Governance in Nursing
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The issue of who should control nursing is rooted in an age old conflict between nurses and physicians (Webster, 1988), and it is rooted in the contemporary restructuring of the health care delivery environment (McNerney, 1988). Physicians have traditionally assumed a superiority of status with respect to all other care givers, in the delivery of health care services to patient (Friedson, 1970). Nursing, however, considers the patient and patient care from a different, but equally valid, perspective from the approach of physicians (Nelson, 1988), and nurses think their profession requires a significant degree of autonomy from the physician in the delivery of patient care (Brunner, 1985). The restructuring of the health care delivery environment adds new dimensions to the issue of control over the nursing function. First, changes in the locus of delivery of health care services home health care, ambulatory care, and so forth are creating new opportunities and new demands for professional nursing (Weiss, 1983). Second, however, economic factors in the new health care delivery environment have propelled managers and administrators into roles, wherein they attempt to impinge on the autonomy of all health care professionals (Particelli, 1984; Wolper, 1983; Drake, 1982). PRESENT STATE OF THE ISSUE As a result of a combination of factors (increasing costs of health care, changing societal values, advances in treatment therap
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t hospitals will be evaluated against local, regional, and national standards (Brinkley, 1986). Local, regional, and national standards will, in most instances, represent mean performance levels.
DRG procedures, thus, may be used in the determination of (1) funding, (2) access to care, and (3) the designation of provider organizations. Each of these uses holds the potential to affect the health care of Medicare recipients both the quality of the health care services received, and whether they receive care at all.
The changing structure of the health care delivery environment is causing all health care professions to review roles. Such reviews often exacerbate competition between health care professions (McNerney, 1988).
NURSING & THE NURSING AUTONOMY ISSUE
Traditionally, professional nurses have been most concerned with the aspects of health care delivery management which will affect their relationships with patients, and their status as professionals. Their concerns with respect to current trends in health care delivery management are the effects, if any, which these trends would have on the following: (1) public trust in the commitment of nurses to the general welfare of patients; (2) the
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DRG PPO, ISSUE Traditionally, HMO HMOs, ISSUE DEFINITION, Tillotson Rosada, health care, PPOs Currin, Advisers CEA, OUTLOOK Managers, RESEARCHER POSITION, care services, health care services, Mentkowski Doherty, health care delivery, care delivery, delivery health care, delivery health, ambulatory care, primary health care, primary health, for profit hospitals, care team, health care team, cushner 1986, prospective reimbursement,
Approximate Word count = 2861
Approximate Pages = 11 (250 words per page)
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