McDonald Ruth, Campbell Stephen, Lester Helen
National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK.
Soc Sci Med. 2009 Apr;68(7):1206-12. doi: 10.1016/j.socscimed.2009.01.039. Epub 2009 Feb 28.
This paper reports the impact on nurses working in primary health care settings of changes to the general practitioner (GP) contract in England implemented in 2004. Previous changes to the GP contract in 1990, which gave financial rewards for health promotion activities, were seen as enabling nurses to take on work that GPs did not want and providing an impetus for the development of a professional project (Broadbent, J. (1998). Practice nurses and the effects of the new general practitioner contract in the British NHS: the advent of a professional project? Social Science & Medicine, 47(4), 497-506). Our study, which involved interviews with nurses from 20 practices, finds that nurses are taking on work which has previously been the exclusive preserve of medical professionals. An increasing emphasis in nurses' accounts on technical skills and knowledge may help decouple nursing from a narrative of caring, which has been seen as detracting from professional advancement. Our research suggests that practice nurse work is changing to reflect a more medical (and masculine) orientation to service delivery. At the same time, nursing work is described as routine and template driven, which may limit claims to 'professional' status. The reaction of some practice nurses to Health Care Assistants encroaching on what was previously practice nurse territory suggests a policing of boundaries, rather than an inclusive approach to colleagues within the nursing team. This resonates with Davies' (Davies, C. (1995). Gender and the professional predicament in nursing. Bucks: Open University Press) suggestion that professionalisation as a process involves compliance with a masculine notion of professionalism (autonomous, elite, individual, divisive, detached) which marginalises feminine attributes and devalues the work done by women. The study also raises questions about the role of caring in general practice settings where nurses choose to prioritise other concerns.
本文报告了2004年在英格兰实施的全科医生（GP）合同变更对在初级卫生保健机构工作的护士的影响。1990年全科医生合同的先前变更为健康促进活动提供了经济奖励，被视为使护士能够承担全科医生不想做的工作，并为一个专业项目的发展提供了动力（布罗德本特，J.（1998年）。执业护士与英国国民健康服务体系中新的全科医生合同的影响：一个专业项目的出现？《社会科学与医学》，47(4)，497 - 506）。我们的研究涉及对来自20家医疗机构的护士进行访谈，发现护士们正在承担以前一直是医学专业人员专属领域的工作。护士们在描述中越来越强调技术技能和知识，这可能有助于使护理与关爱叙事脱钩，而关爱叙事被视为不利于职业发展。我们的研究表明，执业护士的工作正在发生变化，以反映出对服务提供的更具医学（和男性化）导向。与此同时，护理工作被描述为常规的且由模板驱动，这可能会限制对“专业”地位的主张。一些执业护士对医疗保健助理 encroaching on 以前属于执业护士领域的情况的反应表明，他们在划定界限，而不是对护理团队中的同事采取包容的态度。这与戴维斯（戴维斯，C.（1995年）。《护理中的性别与职业困境》。巴克斯：开放大学出版社）的观点相呼应，即职业化作为一个过程涉及符合男性化的专业主义观念（自主、精英、个人、分裂、超脱），这会边缘化女性特质并贬低女性所做的工作。该研究还对在护士选择优先考虑其他问题的全科医疗环境中关爱的作用提出了疑问。 （注：“encroaching on”这里原文可能有误，推测是“ encroaching upon”，意思是“侵犯，蚕食” ）
