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Rapid Responses: Rapid Responses published:
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Nurses can lead primary care services but do not have to be substitute doctors
- Sarah A Redsell, Francine M Cheater (9 September 2008)
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Keep the boundaries clear
- Sookhoe Eng (19 September 2008)
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Sarah A Redsell, Principal Research Fellow University of Nottingham, NG7 2UH, Francine M Cheater
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Sibbald 1 and Knight 2 put forward interesting arguments in respect of nurses leading primary care services. What a nurse “can’ and “cannot” do in clinical practice has been everybody else’s business since Florence Nightingale raised the status of nursing to a ‘respectable level’ in 1860. What is or is not considered within the scope of medical and nursing practice is socially constructed and changes as technology and clinical evidence advance. Fifty years ago taking a blood pressure was a medical not a nursing procedure, now the task is delegated to nurses or care assistants. Historical barriers such as unnecessary regulatory restrictions, medical dominance and professional uncertainty about role boundaries have long limited nurses’ contribution to primary care services. As some regulatory restrictions have been lifted many nurses are now providing patients with accessible, responsive, high quality first contact health care. However, implicit and explicit medical dominance continues to be evident in the literature and in clinical practice. For example, traditional professional boundaries are re-inforced by the use of terms like ‘nurse/doctor substitution’ which serve only to define nursing in relation to doctors’ work. Knight 2 is one of many doctors who argue that “ANP education is woefully inadequate” but this view fails to acknowledge that nurses are different to doctors. Perhaps it is time to consider that nurses have a distinctive role to play that is different from being substitute doctors? Certainly patients seem to think nurses offer something different – perhaps complementing doctors rather than replacing them? For example, patients particularly value nurses for their empathy and information-giving abilities and doctors for their technical skills.3 4 Why not develop alternative models of primary care service based on the different but complementary qualities nurses and doctors bring to the clinical encounter? Appropriately prepared nurses are more than capable of leading primary care services leaving doctors free to specialise in their areas of interests.5 In the future Primary Care Services should be designed by nurses and doctors (and other health professionals) in equal partnership with each professional group respecting the others’ contribution. This is surely the best way to deliver high quality patient care. References 1. Sibbald B Should primary care be nurse led? Yes BMJ 2008;337:a1157 2. Knight R Should primary care be nurse led? No BMJ 2008;337:a1169 3. Redsell SA, Stokes T, Jackson C, Hastings AM, Baker R. Patients accounts of the differences in nurses’ and doctors’ roles in primary care Journal of Advanced Nursing 2007;52(2):172-180 4. Cheater FM, Bonsall K, Edwards J, Leese B, McMurray R, Gill C, Sutcliffe R What makes a ‘good’ first contact nurse in primary care. A national study of patient perspectives and nurse aspirations. Final report submitted to the Department of Health Policy Research programme, 2007. University of Leeds. 5. Walsh N, Roe B, Huntington J. Delivering a different kind of primary care? Nurses working in personal medical service pilots. Journal of Clinical Nursing, 2003;12(3):333-340 Competing interests: None declared |
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Sookhoe Eng, PhD Student University of Leeds
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Nurses wishing to be doctors must take the appropriate training. Years of experience in nursing do not count; gaps in medical knowledge are life threatening. It is interesting that nurses want to be doctors. I've not heard of doctors fighting for a position in nursing. Have you? Competing interests: None declared |
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