Intended for healthcare professionals

Rapid response to:


The nursing profession's coming of age

BMJ 2005; 331 doi: (Published 08 December 2005) Cite this as: BMJ 2005;331:1415

Rapid Response:

The nurse practitioner: enhancing the quality of patient care


I have read with interest the many responses to my Personal View (1)
and welcome the debate that is now taking place but would like to clarify
some misconceptions.

One widely expressed reactionary fear is that any blurring between
medicine and nursing might herald the end of each as a distinct profession
and that the NHS would be the poorer because of it. Pearson and Coull
refer to the “dumbing down” of medicine by nurse practitioners (NPs) and
Leeds perceives the NP as an unnecessary duplicate general practitioner
(GP). In my own practice patients often ask to see me rather than a
doctor, not because I am better, but because I can respond more
appropriately to their needs, and in so doing I free up doctor time for
patients of a different complexity who prefer medical care.

There are clearly aspects of medicine that only a doctor can perform,
just as some roles are primarily the province of nursing and thus each
profession can never fully substitute for the other. However, there is a
large middle ground where distinctions are less well demarcated. Thus when
I auscultate the chest of a patient does this mean I am being a doctor,
and therefore less of a nurse? Obviously not! When a doctor holds the hand
of a patient and comforts them, is he or she being a nurse? No, merely
being compassionate and caring! This is where the divisions between
medicine and nursing are unhelpful. I find insulting the accusation that
in becoming a NP I despise my profession of nursing (Duncan) and Coull’s
extreme view that senior nurses such as myself are causing “the death of
good nursing care” has no basis in fact. On the contrary my expanded role,
encompassing aspects of both medicine and nursing, allows me to give
better and more complete care.

I am also accused of attempting to equate my years of education and
experience to a medical degree (Duncan, Roscoe, Henry). This is not so.
However I do argue that my education has had sufficient breadth and depth
to equip me with the skills needed for my role. I am fortunate in working
with GP colleagues who are on hand to advise me whenever I need a medical
opinion, and they in turn, often approach me with a clinical query. This
is how it should be: doctors and nurses supporting each other in a spirit
of mutual respect and trust, acknowledging the contributions of each to
patient care and learning from each other, and at all times working within
the confines of their own competence. The NP, although often dubbed an
“autonomous practitioner”, works interdependently to complement but not
replace the doctor.

I welcome the Nursing and Midwifery Council’s (NMC) move to regulate
the role of the “advanced nurse practitioner” so that only those who have
demonstrated the required standard can use the title. This will protect
the public and also the nurse in terms of giving him or her the authority
to practise. The Royal College of Nursing (RCN) (2) has developed
competencies and domains of practice for the NP role and this defines the
standards we work to and outlines our responsibilities.

This brings me to medico-legal issues (Nesbitt). Yes, the NP is
indeed accountable for his or her clinical and prescribing decisions. The
RCN indemnifies us and many also belong to a medical defence organisation.
Learning to manage uncertainty and risk taking is integral to the NP role
and why I believe the soonest the NP title is regulated by the NMC the

I would like to apologise if I gave the impression that only nurses
can give holistic care and are better communicators than doctors. There is
however research (3, 4) to suggest enhanced patient satisfaction with
nurse consultations, but this does not mean that nurses have the monopoly
in care and compassion. Many nurses spend more time with their patients
and this is one reason why patient satisfaction is higher. As Seale has
said the challenge for nurses is to speed up without affecting outcomes
and that the challenge for doctors might be to learn from nursing
communication styles (4). So, yet again, we could learn from each other
and we should celebrate our differences, not feel threatened.

In conclusion, NPs are most definitely “not wannabee doctors”
(Magennis). We are proud to be nurses offering our patients better care
because of our greater knowledge and we complement, but do not replace the
roles of our medical colleagues. In the modern NHS it is not possible to
deliver the care patients need without working in active cooperation-
doctor, patient and nurse in partnership.

1. Young G. The nursing profession’s coming of age. BMJ 2005;

2. Nurse Practitioners –an RCN Guide to the NP Role, Competencies and
Programme Accreditation. Royal College of Nursing 2005

3. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse
practitioners working in primary care can provide equivalent care to
doctors. BMJ 2002; 324: 819-823

4. Seale C, Anderson E and Kinnersley P. Comparison of general
practitioner and nurse practitioner consultations: an observational study.
Br J Gen Pract 2005; 55: 938-43

Competing interests:
I am a nurse practitioner in general practice

Competing interests: No competing interests

19 December 2005
Ghislaine C Young
nurse practitioner
Sjpley BD183EE