Doctor or nurse? Blurring the lines of medical treatment
Friday, April 18, 2014
Academic Medicine, the journal of the American Association of Medical Colleges, recently called for articles addressing these questions: What is a doctor? What is a nurse? Thirty years ago this would have been an absurd issue not only for doctors and nurses, but for patients as well.
Roles were clearly delineated within the disciplines. The white coat indicated a doctor, and the white uniform and cap identified the nurse. These two questions alone could minimize the role of the doctor in today's society.
But the big reason for the question raised by Academic Medicine is that there has been an influx of women into the field of medicine. The unspoken question here is whether nurses and doctors still have delineated roles, or are the roles, along with the skills, beginning to equalize? It could be argued that the only thing truly separating doctors from nurses is ultimate responsibility.
To prove a point, a clinical trial was published in March determining if nurses in the emergency department could reduce pulled elbows — a common injury in young children under age 5 — at a rate similar to that of physicians. Andrew Dixon, M.D., and colleagues performed an open, cluster-randomized controlled trial to determine whether triage nurses in the ED could fix the condition, often referred to as nursemaid's elbow.
The trial involved 268 children at the Children's Hospital of Eastern Ontario in Ottawa, Canada. The children were assigned to either a physician or a nurse trained in treating the condition. Of the children assigned to receive physician-initiated care, 96.7 percent had a successful reduction. Those who were assigned to receive nurse-treatment care had an 84.7 percent successful reduction, 12 percent below the physician rate.
In most cases, nurses accurately identified and reduced radial-head subluxation, and children in the nurse-treatment group had a shortened length of stay compared to children in the physician-treatment group, spending an average of 55 minutes less in the ED.
So, what does this all mean?
As far as this study goes, it is unclear why the nurses were not as successful as physicians at reducing radial head subluxation, but it might be related to lack of experience with the procedure. Although the nurses did not meet the target for reducing the injury, their success rate was still high, and there could be benefits for using trained nurses to help reduce the injury.
According the authors, task-shifting in healthcare involves trade-offs.
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