Dowling S, Barrett S, West R
Department of Social Medicine, University of Bristol.
BMJ. 1995 Jul 29;311(7000):309-13. doi: 10.1136/bmj.311.7000.309.
The boundaries between the work of doctors and that of nurses are changing, with nurses taking over important parts of junior hospital doctors' clinical work. In 1993 an exploratory study was carried out to identify the professional, educational, and management issues that such developments raise. Interviews were carried out with a range of stakeholders in three innovatory posts in which nurses were doing much of the clinical work of house officers. A complex picture of perceived benefits and problems for patients, junior doctors, and nurses emerged. These seemed to be associated with (a) the extent to which the contribution of professional nursing was valued in the new role and (b) the amount of clinical discretion which the postholder was allowed, this depending on the type of preparatory education provided and the management of the post. The study points to the need for strategic issues--such as the development of appropriate education and the professional recognition of these new clinical roles--to be addressed at a national and regional level.
医生和护士的工作界限正在发生变化，护士正在接管初级医院医生临床工作的重要部分。1993年进行了一项探索性研究，以确定此类发展所引发的专业、教育和管理问题。对三个创新岗位的一系列利益相关者进行了访谈，在这些岗位上，护士承担了住院医生的大部分临床工作。对于患者、初级医生和护士而言，出现了关于感知到的益处和问题的复杂情况。这些似乎与以下两点相关：(a) 在新角色中专业护理贡献被重视的程度；(b) 任职者被允许的临床自主权的大小，这取决于所提供的预备教育类型和岗位管理情况。该研究指出，需要在国家和地区层面解决一些战略问题，比如开展适当的教育以及对这些新临床角色进行专业认可。
