The aim of this article is to describe job satisfaction and burnout among two categories of community-based nurses (N = 402) in the Netherlands taking account of job and individual characteristics. Results show that these nurses are moderately satisfied with their jobs and the effects of burnout are average. Further, community nurses are less satisfied and have experienced burnout to a greater extent than community nurse auxiliaries. Both job characteristics and individual characteristics are related to job satisfaction and burnout. However, job satisfaction is affected to a greater extent by job characteristics whereas burnout is more often a result of individual characteristics. As research in this area is scarce and home care is changing radically, these results may be valuable in coping with change without losing sight of nursing's professional values.

In most agencies for community nursing at least two types of nurse are employed. To ensure efficient use of personnel and high quality of nursing care, the principles of differentiated practice and specialization are used. It is suggested that these types of work redesign will have consequences for nurses and their work. We made a review of the literature to see how these principles are used and their effects on job satisfaction, burnout and quality of care. This review provides several views and descriptions of nursing activities, but it also shows that there is a paucity of quantitative data about the effects of differentiated practice and specialization in community nursing. To study these effects more systematically, a research model is presented. This model makes it possible to describe the changes in job characteristics caused by differentiated practice and specialization. Secondly, it allows the effects on job satisfaction, burnout and quality of care to be studied.

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 distinction 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 or (preventive) mother and child care. First 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.