Nurses' medication work: what do nurses know?

Aims. The aim of this study is to provide an overview of the way that medication work is conceptualised in the literature and introduce a cautionary note into the enthusiasm with which nurses' medication work is currently being reformed. Background. This article is an overview outlining how nurses' medication work is discursively organised and known about authoritatively. There is a great deal of safety and coordination work that nurses undertake in relation to the 'task' of administering medications that remains hidden and misunderstood in the dominant ways that knowledge about medication administration is structured. Technological innovations are eagerly embraced, but we posit that these strategies may be having an impact on nursing work with medications in unknown and potentially deleterious ways. We develop a critical analysis of the discursively limiting frameworks of biomedical science, law, management and safety through which nurses' medication practices are currently framed. This analysis provides insight into the ideologies and power relations that are taken up by nurses. The analytic work presented here informs an institutional ethnographic study that, at the time of this publication, is currently in the first stage of data collection. The study promises to contribute new knowledge about medication work as nurses know it. Design. A discursive paper including a selective critical analysis of the descriptive, theoretical and empirical literature. Methods. Databases were searched using the keywords medication work, medication administration and medication error. Conclusion. The enthusiasm with which technological innovations are being introduced must be tempered with equal attention to the impact that this has on nursing work. Relevance to clinical practice. The way that medication work is conceptualised is constraining and covers over much of what actually happens in everyday nursing practice. Technological innovations change practice, often in unintended or unknown ways. Explicating the actuality of medication work offers an enhanced understanding and allows nurses to appraise critically the ways their work has been transformed.