Task shifting between physicians and nurses in acute care hospitals

cross-sectional study in nine countries

Claudia B. Maier, Julia Köppen, Reinhard Busse, MUNROS team

Research output: Contribution to journalArticle

3 Citations (Scopus)
7 Downloads (Pure)

Abstract

Background Countries vary in the extent to which reforms have been implemented expanding nurses’ Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals’ perceptions of role change and of task shifting between the medical and nursing professions in nine European countries.Methods Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in ‘medical tasks’ was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN).Results Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession’s domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only.Conclusions Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.
Original languageEnglish
Article number24
Pages (from-to)1-12
Number of pages12
JournalHuman Resources for Health
Volume16
DOIs
Publication statusPublished - 25 May 2018

Fingerprint

cross-sectional study
Scotland
nurse
Cross-Sectional Studies
Myocardial Infarction
Nurses
physician
England
Netherlands
Breast Neoplasms
Physicians
profession
cancer
role change
Advanced Practice Nursing
staff
Professional Role
health professionals
Aftercare
reform

Keywords

  • Health professionals
  • Physicians
  • Nurses
  • Task shifting
  • Advanced practice nursing
  • Scope-of-practice
  • Hospitals
  • Clinical practice
  • Breast cancer
  • Acute myocardial infarction

Cite this

Task shifting between physicians and nurses in acute care hospitals : cross-sectional study in nine countries. / Maier, Claudia B.; Köppen, Julia; Busse, Reinhard; MUNROS team.

In: Human Resources for Health, Vol. 16, 24, 25.05.2018, p. 1-12.

Research output: Contribution to journalArticle

Maier, Claudia B. ; Köppen, Julia ; Busse, Reinhard ; MUNROS team. / Task shifting between physicians and nurses in acute care hospitals : cross-sectional study in nine countries. In: Human Resources for Health. 2018 ; Vol. 16. pp. 1-12.
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title = "Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries",
abstract = "Background Countries vary in the extent to which reforms have been implemented expanding nurses’ Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals’ perceptions of role change and of task shifting between the medical and nursing professions in nine European countries.Methods Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in ‘medical tasks’ was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN).Results Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0{\%} vs. 38.7{\%}, p < .001; AMI 61.7{\%} vs. 37.3{\%}, p < .001), and higher independence in new roles (BC 58.6{\%} vs. 24.0{\%}, p < .001; AMI 48.9{\%} vs. 29.2{\%}, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession’s domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only.Conclusions Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.",
keywords = "Health professionals, Physicians, Nurses, Task shifting, Advanced practice nursing, Scope-of-practice, Hospitals, Clinical practice, Breast cancer, Acute myocardial infarction",
author = "Maier, {Claudia B.} and Julia K{\"o}ppen and Reinhard Busse and Christine Bond and Robert Elliott and Hanne Bruhn and Debbie McLaggan and Daryll Archibald and {MUNROS team}",
note = "The MUNROS study ‘Health Care Reform: The iMpacton practice, oUtcomes and cost of New Roles for health profeSsionals (MUNROS)’, received funding from the European Union under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1), grant agreement number HEALTH-F3-2012-305467EC. The funder had no role in the design of the study, data collection, analysis or interpretation of the data, nor in the write up of the manuscript.",
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TY - JOUR

T1 - Task shifting between physicians and nurses in acute care hospitals

T2 - cross-sectional study in nine countries

AU - Maier, Claudia B.

AU - Köppen, Julia

AU - Busse, Reinhard

AU - Bond, Christine

AU - Elliott, Robert

AU - Bruhn, Hanne

AU - McLaggan, Debbie

AU - Archibald, Daryll

AU - MUNROS team

N1 - The MUNROS study ‘Health Care Reform: The iMpacton practice, oUtcomes and cost of New Roles for health profeSsionals (MUNROS)’, received funding from the European Union under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1), grant agreement number HEALTH-F3-2012-305467EC. The funder had no role in the design of the study, data collection, analysis or interpretation of the data, nor in the write up of the manuscript.

PY - 2018/5/25

Y1 - 2018/5/25

N2 - Background Countries vary in the extent to which reforms have been implemented expanding nurses’ Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals’ perceptions of role change and of task shifting between the medical and nursing professions in nine European countries.Methods Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in ‘medical tasks’ was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN).Results Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession’s domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only.Conclusions Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.

AB - Background Countries vary in the extent to which reforms have been implemented expanding nurses’ Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals’ perceptions of role change and of task shifting between the medical and nursing professions in nine European countries.Methods Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in ‘medical tasks’ was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN).Results Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession’s domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only.Conclusions Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.

KW - Health professionals

KW - Physicians

KW - Nurses

KW - Task shifting

KW - Advanced practice nursing

KW - Scope-of-practice

KW - Hospitals

KW - Clinical practice

KW - Breast cancer

KW - Acute myocardial infarction

U2 - 10.1186/s12960-018-0285-9

DO - 10.1186/s12960-018-0285-9

M3 - Article

VL - 16

SP - 1

EP - 12

JO - Human Resources for Health

JF - Human Resources for Health

SN - 1478-4491

M1 - 24

ER -