Differentiated practice and specialization in community nursing: a descriptive study in the Netherlands.

Nursing roles are described with respect to two principles on the basis of an inventory study
carried out in the Netherlands: differentiated practice and specialization. A total of 58 agencies
for community nursing participated in this study (response = 84%). In each of these agencies an
expert was asked to answer questions by telephone. The results show that a distinction is made
between two levels of nurses working in the community: community nurses and community nurse
auxiliaries. This distinciton is based on the complexity of care, the range of responsibilities 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 for 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
specialization that the generalist work for first level nurses is diminishing : they have to choose
either (curative) adult care of (preventive) mother and child care. Fist and second level nurses
also have the opportunity of specializing in one or more patient categories. The aim of these 'areas
of special expertise' is to improve professionalism and patient 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
of care is recommended. In line with this, special measures have to be taken to upgrade the tasks of
community nurses. In this respect the use of areas of special expertise and activities relating to
coordination of care seem to be appropriate measures. (aut.ref.)