Phillips Christine B, Pearce Christopher, Hall Sally, Kljakovic Marjan, Sibbald Bonnie, Dwan Kathryn, Porritt Julie, Yates Rachel
Academic Unit of General Practice and Community Health, Australian National University, Canberra, ACT, Australia.
Med J Aust. 2009 Jul 20;191(2):92-7. doi: 10.5694/j.1326-5377.2009.tb02701.x.
To describe the evolving roles of practice nurses in Australia and the impact of nurses on general practice function.
DESIGN, SETTING AND PARTICIPANTS: Multimethod research in two substudies: (a) a rapid appraisal based on observation, photographs of workspaces, and interviews with nurses, doctors and managers in 25 practices in Victoria and New South Wales, conducted between September 2005 and March 2006; and (b) naturalistic longitudinal case studies of introduced change in seven practices in Victoria, NSW, South Australia, Queensland and Western Australia, conducted between January 2007 and March 2008.
We identified six roles of nurses in general practice: patient carer, organiser, quality controller, problem solver, educator and agent of connectivity. Although the first three roles are appreciated as nursing strengths by both nurses and doctors, doctors tended not to recognise nurses' educator and problem solver roles within the practice. Only 21% of the clinical activities undertaken by nurses were directly funded through Medicare. The role of the nurse as an agent of connectivity, uniting the different workers within the practice organisation, is particularly notable in small and medium-sized practices, and may be a key determinant of organisational resilience.
Nursing roles may be enhanced through progressive broadening of the scope of the patient care role, fostering the nurse educator role, and addressing barriers to role enhancement, such as organisational inexperience with interprofessional work and lack of a career structure. In adjusting the funding structure for nurses, care should be taken not to create perverse incentives to limit nurses' clinical capacity or undermine the flexibility that gives practice nursing much of its value for nurses and practices.
描述澳大利亚执业护士角色的演变以及护士对全科医疗功能的影响。
设计、背景与参与者：两项子研究中的多方法研究：（a）2005年9月至2006年3月间，基于观察、工作场所照片以及对维多利亚州和新南威尔士州25家诊所的护士、医生和管理人员进行访谈的快速评估；（b）2007年1月至2008年3月间，对维多利亚州、新南威尔士州、南澳大利亚州、昆士兰州和西澳大利亚州7家诊所引入变革的自然主义纵向案例研究。
我们确定了护士在全科医疗中的六个角色：患者护理者、组织者、质量控制者、问题解决者、教育者和联络推动者。尽管前三个角色被护士和医生视为护理优势，但医生往往不认可护士在诊所内的教育者和问题解决者角色。护士开展的临床活动中只有21%直接由医疗保险基金资助。护士作为联络推动者，将诊所组织内的不同工作人员团结在一起的角色，在中小型诊所中尤为显著，可能是组织复原力的关键决定因素。
可通过逐步扩大患者护理角色范围、培养护士教育者角色以及消除角色强化障碍（如跨专业工作的组织经验不足和缺乏职业架构）来加强护理角色。在调整护士的资金结构时，应注意避免产生不良激励措施，限制护士的临床能力或破坏赋予执业护士对护士和诊所诸多价值的灵活性。
