Smith J P
J Adv Nurs. 1979 Jul;4(4):439-52. doi: 10.1111/j.1365-2648.1979.tb00877.x.
The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.
英国国民医疗服务体系于1974年进行了重组。当时，此前分别管理的医院服务和社区卫生服务被整合到一个机构：地区卫生局。这次重组是早在1589年第一部《济贫法》通过后引发的一系列发展的 culmination ，但更具体地说，这次重组是过去30年中发布的一些重要政府和专业护理报告的自然结果。因此，自1974年以来，社区和医院护理服务在护理服务主管的领导下进行了合并：地区（或区域）护理官员，他与医疗、行政和财务同事一起，在一个通过协商一致进行管理的团队中日常管理卫生服务。护士在管理团队中的角色既是行政性的也是专业性的：护士的独特贡献在于他/她将护理视角带入管理。新的护理服务组织为将中级护士管理人员重新定位到临床角色提供了新机会。它还为创新社区和医院护士的综合团队以及发展专科护理角色提供了机会。护士现在还能够通过参与医疗保健规划团队活动以及成为法定地区和区域护理及助产咨询委员会的成员，为医疗保健做出其他额外贡献。但是，总体而言，对医疗保健的变革和影响主要是由英国护理管理结构的变化带来的，自弗洛伦斯·南丁格尔改革以来，这似乎一直是英国护理专业的一个普遍观点，并且通过英国护士培训这一强大的社会化因素得以延续。由于医疗保健和护理服务组织应该是实现优质患者护理这一目标的手段，也许现在是时候关注由单独组织的行政结构支持的自主护士从业者的建议了。
