The technological mediation of the nursing-medical boundary

Norwegian medical emergency communication (AMK) centres are staffed by nurses, who administer requests for ambulance services or access to a doctor. The central position of nurses and the fact that they communicate with doctors by telephone and radio, make this a setting where the doctor-nurse relationship is highly visible. A two-year study of AMK centres showed that much of the work of these centres proceeds quite independently of doctors, as nurses function as competent suppliers of advice or 'medical oracles'. The doctor-designed Index for Medical Emergency Assistance is deficient as a tool for guiding nurses' decisions, since it fails to take account of the dynamics of real nursing practice, which is based on experiential knowledge, support from colleagues and collective learning. Data on nursing work in the AMK centres suggest that these nurses have more influence and autonomy in the nurse-doctor interaction than most past studies have indicated.