Cavanagh S J, Bamford M
College of Nursing, Wayne State University, Detroit, Michigan, USA.
J Nurs Manag. 1997 Nov;5(6):333-9. doi: 10.1046/j.1365-2834.1997.00029.x.
The introduction of market forces into health care delivery systems has had a number of important influences on the roles nurses perform. There have been increasing efforts to find alternative and more cost-effective ways of delivering care. One facet of this situation has been the examination of the roles and responsibilities of registered nurses (RNs) with the view of exploring different ways of using professional skills and determining if RN services are always required. One result of this has been the increased use of unlicensed personnel. The substitution of professional nursing staff by unlicensed personnel has become a major concern for practitioner, manager and client alike. This paper reviews some of the concepts of economic substitution as well as the assumptions advanced for the use of unlicensed personnel in clinical areas as a substitute for nursing services. While there has been increased use of unlicensed staff, the evaluation of clinical outcomes has been poor. This paper reviews primarily the hospital-based evidence about the impact of using unlicensed personnel in practice, and suggests there are methodological problems with the research published to date. Findings suggest that substitute service providers generally 'do no harm'. By contrast, evidence is presented indicating the major contributions nurses make to client care when adopting advanced practice roles (acting as a substitute for other professionals).
将市场力量引入医疗保健服务体系对护士所扮演的角色产生了诸多重要影响。人们越来越努力寻找替代的、更具成本效益的护理提供方式。这种情况的一个方面是审视注册护士（RN）的角色和职责，以期探索运用专业技能的不同方式，并确定是否总是需要RN服务。其结果之一是无执照人员的使用增加。用无执照人员替代专业护理人员已成为从业者、管理者和客户共同关注的主要问题。本文回顾了一些经济替代的概念以及在临床领域使用无执照人员替代护理服务的相关假设。尽管无执照人员的使用有所增加，但对临床结果的评估却很差。本文主要回顾了基于医院的关于在实践中使用无执照人员影响的证据，并指出迄今发表的研究存在方法问题。研究结果表明，替代服务提供者通常“无害”。相比之下，有证据表明护士在承担高级实践角色（替代其他专业人员）时对客户护理做出的主要贡献。
