Brannon R L
Department of Sociology, University of Kentucky, Lexington 40506, USA.
Int J Health Serv. 1996;26(4):643-54. doi: 10.2190/AERK-G2VH-KMUQ-W5VD.
Registered nurses are currently threatened by a new managerial strategy to restructure work on hospital wards through the implementation of "Continuous Quality Improvement" and the "downsizing" of the professional work force. The strategy reintroduces nonprofessional and unlicensed nursing personnel in a manner that may displace large numbers of registered nurses (RNs) and affect patient care adversely. Ironically, not only is this change being implemented principally to reduce hospital costs rather than to improve quality, it reverses the cost-containment strategy implemented in the 1980s when hospitals displaced nonprofessional nursing workers and moved toward a professional work force. In this article, the author reviews the prior shift from "team nursing" with a stratified work force that included licensed practical nurses and nurses' aides to "primary nursing" and the trend toward all-RN staffing, and explains how this trend contributed to the present effort to reverse the process. The author then discusses current work redesign methods that have been adapted from traditional industrial applications to destroy work jurisdictions and further rationalize hospital production through the downsizing of the professional work force and the creation of cross-trained workers in a new team-based management approach. The article concludes by discussing nursing's response to corporate-imposed work restructuring and the significance of these changes.
注册护士目前正受到一种新管理策略的威胁，该策略通过实施“持续质量改进”和专业劳动力“精简”来重组医院病房的工作。这种策略以一种可能取代大量注册护士（RN）并对患者护理产生不利影响的方式重新引入了非专业和无执照的护理人员。具有讽刺意味的是，实施这一变革主要是为了降低医院成本而非提高质量，它还逆转了20世纪80年代实施的成本控制策略，当时医院辞退了非专业护理人员并朝着专业劳动力方向发展。在本文中，作者回顾了之前从包括执业护士和护理助理的分层劳动力的“团队护理”向“初级护理”的转变以及全注册护士人员配置的趋势，并解释了这一趋势如何促成了目前扭转这一过程的努力。然后作者讨论了当前从传统工业应用改编而来的工作重新设计方法，这些方法通过精简专业劳动力和在基于团队的新管理方法中创建交叉培训的工人来打破工作管辖范围并进一步使医院生产合理化。本文最后讨论了护理行业对企业强制实施的工作重组的应对措施以及这些变革的意义。
