Brannon R L
Department of Sociology, University of Kentucky, Lexington 40506.
Int J Health Serv. 1990;20(3):511-24. doi: 10.2190/1RNJ-DC8M-3R0K-PV6V.
The author presents a labor process analysis of recent changes in nursing work on hospital wards. In the immediate post-World War II decades, hospital nursing was organized to include stratified nurses--registered and auxiliary nurses (licensed practical nurses and nurses' aides)--in a common labor process called "team nursing." Team nursing adapted Taylorist principles to sharply demarcate tasks between registered nurses (RNs) and auxiliaries. In the 1970s and 1980s, team nursing increasingly replaced by "primary nursing" with a majority of RNs. Auxiliaries were displaced as RNs assumed undivided responsibility for complete nursing care. The transition to primary nursing is partly explained through the convergence of managerial interests with the professionalizing interests of nursing's elite. However, primary nursing was not simply imposed from the top down. Team nursing produced divisiveness between RNs and auxiliaries at the same time that it forced these workers to violate the official differentiation of tasks and held RNs responsible for work performed by auxiliaries. Primary nursing eliminates the problems of team nursing as RNs perform reunified tasks in an unmediated RN-patient relationship. However, primary nursing has produced a new set of contradictions, including an intensified labor process.
作者对医院病房护理工作的近期变化进行了劳动过程分析。在二战后的几十年里，医院护理工作组织形式包括分层护士——注册护士和辅助护士（执业护士和护工）——参与一个名为“团队护理”的共同劳动过程。团队护理采用泰勒主义原则，在注册护士（RN）和辅助护士之间明确划分任务。在20世纪70年代和80年代，团队护理逐渐被多数由注册护士参与的“责任制护理”所取代。随着注册护士承担起完整护理的全部责任，辅助护士被取代。向责任制护理的转变部分是由于管理利益与护理精英的专业化利益趋同。然而，责任制护理并非简单地自上而下强制推行。团队护理在迫使这些工作人员违反官方任务区分并让注册护士为辅助护士所做工作负责的同时，也在注册护士和辅助护士之间制造了分歧。责任制护理消除了团队护理的问题，因为注册护士在直接的护患关系中执行统一的任务。然而，责任制护理产生了一系列新的矛盾，包括劳动过程的强化。
