Segesten K, Lundgren S, Lindström I
Vänersborg University College of Health Sciences, Mölndal, Sweden.
J Nurs Manag. 1998 Jul;6(4):223-30. doi: 10.1046/j.1365-2834.1998.00069.x.
Pressure on governments to reduce the costs of healthcare whilst improving the quality continue unabated throughout the developed world. As a consequence of budget cuts on a large Swedish University hospital, a decision to change from mixed nurse staffing to all registered nurses (RNs) in one surgical ward was made to evaluate if nursing costs could be reduced.
This study was developed to gain a deeper understanding of the process of change in a hospital ward when all practical nurses were replaced by registered nurses.
A substantive theory was inductively derived, using a modified version of grounded theory methodology.
The change encouraged the nurses to become versatile. When the nurses adopted a patient focussed philosophy the content of their work changed and individualized care became possible. The versatility fostered a spirit of creativity, permitted a high degree of freedom of choice and increased the competence, but also led to some negative reactions in the form of complaints about weariness, lack of support and vulnerability with regard to the working environment.
Versatility can be an opportunity for the nurses to expand their knowledge and develop nursing care but there is a risk that versatility results in weariness.
在整个发达国家，政府面临着在提高医疗质量的同时降低医疗成本的持续压力。由于瑞典一家大型大学医院削减了预算，因此决定在一个外科病房从混合护士配置改为全部由注册护士（RN）组成，以评估是否可以降低护理成本。
本研究旨在更深入地了解当所有实习护士被注册护士取代时医院病房的变革过程。
采用扎根理论方法的修改版，归纳得出一个实质性理论。
这种变革促使护士变得多才多艺。当护士采用以患者为中心的理念时，他们的工作内容发生了变化，个性化护理成为可能。这种多才多艺培养了创造力，允许高度的选择自由并提高了能力，但也引发了一些负面反应，表现为对工作疲劳、缺乏支持以及工作环境易受伤害的抱怨。
多才多艺对护士来说可能是一个扩展知识和发展护理的机会，但存在多才多艺导致疲劳的风险。
