Nurses taking on junior doctors' work: a confusion of accountability

Abstract

The number of hospital based posts in which nurses take over clinical work previously done by junior doctors is growing. Accountability for the scope of such new roles and the standards of practice which apply to them are still unclear. When analysed together and compared, the regulations arising from the professional bodies (GMC and UKCC), civil law concerning certain wrongs to patients, and employment law are sometimes contradictory and hard to interpret. The resulting uncertainties about appropriate management for clinical roles evolving between the professions, coupled with an increasingly litigious public, put the nurses and consultants involved at risk ofcomplaints and ofdisciplinary and legal action. Drawing on our current research into changing clinical roles at the medical-nursing interface, we suggest strategies to reduce risk. Doctors and nurses should be equal partners in planning and managing these new posts, patients should be informed adequately about the nature of the postholder's role and training, significant changes in the work of such postholders should be formally acknowledged by the employer and relevant insurers, individuals taking up new roles should have access to legal advice and support to cover legal risk, and national regulatory bodies need to work together to harmonise their codes of practice in relation to changing clinical roles between the professions.

Nurses’ responses to expert patients: The rhetoric and reality of self-management in long-term conditions: A grounded theory study

“…In contrast, although many of the nurses highlighted the need to document the information giving, the majority expressed concerns that this would not be sufficient if the patient made an error in their self-management. Whilst it is acknowledged that there is an increasingly litigious public (Dowling et al, 1996), nurses appeared to believe that expert patients were likely to "twist things" and be "very quick to blame the nurse".…”

“…Whilst the development of multidisciplinary teams is linked to the rhetoric of nursing autonomy, the reality is all too often that they are medically dominated (Cott, 1997). Often nurses have little say in the planning and management of new posts (Dowling et al, 1996), with substitution for doctors the main driving force rather than innovation in care (Salvage, 2002) and many nurses feeling forced to accept identities that meet organizational goals but not their own (McDonald, 2004). In order to respond appropriately to expert patients, nurses need to work in an organizational environment where professionals and patients learn from each other and where ways of working are not decided by one group on behalf of another, but where activities are undertaken together (Kitson, 2002).…”

Delegation Dilemma: Accountability is Undermined by a Lack of Role Clarity

“…Thus, as there is no consensus between these regulated professions the uncertainty will remain. This confusion is further illustrated by research (Dowling et al 1996), which is further emphasised by conflicting decisions made in the courts (Tingle 1997). When all aspects are compared the regulations from the professional bodies are contradictory and in some respects difficult to apply to actual working practices.…”

“…The (Dowling et al 1996, Tingle 1997. These changes raise important legal and professional issues, which should be a source for consideration by managers of risk, for responsible governance and when a case of clinical negligence arises out of issues from these expanding and diversifying roles.…”

OECD Health Working Papers

“…Dowling et al (1996) suggest that delegating roles from doctors to nurses have raised issues of accountability for both nurses and doctors, although there is no evidence to indicate that nurses will make more mistakes than doctors undertaking the same work. These accountability issues may be limited by inclusive planning for these roles with each professional group aware of the different demands placed on each profession with regard to professional regulation, accountability and scope of practice (Dowling et al 1996).…”