A gold-standard review of patient care in the NHS and 19 other countries has shown that, for some traditional doctor jobs, nurses were just as good – if not better
Nurses can safely do many jobs traditionally done by doctors, new research suggests.
A gold-standard review has shown that in many aspects of care there was “little to no difference” whether a patient was looked after by a nurse or a doctor. A group of researchers from Ireland, the UK and Australia examined data from 82 studies involving more than 28,000 patients across 20 countries. More than a third of the studies were conducted in the UK.
The four services examined were: inpatient hospital care with mostly nurses looking after “post-acute” patients or those in recovery; nurse-led clinics where nurses took over clinics usually provided by a doctor; so-called “role substitution” including nurses in emergency departments providing care for patients with minor injuries; and jobs such as endoscopy, medical abortion or pre-operative assessment.
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Substituting nurses for doctors results in little to no difference in deaths or patient safety events. In some cases, including diabetes and eczema management, nurse-led care resulted in a slight improvement in some clinical outcomes.
Professor Michelle Butler, from Dublin City University, said: “We are very much aware of the challenges that hospitals face with increasing demand and a shortage of all types of staff, including doctors so this often results in long wait times or patients may not get the care that they need.
“We knew that there were some initiatives where nurses took on some of the care that doctors took on, and we wanted to see what the impact might be on patient outcomes and and care outcomes. What we found was that for death rates and safety events, there was little to no difference.
“And we found that for a small number of clinical outcomes, there were some improvements. All in all, these interventions are as safe and effective as the traditional form of care which is doctor-led.”
It comes after the Government announced a review of all band 5 nurses in England following talks with the Royal College of Nursing. The nursing union successfully argued that many of its members were doing work above their pay grade and not being properly valued. The move announced on Wednesday could see tens of thousands of NHS nurses get a promotion.
Prof Butler said that they were not proposing that “nurses replace doctors”, adding: “What we’re talking about is nurses taking on some of the care that doctors would have provided in the past, with a view to increasing access and maybe patients having to wait less for their care.”
Lynn Woolsey, chief nursing officer at the Royal College of Nursing, said: “At the heart of this study is evidence of the highly skilled nursing profession that leads patient care and is central to all health and care services. When there are the right number of staff to meet patient needs, outcomes for people improve.
“Nursing staff, however, must never be seen as a substitute for any other profession. They are the ones delivering the vast majority of care in every health and care setting and must be better recognised and valued. The biggest challenge remains that the tens of thousands of vacant nursing posts leave patients waiting longer for care, and a depleted and undervalued workforce exhausted.”
