Nursing challenges: are changes in nursing role and skill mix improving patient care?
Posted on 28 July 2005
This is one of the conclusions of the latest paper in the University of York's Health Policy Matters series published in conjunction with the Dr Foster Ethics Committee. The paper highlights the need for further research.
- The "modernisation" of the NHS has led to major changes in the roles of nurses. Nurse roles in primary care have expanded with the development of nurse prescribing. Further changes in secondary care settings have been suggested, such as developing roles in anaesthetics, endoscopy and surgery.
- With the exception of midwifery, where there is a more robust evidence base supporting the shifting of tasks from doctors, the quality of research is poor. A recent Cochrane review of available studies in primary care concluded that whilst patient outcomes were similar for doctors and nurses, there were no cost savings.
- The majority of the evidence on the impact of change in nursing workforce levels on patient outcomes such as post operative complications and mortality is North American. The evidence indicates that lower levels of numbers and skills of nurse staffing are associated with higher levels of complications and failure to rescue rates. There is weaker evidence of a relationship between nurse staffing levels and patient mortality. These relationships do not appear to be linear, with diminishing returns setting in as staffing levels rise. The identification of the optimal or best staffing levels to cost effectively reduce adverse events is unclear and further research is urgently needed.
The authors argue, "In the context of the evidence base, the considerable changes in skill mix and nursing roles are a large social experiment with significant risks for the patient and the taxpayer and poor evaluation of its costs and benefits."
Notes to editors:
- Dr Annette Lankshear is a Senior Research Fellow in the Department of Health Sciences (DoHS), Professor Trevor Sheldon is Pro-Vice Chancellor at the University of York, Alan Maynard is Professor of Health Economics in DoHS at York, and Karen Smith is an Information Specialist DoHS. The full paper can be accessed electronically at www.york.ac.uk/healthsciences/pubs/hpmindex.htm
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