Do nurses do it better?
- Regional Respiratory Centre, Belfast City Hospital, Belfast BT9 7AB, UK
- Correspondence to:
Dr J S Elborn, Regional Respiratory Centre, Level 11, Belfast City Hospital, Belfast BT9 7AB, UK;
stuart.elborn{at}bch.n-i.nhs.uk
Can nurse led clinics produce outcomes in respiratory care that are as effective as those produced by respiratory physicians?
The role of respiratory nurse specialists (RNS) in secondary care has increased dramatically during the past 10 years as a result of an increase in the skills and expertise of nurses and pressures to improve access of patients to appropriate care services.
The remit of the RNS is clinical and consultative—encompassing education, support, organisation of care, and the application of research.1 However, it is difficult to identify which patient outcomes are directly attributable to the actions of nurses. A recent systematic review in primary care concluded that nurse practitioners can provide high quality care for patients which is of similar quality to—or better than—that provided by general practitioners.2 In secondary care, however, it is less certain whether outpatient services can be provided by nurses. Studies in rheumatology and Parkinson’s disease clinics show an equivalence between specialist nurse or nurse practitioner and specialist physician care.3,4 These studies, however, had methodological deficiencies such as small sample sizes, or there were referrals across the control and intervention groups to the nurse or physician.
In this issue of Thorax a randomised crossover trial by Sharples et al is published which explores the impact of a clinic for patients with stable bronchiectasis led by a nurse practitioner.5 The aims of the study were to determine whether a clinic led by a nurse practitioner can provide care that is as cost effective and safe as care provided by a respiratory physician. Eighty patients with stable bronchiectasis were randomised …
