Sullivan P A, Brown T
Department of Nursing Education, University of Maryland School of Nursing, Baltimore.
Nurs Clin North Am. 1989 Jun;24(2):557-69.
The current nursing shortage is a supply-and-demand problem. Factors contributing to the shortage include increased hospital use of RNs; decreased nursing school enrollment; increased demand for RNs outside of hospitals in skilled nursing facilities, health maintenance organizations, and home health care programs; noncompetitive salaries; and lack of autonomy. The nursing shortage has triggered the development and implementation of programs to prepare non-nurse bedside technicians to work in partnership with RNs. The functions of these unlicensed persons range from housekeeping, stocking, and clerical responsibilities to several technical treatments that once fell within the role responsibilities of registered or practical nurses. The partnerships between unlicensed persons and RNs in patient care settings have given rise to several administrative, policy, and ethical issues for nurse leaders. An ethical analysis, based on the application of ethical principles and moral dilemmas found in "The Parable of the Sadhu," offers some guidelines to nursing leaders in the administrative and policy decisions inherent in the development and retention of licensed persons in patient care settings. Some conclusions drawn from the ethically based questions are: The acquisition and retention of RNs and other licensed caregivers should take precedence over the development of programs for non-nurse bedside technicians. RNs in partnership with unlicensed persons in patient care settings must know what they can legitimately delegate. The RN has personal responsibility for ensuring optimal standards of nursing practice in the delegation of duties. The partnership between professional nurses and unlicensed persons must be a participative effort, not a manipulative or coercive one. In putting the organizational principle of subsidiarity into practice, decision makers will be able to maintain respect for human dignity and the uniqueness of patients and caregivers as well. The development and retention of unlicensed persons in patient care settings depends on a well-developed personal ethic that needs to be congruent with the mission, philosophy, and codes of ethics of national and local health care organizations.
当前的护士短缺是一个供需问题。导致短缺的因素包括医院对注册护士的使用增加；护理学校入学人数减少；熟练护理机构、健康维护组织和家庭医疗保健项目等医院外对注册护士的需求增加；薪资缺乏竞争力；以及缺乏自主权。护士短缺引发了一些项目的开发和实施，这些项目旨在培养非护士床边技术员与注册护士合作工作。这些未经许可人员的职责范围从家务管理、物资储备和文书工作到一些曾经属于注册护士或执业护士职责范围内的技术治疗。在患者护理环境中，未经许可人员与注册护士之间的合作引发了护士领导者面临的一些行政、政策和伦理问题。基于对《舍罕王的故事》中伦理原则和道德困境的应用进行的伦理分析，为护士领导者在患者护理环境中持证人员的培养和留用所固有的行政和政策决策提供了一些指导方针。从基于伦理的问题中得出的一些结论是：获取和留用注册护士及其他持证护理人员应优先于非护士床边技术员项目的开发。在患者护理环境中，与未经许可人员合作的注册护士必须知道他们可以合法委托哪些工作。注册护士在职责委托中对确保达到最佳护理实践标准负有个人责任。专业护士与未经许可人员之间的合作必须是一种参与性的努力，而不是操纵性或强制性的。在将辅助性组织原则付诸实践时，决策者将能够维护对人的尊严以及患者和护理人员独特性的尊重。在患者护理环境中培养和留用未经许可人员取决于一种完善的个人伦理，这种伦理需要与国家和地方医疗保健组织的使命、理念和伦理准则相一致。
