Models of differentiated practice and specialization in community nursing: a review of the literature.

In most agencies for community nursing at least two types of nurse are employed. To ensure efficient use of personnel and high quality of nursing care, the principles of differentiated practice and specialization are used. It is suggested that these types of work redesign will have consequences for nurses and their work. We made a review of the literature to see how these principles are used and their effects on job satisfaction, burnout and quality of care. This review provides several views and descriptions of nursing activities, but it also shows that there is a paucity of quantitative data about the effects of differentiated practice and specialization in community nursing. To study these effects more systematically, a research model is presented. This model makes it possible to describe the changes in job characteristics caused by differentiated practice and specialization. Secondly, it allows the effects on job satisfaction, burnout and quality of care to be studied.