Intended for healthcare professionals


New opportunities in practice nursing

BMJ 1995; 311 doi: (Published 01 July 1995) Cite this as: BMJ 1995;311:3
  1. Pamela Venning,
  2. Martin Roland
  1. Lecturer in practice nursing Professor of general practice Department of General Practice, University of Manchester, Manchester M14 5NP

    Roles matter more than titles

    Important changes in the education of practice nurses are imminent. Hitherto such nurses have come from widely varying backgrounds and have often had little prior training in practice nursing despite undertaking an increasing range of tasks. New courses are about to define areas of professional responsibility and accountability rather than focusing on isolated areas of competence.1 Nurses will be able to attain a qualification equivalent to a first degree to work as a district nurse, health visitor, or general practice nurse from a common core curriculum. Recognition of advanced practice in nursing will be obtained by showing continuous development in clinical, managerial, or academic skills. This concept of advanced practice will include areas of work currently performed by nurses working as nurse practitioners.2 3

    What will this new breed of nurses do? Some of the opportunities can be found in the work of nurse practitioners. Nurse practitioners may be the first contact for patients with acute problems or may provide a substantial part of continuing care in chronic illness. They diagnose new problems and make decisions on management. A recent British study suggested that they are popular with patients and work particularly well with singlehanded practitioners.4 They may be particularly effective with populations poorly served by general practitioners--for example, homeless people. Whether they are a cost effective alternative to general practitioners is unknown, partly because they spend more time with patients. Most published evaluations of nurse practitioners have been descriptive, with few accounts of outcome in the patients4 5 6 7; the only controlled trials have been carried out in the United States.8 9

    Do practice nurses differ from nurse practitioners? A recent British survey found that 84% of practice nurses advised on acute problems, and that a similar proportion participated in clinics for chronic diseases.10 Most used auriscopes and peak flow meters, and a few also used stethoscopes and ophthalmoscopes. Many practice nurses are clearly already working as “advanced practitioners,” with or without formal qualifications.

    How can we make sense of these new roles? The relationship between nurses and general practitioners is the key to this. General practitioners employ most practice nurses at present. The transfer of purchasing power to general practitioners11 means that they will increasingly exert control over the work of most nurses based in primary care and possibly over their educational requirements as well. Nevertheless, recognition of the key role of practice nurses means that doctors and nurses need to decide together on their mutual roles.

    Are nurses merely an alternative to general practitioners--or is there a range of roles for which they are not only better prepared but also cheaper? Nurses are going to be increasingly well qualified, and they will expect to have a substantial voice as practices choose how to develop their services.


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