Education And Debate

Towards an ethos of interdisciplinary practice

BMJ 1995; 311 doi: (Published 29 July 1995) Cite this as: BMJ 1995;311:305
  1. Mike Nolan

    Anyone browsing through the nursing journals over the past few months will have noticed that the profession seems to be undergoing sustained and quite unprecedented change. While change characterises the health care environment in general, several factors seem to have impinged on nursing and exacerbated an already fraught situation.

    On the one hand there are dire warnings of the potential impact of “multiskilling,” whereby unqualified and minimally trained personnel are undertaking activities previously deemed to be the province of nurses. Indeed in the United States such workers seem to be already moving into quasi-medical territory and are suturing wounds, injecting intravenous drugs, and inserting catheters.1 Paradoxically, in Britain there are concurrent accounts of the potential benefits, particularly for junior doctors, of nurse practitioners completing a similar range of tasks.2

    Although some experts feel that the development of the nurse practitioner will also benefit nursing, there are those who argue that such an initiative is of questionable value and does little but reinforce the traditional “handmaiden” relationship, with the nurse now cast in the role of “technical functionary.”3 In considering alternatives, others assert that nursing's future lies outside acute care, in such domains as health promotion, which is seen to offer “truly infinite scope” for professional growth and development.4

    Against this backcloth Castledine suggested that nursing is currently in the throes of an identity crisis, initiated and sustained by the scale and pace of technological, economic, and scientific change in the NHS.5 To consider the likely impact of such factors on the delivery of health and social care and the role of the nurse in …

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