Who's the boss? Children's perception of hospital hierarchy.

Young people in an in-patient mental health unit seemed to recognise that a hierarchy existed within the multidisciplinary team and that it had an effect upon their care and treatment. A literature review suggested that the prevailing culture perpetuated a hierarchy and those who get things done ('the bosses') have power while nurses have 'relational' power (Souminen et al 1997). The views of 35 in-patients aged between 13 and 17 years were obtained using a questionnaire and discussion. These young people believed that doctors (and possibly psychologists) make the important decisions, with nurses perceived as being 'all rounders' with no particular authority. Other professionals had distinct roles but were also subordinate. The findings of this exploratory study are relevant for the multidisciplinary team but further studies are needed to identify more specific implications for practice.