"What do you want to do?": expertise tension and authority negotiation in emergency nurse–physician interactions.

This article examines how expertise tensions—situations where individuals possess valuable knowledge but lack corresponding authority, or vice versa—are communicatively managed between physicians and nurses in a hospital emergency department (ED). Through ethnographic observations and interviews with 21 ED providers, the study identifies three problem-solving activities—instruction by demand, reversed instruction, and collaborative improvisation—that reflect how nurses assert situational authority while respecting physicians' formal decision-making roles. The findings highlight the importance of a communicative view of expertise, showing that nurses' anticipatory questioning ("What do you want to do?") both signals their contributory expertise and negotiates authority without undermining hierarchical structures. This research underscores the dynamic negotiation of knowledge and authority in high-reliability healthcare settings and suggests that fostering flexible, context-sensitive communication can enhance collaborative decision making and patient care.