Structural Separation of Intervention-Focused Nursing and Maintenance-Focused Nursing : An Analysis of the Structural Contradiction in Which Both Intervention Efficiency and Emotional Maintenance Are Simultaneously Demanded

Correspondence: solarsystemmilkyway@naver.com

 Nature of the Document

This document was developed based on structural problems repeatedly observed in nursing practice. It analyzes the limitations that arise from the fact that the current healthcare system is fundamentally designed around an intervention-centered framework, and it proposes an alternative classification model in response.

This work is not an official project of any academic institution or research institute. Rather, it is an independent study grounded in accumulated clinical observations and structural analysis. Its purpose is to define the domain of maintenance-focused nursing—an area that has remained relatively invisible within existing systems—as an independent structural function, and to present it in a form that can be examined and applied within nursing systems.

2. Scope of Application

This document is not limited to any specific nursing specialty (e.g., adult nursing, maternal nursing, pediatric nursing, psychiatric nursing, or community nursing), nor is it restricted to a particular type of ward or institution.

The structural separation between intervention-focused nursing and maintenance-focused nursing is a perspective that can be broadly applied across diverse settings, including acute care wards, chronic care units, psychiatric facilities, long-term care and nursing homes, rehabilitation settings, traditional medicine institutions, and community-based healthcare and care services.

In other words, the proposed classification framework is not intended to address a problem confined to a particular specialty. Instead, it is designed to explain a structural phenomenon that repeatedly emerges across nearly all contexts in which nursing is practiced.

Accordingly, this document does not propose a set of techniques for a specific clinical domain; rather, it offers a system-level proposal aimed at restructuring the way nursing functions are organized and delivered.

3. Problem Statement

Modern healthcare systems have become increasingly sophisticated in intervention-centered design in order to improve treatment outcomes. This development has significantly enhanced clinical safety and efficiency. However, it has also revealed a structural gap that is repeatedly observed in real-world healthcare settings.

Specifically, the emotional stability, relational safety, and the experience of “being with” that patients and families require during medical care often remain insufficiently structured within the system.

This gap is most clearly manifested in nursing. Nurses are required not only to perform clinical interventions for treatment and recovery, but also to provide emotional and relational support so that patients and families can endure the medical experience. Yet despite the fact that these two functions operate through fundamentally different mechanisms and require different competencies, they are frequently demanded simultaneously within a single role in clinical practice.

As a result, nurses repeatedly face a structural burden: they must carry both an intervention-focused role that requires speed and precision, and a maintenance-focused role that requires sustaining flow, context, and relational stability.

Within this structure, emotional and relational care tends to remain underdeveloped and insufficiently standardized as a clinical skill. Instead, it is often treated as an area dependent on personal disposition, attitude, or goodwill and devotion. Consequently, patients may receive medical interventions throughout treatment while not being adequately supported in an emotionally safe manner. Meanwhile, nurses continue to bear emotional demands that are difficult to recognize as professional expertise. Over time, this condition intensifies burnout and role conflict among nurses.

This document understands these issues not as problems of individual competency or personality, but as consequences of an insufficiently differentiated role structure within healthcare and nursing systems. After examining the structural causes through the lenses of the educational system, professional specialization structures, and physician-centered command hierarchies, this document proposes the necessity of redesigning nursing roles through a functional separation between intervention-focused functions and maintenance-focused functions.

4. Proposal

This document interprets the emotional gaps observed in clinical nursing settings and the burnout experienced by nurses not as problems of individual competency or attitude, but as consequences of an insufficiently differentiated role structure. Based on this perspective, it presents a structural proposal intended to address these issues.

The core proposal is to classify nursing functions into intervention-focused nursing and maintenance-focused nursing, and to clearly separate and define the competencies and responsibilities required for each function. Through this separation, intervention-focused nursing can concentrate on clinical execution for treatment and recovery, while maintenance-focused nursing can systematically assume responsibility for emotional stability, relational safety, and context-based care.

Furthermore, this document argues that such functional separation is not merely a division of labor. Rather, it may serve as a new practical structure capable of reconstructing nursing professionalism and improving the overall quality of the healthcare experience.

5. Intended Audience and Request for Review

5.1 Intended Audience

This document is primarily intended for the following audiences:

• Nursing faculty members and researchers

• Clinical nursing managers (head nurses, nursing departments, QI personnel, nurse educators, etc.)

• Advanced practice nurses and clinical leader nurses across specialties

• Personnel responsible for workforce structure and job design within hospitals (nursing administration, strategic planning, human resources, etc.)

• Nurses who have experienced role conflict and burnout across diverse settings, including acute care, chronic care, psychiatric care, long-term care, and community-based care

In addition, this document is not intended to remain solely within internal nursing discourse. In order for the proposal to function structurally within real healthcare environments, it also requires review from the following related professional groups:

• Physicians and multidisciplinary healthcare professionals (regardless of specialty)

• Therapists (physical therapy, occupational therapy, speech therapy, etc.)

• Social workers and community liaison coordinators

• Psychological and mental health professionals (clinical psychologists, mental health practitioners, etc.)

• Policymakers and institutional designers responsible for healthcare systems and regulations

5.2 Request for Review

This proposal is not intended to remain a conceptual declaration. In order to develop into a structure that can be applied in real clinical settings, the following forms of review and validation are requested:

1. Feasibility of role separation

• Whether the differentiation between intervention-focused and maintenance-focused roles is operationally feasible in actual wards and institutions

• Whether staffing models, work schedules, and collaboration structures can be realistically designed

2. Clarification of scope of practice and accountability structure

• Whether the boundaries between the two roles can function in practice without operational conflict

• Whether accountability and decision-making structures remain clear rather than becoming ambiguous

3. Design feasibility of education, competency, and evaluation systems

• Whether maintenance-focused nursing competencies can be structured into teachable, trainable, and assessable forms

• Whether psychiatric nursing competencies can be expanded as universal clinical skills rather than remaining concentrated in specific wards

4. Evaluation of effects on patient experience and treatment processes

• Impact on patient safety, treatment adherence, reduction of anxiety and fear, and continuity of care

• Impact on family experience and on clinician–patient relationships

5. Review of effects on nurse burnout and turnover reduction

• Whether reduced role conflict decreases burnout, emotional labor burden, and turnover rates

• In particular, effects on the sustainability of early-career nurses and mid-career nurses