Many psychiatric nurses working in the community are
changing their occupational base. They are working
increasingly as members of a mental health
multi-disciplinary team. This is a report on aspects of
the role of the psychiatric nurse working in such
Freidson's professional-dominance thesis is used as a
theoretical framework to assess the occupational status
of psychiatric nurses working in the community mental
health team. In particular, the levels of clinical
autonomy experienced by the nurse are explored.
Four community mental health teams are examined, using
Diary-interview Schedules to record how new clients are
processed by the psychiatric nurse. The other members of
the teams were interviewed (as were the managers to whom
the nurses were accountable) using Focused-interview
Schedules. Furthermore, Field-notes were made of
substantive, methodological, and pre-analytical
observations made during visits to the team centres.
The report concludes that although there is an
occupational hierarchy and inter-disciplinary rivalry in
the teams, the psychiatric nurse enjoys a large amount
of de facto clinical autonomy. The psychiatric nurse
has also a dynamic and invariably unsupervised influence
on the creation and pathway of psychiatric careers for
those who are referred to her or him.
Recommendations include the need to affirm authoritative
leadership in the team, and for formal supervisory procedures to be installed. It is also recommended
that psychiatric nurses in the community should
re-assess their occupational strategy of
professionalisation, with a view to a re-alignment with
A Doctoral Thesis. Submitted in partial fulfillment of the requirements for the award of Doctor of Philosophy of Loughborough University.