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Expert nurses as good as doctors – new research

Expert nurses as good as doctors – new research

Nurse practitioners are just as good as registrars in making patient diagnoses – even very complex ones – and planning the correct care, says a new Doctor of Philosophy from Massey University.

Alison Pirret, from the School of Nursing on Massey’s Albany Campus, compared the diagnostic reasoning of nurse practitioners to that of trainee medical specialists for her PhD research and found no differences.

The role of the nurse practitioner – expert nurses with advanced knowledge and skills – has been controversial because they provide a diagnostic role historically delivered by doctors, and particularly since the regulations of 2005 authorised them to prescribe drugs for patients.

They were set up to increase access to healthcare for patients and provide a solution for workforce shortages, including doctor positions.

There was a reluctance by some employers to employ them and there was also debate about whether they had the cognitive abilities required for the job, says Dr Pirret who is also a nurse practitioner.

“That was related to doctors needing to have the cognitive abilities for complex cases, because when these patients present for the first time their symptoms are not immediately clear which requires more examination, a lot of thinking and knowledge to work out the diagnosis.”

Although there is international research showing nurse practitioners manage chronic conditions and minor illness and injuries just as well as doctors, there is no research on their management of complex cases presenting for the first time.

Neither was there any New Zealand research, so Dr Pirret decided to find out the situation in this country.

“The risk was we could have come out poorly and I felt a huge responsibility doing this study.”

Dr Pirret used a complex case scenario based on a real person with multiple co-morbidities who had the potential for multiple diagnoses. She also used an instrument to identify diagnostic reasoning style and a questionnaire to find out what maxims are used when determining diagnoses and planning care.

She looked at a sample of 30 nurse practitioners and 16 registrars, finding no difference between their diagnostic reasoning abilities, their diagnostic style or the maxims they employed to guide their diagnostic reasoning.

A difference she did find was that although nurse practitioners practiced independently and autonomously they had built relationships with medical specialists and were far more likely to consult than the registrars.

“Nurse practitioners have often been criticised for being independent and autonomous, however, they can manage these more complex patients presenting for the first time and when these patients exceed their abilities to manage independently they readily collaborate with their medical colleagues and have developed those relationships to do so.”

Dr Pirret believes many doctors have felt threatened by nurse practitioners as they can get Ministry of Health funding for seeing patients that have previously been given to doctors.

But they give patients more choice and from a clinical perspective “what we can do for patients is exactly the same. According to international research we spend more time than doctors educating patients and their families about their condition and how to manage it.”


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