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Health care system reform and the scope of independence in decision making by environmental/family nurses. I. Conditions for bearing responsibility for work results.

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  • 1Chair and Department of Management in Nursing, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland.


The reform of health care system, as well as the Act concerning health care units and public health insurance, provided an incentive for gaining independence by health services providers. This also pertains to environmental/family nurses who should decide on the scope of care provided and the results of nursing. Hence, a research problem was posed concerning the effect of health care system reform on the scope of independence in decision making by environmental/family nurses. This problem covered detailed questions with respect to changes in work schedule tasks, competence and responsibilities, as well as the provision of a resource base at workplaces. The study covered a total number of 110 people - 50 employed in non-public health care units and 60 in public institutions. The method of diagnostic survey and two types of statistical tests--Student's t test and 'u' test--were applied in the study. The results of the survey showed that nurses employed in new organizational forms of PHC had better conditions with respect to both their work schedules and provision of equipment at workplaces. This especially concerned a higher standard of resource base and equipment available for the staff employed on contract basis. It was confirmed that the number of nurses employed on independent contracts was small; hence a small area of independence in making decisions by environmental/family nurses.

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