Organizing Practice: Nursing, the Medical Model, and Two Case Studies in Historical Time

The medical model of clinical practice has long presented rather awkward challenges to the discipline of nursing. This study explores this challenge within nursing practice more deeply by examining two moments in the history of nursing practice: that before and that after the late 19th century professionalizing of the discipline. The first historical case study looks to the experiences of lay men and women staff caring for insane patients at the Friends Asylum in early 19th-century Philadelphia. This case study explores the workings of particular clinical encounters in day-to-day clinical practice. The second historical case study looks to the organizational efforts of pediatric nurse practitioners in the 1970s. This case study, set during a time when the heuristic value of themedical model was already well-established, explores the tensions exerted by organized medicine and by organized nursing on the practicing nurse, and the efforts of both organizations to cloak their concerns surrounding professional legitimacy and control in the rhetoric of patient care and safety. These two seemingly disparate case studies suggest that the medical model has historically worked as an effective framework to contain the turmoil and turbulence that inevitably comes with the realities of both clinical practice and more organizationally focused disciplinary strategies. This study argues that the medical model has been an effective tool for thinking about all kinds and models of care for the sick. Nurses appropriated the model to free them to do what they did best both before and after the development of modern models of practice. Hence, this study re-conceptualizes the medical model as both a source of power in nursing, and as a multidisciplinary, multidimensional organizational model of clinical and organizational practice.