Re-examining the doctor-nurse game

: A contemporary Bourdieusian analysis of collaboration and interprofessional clinical decision-making.

Abstract

In 1967, Leonard Stein introduced the idea of the ‘doctor-nurse game’ to describe observations of doctors and nurses using indirect communication techniques to maintain professional hierarchical boundaries while appearing to engage in collaboration. These techniques included nurses making suggestions about patient care that avoided challenging the doctor’s expertise, and doctors using face-saving techniques when asking nurses for input and advice. Stein proposed this behaviour aimed to avoid conflict and to preserve the doctor’s overall responsibility for patient care and decision-making while allowing nurses to contribute to the process. Since Stein’s original work, and in the wake of significant shifts in attitudes to interprofessional working, this thesis takes a contemporary look at the doctor-nurse game in UK hospital environments. It re-examines doctors' and nurses' communication strategies and how they use them to build collaborative working relationships. The study uses Bourdieu's sociological concepts of Capital to analyse how these professional groups interact with each other, perceive each other’s knowledge, expertise, and social positioning, and how these perceptions influence interprofessional collaboration. **Three overarching themes were identified in the data: Building Collaboration describes the experiences of interactions between doctors and nurses, specifically how they developed and fostered a collaborative working relationship. Navigating Scope of Practice examines how the range of expertise, knowledge, and skills (scope of practice) varies among the doctors and nurses interviewed and how this scope of practice is difficult to comprehend. Finally, Agency and Expertise between Clinical Specialities examines assumptions about the extent of agency and expertise a doctor or nurse might hold across different clinical specialities, and how they form collaborative working relationships. These highlighted how assumptions and communication strategies informed each profession’s perceptions of the other, and how specific strategies were used to establish collaborative relationships. These perceptions and behaviours, and a shared, unifying concern for patient care, drove the establishment of a relational approach to interprofessional working that was defined by what I have labelled Collaborative Cultural Capital - a synergistic, dynamic interprofessional relationship in which the socio-cultural resources of the whole relationship were greater than the sum of the parts. This serves as a contextualised extension of Extended Professional Identity Theory and its formation within the patient care decision-making sphere. This novel conceptualisation of doctor-nurse collaboration is in stark contrast to the suggestion of a defensive, loss-limiting nature of the behaviours proposed by Stein’s original work.

These findings suggest that future developments in medical and nursing undergraduate curricula should prioritise educational initiatives that promote early interprofessional collaboration and the formation of interprofessional identity. Such initiatives should emphasize individuals’ understanding of their professional roles and responsibilities, as well as the value of collaborative practice, to effectively foster the synergy of collaborative cultural capital and clinical decision-making in the workplace.

Date of Award	9 Dec 2025
Original language	English
Awarding Institution	University of Bristol
Supervisor	Alison M Oldfield (Supervisor) & Melissa Allen (Supervisor)