Primary care nurses taking on tasks traditionally carried out by doctors has become “common” in many countries worldwide, new research has shown.
The majority of countries across the European Union, plus the US, Canada, Australia and New Zealand, have expanded nurses’ official practice in this care setting, according to leading nursing academics at the University of Pennsylvania.
“Task-shifting from physicians to nurses has become common in many countries worldwide, demonstrating its feasibility across differently organised health systems”
The study of 39 countries, including all EU states, looked at the extent to which nurses were authorised to work at this advanced level and also the policy changes supporting this change.
It found that just over two thirds of countries were shifting tasks – prescribing, providing diagnosis, treatment, ordering medical tests, making referrals, having responsibility for a panel of patients, and being the first point of contact – from doctors to primary care nurses who were educated to an advanced level.
In 28% of countries advanced nurses in primary care were authorised to perform all of these seven clinical activities, while in 41% of countries they were allowed to carry out at least two of the tasks.
Meanwhile, 31% of countries did not officially allow nurses to take on activities from doctors, according to the research, although this was sometimes happening informally.
Professor Linda Aiken
Source: Professor Linda Aiken
The study also noted that in the countries where nurses were able to carry out all seven clinical activities, regulatory barriers had been removed to expanding the scope of practice of advanced practice nurses.
Similarly, in those countries where nurses had taken on some extra tasks, regulations had been changed but often limited so that doctors still had oversight, particularly with prescribing.
However, the researchers, who included Professor Linda Aiken, highlighted regulatory reforms were often lengthy, controversial and opposed by doctors.
The third of countries without official authorisation for nurses to take on more tasks had mostly only introduced educational reforms to support advanced practice.
The research noted that while there was a trend of increasing advanced practice among nurses, there were still “stark differences” across countries about the extent to which this was happening.
It suggested this could be down to whether countries had a shortage of doctors, high supply of nurses, increasing healthcare needs or if they had introduced degree-level education for primary care nurses.
“Policy and educational reforms suggest that the boundaries between the medical and nursing professions may shift further in the future”
Developing standardised titles internationally for nurses working at an advanced level - to reflect both practice levels and educational requirements – would help improve recognition of these roles as nurses increasingly move between countries for work, it added.
“Task-shifting from physicians to nurses has become common in many countries worldwide, demonstrating its feasibility across differently organised and financed health systems,” concluded the research paper published in the European Journal of Public Health.
“Policy and educational reforms suggest that the boundaries between the medical and nursing professions may shift further in the future,” it said.
“As more countries are investing in a nurse practitioner or advanced practice nurse workforce, maximising its use requires regulatory and financing structures flexible enough to adjust as the workforce changes,” it added.
Howard Catton, director of nursing and health policy at the International Council of Nurses, said the expansion of nursing roles worldwide brought significant benefits such as increasing access to healthcare, continuity of care and efficiency.
“These roles will without a doubt be key to addressing future health demands as part of patient centred, integrated and cost effective new models of care,” he said.
“However the research also highlights significant variations in definitions of the roles, their education and regulation. Addressing these will be important steps to the further development of these roles and truly realising their potential and benefits for patients,” he added.