Education And Debate

Nurses taking on junior doctors' work: a confusion of accountability

BMJ 1996; 312 doi: (Published 11 May 1996) Cite this as: BMJ 1996;312:1211
  1. Sue Dowling, consultant senior lecturera,
  2. Robyn Martin, lecturerb,
  3. Paul Skidmore, lecturerb,
  4. Lesley Doyal, professor of health and social carec,
  5. Ailsa Cameron, research fellowc,
  6. Sharon Lloyd, lecturerd
  1. a Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. b Department of Law, University of Bristol, Bristol BS8 1RJ
  3. c School for Policy Studies, University of Bristol, Bristol BS8 4AE
  4. d OPUS Consulting, Edgecombe Hall, Bristol BS8 1AT
  1. Corespondence to: Dr Dowling.
  • Accepted 8 March 1996

The number of hospital based posts in which nurses take over clinical work previously done by junior doctors is growing. Accountability for the scope of such new roles and the standards of practice which apply to them are still unclear. When analysed together and compared, the regulations arising from the professional bodies (GMC and UKCC), civil law concerning certain wrongs to patients, and employment law are sometimes contradictory and hard to interpret. The resulting uncertainties about appropriate management for clinical roles evolving between the professions, coupled with an increasingly litigious public, put the nurses and consultants involved at risk of complaints and of disciplinary and legal action. Drawing on our current research into changing clinical roles at the medical-nursing interface, we suggest strategies to reduce risk. Doctors and nurses should be equal partners in planning and managing these new posts, patients should be informed adequately about the nature of the postholder's role and training, significant changes in the work of such postholders should be formally acknowledged by the employer and relevant insurers, individuals taking up new roles should have access to legal advice and support to cover legal risk, and national regulatory bodies need to work together to harmonise their codes of practice in relation to changing clinical roles between the professions.

A quiet revolution is occurring in the division of labour between the professions of medicine and nursing,1 2 created partly by requirements to reduce junior hospital doctors' work3 4 and to compensate for their shortage in some specialties.5 Nurses in particular are taking on clinical work that has traditionally been done by doctors. Our research into the resulting new roles in hospitals has made us aware of the confusion surrounding the management of accountability for the scope of these new roles and the standards that …

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