DIFFERENTIATED PRACTICE AND SPECIALIZATION IN COMMUNITY NURSING - A DESCRIPTIVE STUDY IN THE NETHERLANDS

Nursing roles are described with respect to two principles on the basi s of an inventory study carried out in the Netherlands: differentiated practice and specialization. A total of 58 agencies for community nur sing participated in this study (response = 84%). In each of these age ncies an expert was asked to answer questions by telephone. The result s show that a distinction is made between two levels of nurses working in the community: community nurses and community nurse auxiliaries. T his distinction is based on the complexity of care, the range of respo nsibilities and a division between curative and preventive care (adult care vs. mother and child care). Assessment and diagnosis is reserved for nurses at the first level. Second level nurses are responsible fo r the other components of the nursing process. This study also showed that first level nurses regularly perform tasks that do not require a first level of expertise. It has become obvious with regard to special ization that the generalist work for first level nurses is diminishing : they have to choose either (curative) adult care or (preventive) mot her and child care. First and second level nurses also have the opport unity of specializing in one or more patient categories. The aim of th ese 'areas of special expertise' is to improve professionalism and pat ient care in community nursing. Based on the results of this study the use of measures to guarantee that the mix of staff meets the demand o f care is recommended. In Line with this, special measures have to be taken to upgrade the tasks of community nurses. In this respect the us e of areas of special expertise and activities relating to coordinatio n of care seem to be appropriate measures.