Sullivan Elise, Francis Karen, Hegney Desley
School of Nursing, University of Queensland, Qld, Australia.
J Clin Nurs. 2008 Jun;17(12):1543-52. doi: 10.1111/j.1365-2702.2007.02087.x.
This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia.
The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge - traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context.
This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce.
In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative.
A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour.
This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care.
本文基于对澳大利亚及国际上有关护理与医疗分工的文献综述。它还探讨了这种分工如何影响澳大利亚维多利亚州农村小型医疗服务机构中患者获得紧急护理的情况。
本文描述了澳大利亚未来的卫生人力状况及其对维多利亚州农村地区的影响。对分工概念及其与护理和医学的关系进行了批判性审视。出现了两种分工形式——传统分工和协商分工。从描述农村背景下传统分工形式影响的文献中提炼出关键主题。
本文基于对澳大利亚及国际文献的综述，包括灰色文献，内容涉及农村紧急服务、专业界限与角色、分工、专业关系与权力以及澳大利亚卫生人力。
在澳大利亚，合同制劳动力意味着卫生专业人员之间的传统分工若不减少维多利亚州农村地区紧急护理的可及性就无法维持。传统分工导致农村医疗服务容易受到医疗人力轻微变动的影响、服务不安全以及存在招聘和留用问题。协商形式的分工提供了一种切实可行的替代方案。
需要一种由医生和护士协商并由法律和临床治理框架支持的分工，以支持农村紧急服务。已发表的证据表明，维多利亚州目前不存在这种情况。文中提供了创建和支持协商分工的策略。
本文提供了一些在农村紧急护理中建立医生和护士协商分工的策略。
