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Nurses can lead on improving outcomes and patient experience

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Nursing Times recently reported on the findings of a Cochrane systematic review into the impact of nurses working as substitutes for primary care doctors.

It comes at a time when there is much interest in how advanced nursing roles can be deployed to address the widespread shortage of GPs.

The systematic review of evidence published on 16 July, titled Nurses as substitutes for doctors in primary care, looked at how nurses carried out tasks such as diagnosis, treatment, prescription and referral, and concluded that nurses delivering primary care obtain the same or better outcomes as doctors.

The authors wrote: “This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients.”

Two other points stand out: the review also found that nurses probably achieve higher levels of patient satisfaction compared to primary care doctors and that patients are probably slightly more likely to attend follow-up appointments with nurses than with doctors.

This was not just any old review, but one handled by the Cochrane network, a worldwide initiative that conducts the most rigorous reviews of evidence and is widely regarded as one of the most reliable sources of evidence across all areas of healthcare.

“Nursing has long grappled with difficult, negative or innacurate perceptions”

While the findings may not come at all as a surprise to some readers – particularly those working in primary care – they are welcome. Nursing has long grappled with difficult, negative or inaccurate perceptions, particularly in relation to other medical professionals, such as doctors.

And the review does not suggest that nurses should replace doctors in primary care. Instead, it simply highlights another way in which good-quality nursing care can be applied to practice.

Even if thousands more doctors were trained to meet increasing demand (which is unlikely to happen because of funding constraints), nurses with suitable training can, working alongside other medical colleagues, make enormous contributions to patient care and care quality. This is not about nurses undertaking a secondary role.

While there still may be negative mutterings from individual doctors (something along the lines of “Nurses couldn’t possibly do such a job”), or perfectly justified calls for more doctors, to be fair, the medical bodies have all recognised the enormous potential value of such developments.

”This would help improve outcomes and individual patient experiences”

They can see that, far from nurses in advanced roles amounting to healthcare ‘on the cheap’, this would improve outcomes and the individual patient experience.

Nursing of course still faces many of its own challenges, particularly relating to its workforce, as training and retention issues have consistently been in the news in recent times, but the review highlights just one of the many settings where nurses can have a positive impact on patient care.

The nursing role has undergone tremendous change since it first appeared and it continues to evolve. Nurses work in more settings and undertake more tasks than ever before.

Inevitably, the way healthcare is delivered will continue to change, and nurses can be leaders in such change.

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