Date of Defense




First Advisor

Dr. Shirley Bach

Second Advisor

Dr. Diane Hamilton

Third Advisor

Dr. John Martell


In the British National Health Service (NHS), the general practice physician (GP) serves as gatekeeper to resources.1 In the United States, managed care physicians, who attempt to contain health care expenditures by establishing priorities and strictly regulating treatment accessibility, necessarily employ gatekeeping responsibilities in practice.2 However, both systems of health care generally overlook the potential contribution of nurses in identifying and implementing effective methods of resource allocation. The central focus of this thesis includes two primary assertions. First, I will argue that nurses currently function as gatekeepers both in England and the United States, and that the traditional nursing paradigm includes skills which naturally facilitate the gatekeeping role. For clarification, my argument is not that nurses should replace physicians as gatekeepers, but rather, that the nurse-gatekeeping model offers a viable alternative with merit significant enough to justify further investigation and potential incorporation into health policy. My second argument is one of philosophy and applied ethics. I will argue that the traditional ethical constraints of nursing do not necessarily preclude nurses from the practice of gatekeeping.

Access Setting

Honors Thesis-Open Access

Included in

Nursing Commons