Interprofessional working or role substitution? A discussion of the emerging roles in emergency care.

AIMS: This article presents a discussion of emerging non-medical roles in emergency care against the current policy context and the issues of role substitution and interprofessional working. BACKGROUND: Non-medical roles in emergency care have grown internationally in response to an increasing demand for emergency care services and to address the growing importance of the quality healthcare agenda. The blurring of role boundaries between professional groups has become more common. Data sources. Searches were made of three electronic databases; CINAHL, Medline and EMBASE. The literature relating to interprofessional healthcare roles, and new roles in emergency care was searched from 1980 to 2010 and underpinned the discussion. DISCUSSION: A theoretical framework that has emerged from the literature is that task, role substitution and interprofessional working lie on a spectrum and evolving non-medical roles can be plotted on the spectrum, usually starting at one end of the spectrum under task substitution and then potentially moving in time towards true interprofessional working. CONCLUSIONS: There is still a great deal of progress to be made until non-medical roles in emergency care can truly be encompassed under the umbrella of interprofessional working and that a more robust critical mass of evidence is required to substantiate the theory that interprofessional working within teams contributes to effective, cost-effective care and better patient outcomes. RELEVANCE TO CLINICAL PRACTICE: It is essential to understand the underlying motivation, policy context and key drivers for the development of new nursing and non-medical roles. This allows services to be established successfully, by understanding and addressing the key predicable barriers to implementation and change.

Should aspiring consultant nurses follow a medical training programme?

AIM: To investigate the level of educational preparation current consultant nurses felt was required to prepare aspiring consultant nurses for the role. BACKGROUND: The radical introduction of the consultant nurse role was thought to be groundbreaking. This new role was to provide better outcomes for patients by improving the service and quality of care delivered to patients. With such great expectations of these professionals there was little guidance available as to the appropriate preparation for such a new and innovative role. METHOD: A national survey was undertaken of the Department of Health Consultant Nurse Emergency Care group (n=18). RESULTS: Key themes emerged around the development of a medical model of educational preparation for this role, as well as the development of a national programme of preparation. The majority favoured the current medical model and certainly supported the concepts of interprofessional programmes of study in universities. CONCLUSIONS: Further work is required in developing a nationally recognised programme of preparation for the role.

A study exploring drug use and management of patients presenting to an inner city emergency department.

Patients who present to an emergency department (ED) with a problem related to illegal drug use can be difficult to identify and are perceived to generate a significant workload for staff. This study suggests that illicit drug use may be more common than previously reported and also that the impact on the ED is perceived by staff to be disproportionately high compared with the actual numbers of patients presenting with complaints related to illicit drug use. We conclude that the over estimation by staff is directly related to the challenges that staff working within the ED setting believe this group of patients pose.