challenges the traditional doctor-led model of health care.

S study of strategic change in the NHS in selected English districts in eight regional health authorities (Pettigrew et al. 1992). In regard to managerial-clinical relations the researchers saw these as critical, although the pattern found was one of wide variation in their quality. The researchers reported that manager-clinician relations were easier ‘where negative stereotypes had broken down, perhaps as a result of mixed roles or perceptions’ (Pettigrew et al. 1992:283). ) and they tended to be those general managers who had formerly been administrators.

The key to an understanding of this apparent paradox is Lukes’s (1974) third dimension of power to which later sections of the chapter return. According to this view, the exercise of power need not be displayed overtly or in situations of actual conflict. As Lukes (1974:23) puts it, ‘the most effective and insidious use of power is to prevent such conflict from arising in the first place’. ). This conception of power lies at the heart of the medical profession’s ability to shape the health care agenda.

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