The BMJ 'Doctors and Nurses' issue (15th April 2000) signally fails
to define or describe nursing, but repeatedly talks about nurses doing
doctors' jobs. The predominance of the theme of substitution of doctors'
work by nurses undermines the ideas of multidisciplinary working, working
together, cooperation and collaboration which also feature in this issue.
Unless doctors are clearer about the role of nurses in health care
discussions about their relationships with nurses will appear patronising
and ignorant.
The importance of difference stressed by Celia Davies frames the
debate.1 This is an essential idea and one which is the foundation of the
utility and pleasure of my relationship with my practice nurse colleagues.
However, following Davies' paper every article strives to seek common
ground between medicine and nursing with nurses seen primarily as an
economic substitute. This continues until the final Personal View by Mark
Radcliffe which with admirable symmetry closes the debate opened by
Davies.2 But between their two papers who is actually celebrating the
difference?
As a GP I do not look to nurses to do the things I dislike doing more
cheaply and more efficiently. I do look to nurses to take on the tasks
they do better than me and to share the tasks they do equally well.
Primary care teams should be looking to employ nurses for the special
skills they have and for the special roles they offer. Sometimes nurses
are less costly because nurse training is shorter and the opportunity to
specialise can therefore come earlier. And, yes, we should be thinking of
the most cost effective services we can provide.
The lack of clarity in the BMJ about what nursing is reminds me of
the soul searching debate in general practice recorded in the 1950's and
1960's in which the discipline was asking itself if it was simply a hotch
potch of the medical specialties or something essentially discrete or
different. The BMJ seems to be having a similar debate about whether
nursing is a less advanced form of medicine. I would be interested to see
a nursing view of the nursing role. If the relationship between medicine
and nursing is really to bear fruit then medicine will have to recognise
more explicitly that nursing is a different profession and that nurse
training prepares different professionals. In their final letter in the
correspondence section Laurant and colleagues epitomise the need for a
more penetrating conceptualisation of the nursing role in talking about
"substituting nurses for doctors….. to improve quality and optimise the
(cost) effectiveness ………".3
Davies highlights the importance of difference: "it is not what
people have in common but their differences that make collaborative work
more powerful…". I look forward to a BMJ and Nursing Times collaboration
which celebrates the difference.
Rapid Response:
Doctors and nurses: celebrate the difference
Dear Sir
The BMJ 'Doctors and Nurses' issue (15th April 2000) signally fails
to define or describe nursing, but repeatedly talks about nurses doing
doctors' jobs. The predominance of the theme of substitution of doctors'
work by nurses undermines the ideas of multidisciplinary working, working
together, cooperation and collaboration which also feature in this issue.
Unless doctors are clearer about the role of nurses in health care
discussions about their relationships with nurses will appear patronising
and ignorant.
The importance of difference stressed by Celia Davies frames the
debate.1 This is an essential idea and one which is the foundation of the
utility and pleasure of my relationship with my practice nurse colleagues.
However, following Davies' paper every article strives to seek common
ground between medicine and nursing with nurses seen primarily as an
economic substitute. This continues until the final Personal View by Mark
Radcliffe which with admirable symmetry closes the debate opened by
Davies.2 But between their two papers who is actually celebrating the
difference?
As a GP I do not look to nurses to do the things I dislike doing more
cheaply and more efficiently. I do look to nurses to take on the tasks
they do better than me and to share the tasks they do equally well.
Primary care teams should be looking to employ nurses for the special
skills they have and for the special roles they offer. Sometimes nurses
are less costly because nurse training is shorter and the opportunity to
specialise can therefore come earlier. And, yes, we should be thinking of
the most cost effective services we can provide.
The lack of clarity in the BMJ about what nursing is reminds me of
the soul searching debate in general practice recorded in the 1950's and
1960's in which the discipline was asking itself if it was simply a hotch
potch of the medical specialties or something essentially discrete or
different. The BMJ seems to be having a similar debate about whether
nursing is a less advanced form of medicine. I would be interested to see
a nursing view of the nursing role. If the relationship between medicine
and nursing is really to bear fruit then medicine will have to recognise
more explicitly that nursing is a different profession and that nurse
training prepares different professionals. In their final letter in the
correspondence section Laurant and colleagues epitomise the need for a
more penetrating conceptualisation of the nursing role in talking about
"substituting nurses for doctors….. to improve quality and optimise the
(cost) effectiveness ………".3
Davies highlights the importance of difference: "it is not what
people have in common but their differences that make collaborative work
more powerful…". I look forward to a BMJ and Nursing Times collaboration
which celebrates the difference.
Yours sincerely,
Patrick White
Senior Lecturer
patrick.white@kcl.ac.uk
1. Davies C. Getting health professionals to work together. BrMedJ
2000;320:1021-2.
2. Radcliffe M. Doctors and nurses: new game, same result. Br Med J
2000;320:1085.
3. Laurent M, Sergison M, Halliwell S, Sibbald B. Evidence based
substitution of doctors by nurses in primary care? Br Med J 2000;320:1078.
Competing interests: No competing interests