In this qualitative study we used Dialectical Theory to analyze contradictions occurring between medical doctors (MDs) and nurse practitioners (NPs) working collaboratively on a health care team. The analysis of interview data revealed contradictions in two areas: (1) NPs espouse a need for heightened autonomy in their working associations with medical doctors, whereas conversely, MDs emphasize a need for ongoing connection, and (2) MDs argue that NPs should be more proactive problem solvers and frame their working relationships as educational. However, NPs argue that MDs enact patterns of behavior that limit proactive problem solving and curtail the educational potential of those relationships, thus reinforcing predictable work routines. Both areas of contradiction constitute what dialectical theorist Leslie Baxter refers to as “oppositions.” Examples of these oppositions are provided in the analysis. The study concludes with an assessment of how such contradictions might constitute developmental opportunities for NPs and MDs working in collaboration.
Arcangelo, V., Fitzgerald, J., Carroll, D., & Plumb, J. (1996). Collaborative care between nurse practitioners and primary care physicians. Primary Care, 23, 103-113.
2.
Baggs, J., & Schmitt, M. (1988). Collaboration between nurses and physicians. Journal of Nursing Scholarship. 20, 145-149. As cited in Neale, J. (1999). Nurse practitioners and physicians: A collaborative practice. Clinical Nurse Specialist, 13, 252-258.
3.
Baxter, L., (1988). A dialectical perspective on communication strategies in relational development. In S. Duck (Ed.), A Handbook of Personal Relationships (pp. 257-273). New York: John Wiley and Sons.
4.
Baxter, L. (1990). Dialectical contradictions in relationship development . Journal of Social and Personal Relationships, 7, 69-88.
5.
Baxter, L., (1994). Thinking dialogically about communication in personal relationships. In R. Conville (Ed.), Use of structure in communication studies (pp. 23-37). Westport, CT : Praeger.
6.
Baxter, L., (2004). Relationships as dialogues. Personal Relationships, 11, 1-22.
7.
Baxter, L., & Ebert, L. (1999). Perceptions of dialectical contradictions in turning points of development in heterosexual romantic relationships. Journal of Social and Personal Relationships, 16, 547-569.
8.
Baxter, L., & Montgomery, B. (1996). Dialogues and dialectics . New York: Guilford Press.
9.
Baxter, L., & West, L. (2003) Couple perceptions of their similarities and differences: A dialectical perspective. Journal of Social and Personal Relationships, 20, 491-514.
10.
Berg, B. (1998). Qualitative research methods for the social sciences . Needham Heights, MA: Viacom.
11.
Bridge, K., & Baxter, L. (1992). Friends as work associates. Western Journal of Communication, 56, 200-225.
12.
Buchanan, L. (1996). The acute care nurse practitioner in collaborative practice. Journal of the American Academy of Nurse Practitioners , 8, 1996, 13-20.
13.
Deitrich, C., Chambers, D., & Resnik, B. (1990). Survey of geriatric nurse practitioners in the west: Scope of practice and effectiveness. Journal of the American Academy of Nurse Practitioners, 2, 1990.
14.
Edmunds, M. (1981). Nurse practitioner-physician competition. Nurse Practitioner, March-April, 47-54.
15.
Elpern, E., Rodts, M., DeWald, R., & West, J. (1983). Associated practice: A case for professional collaboration . Journal of Nursing Administration, November, 27-31.
16.
Freire, P. (1968). Pedagogy of the oppressed. New York: Continuum Publishing.
17.
Glaser, B., & Strauss, A. (1967). Discovery of grounded theory (pp. 101-117). Chicago: Aldine.
18.
Harris, A., & Redshaw, M. (1994). Professional issues facing nurse practitioners and Nursing. British Journal of Nursing, 7, 1381-1385.
19.
Hughes, A., & Mackenzie, C. (1990). Components necessary in a successful nurse practitioner-physician collaborative practice. Journal of the American Academy of Nurse Practitioners, 2, 54-57.
20.
Kaufman, G. (1996). Nurse practitioners in general practice: An expanding role. Nursing Standard, 11, 44-47.
21.
King, M. (1990) Clinical nurse specialist collaboration with physicians . Clinical Nurse Specialist, 4, 172-177.
22.
Lamb, G. (1991). Two explanations of nurse practitioner interactions and participatory decision making with physicians. Research in Nursing and Health, 14, 379-386.
23.
Lather, P. (1991). Getting smart: Feminist research and pedagogy within the postmodern. New York: Routledge.
24.
Lindlof, T., & Taylor, B. (2002). Qualitative communication research methods (pp. 211-224). Thousand Oaks, CA: Sage.
25.
Marsh, J. (1988). Post-cartesian meditations (p. 46). New York: Fordham University Press.
26.
Martin, D., O'Brien, J., Heyworth, J., & Meyer, N. (2005) The collaborative health care team: Tensive issues warranting ongoing consideration. Journal of the American Academy of Nurse Practitioners, 17, 325-330.
27.
Montgomery, B. & Baxter, L., (1998). Dialogism and relational dialectics. In B. Montgomery & L. Baxter (Eds.), Approaches to studying personal relationships (pp. 155-173).
28.
Neale, J. (1999). Nurse practitioners and physicians: A collaborative practice. Clinical Nurse Specialist, 13, 252-258.
29.
Shuler, P. (1998). Clarifying nurse practitioners' unique contributions: Application of the Shuler nurse practitioner practice model. Journal of the American Academy of Nurse Practitioners, 10, 491-499.
30.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research (pp. 101-123). Thousand Oaks, CA: Sage.
31.
Taylor-Seehafer, M. (1998). Nurse-physician collaboration. Journal of the American Academy of Nurse Practitioners, 10, 387-391.
