The reduction in junior doctors' hours in the wake of the New Deal and the expansion of nurses' roles have led to a re-drawing of the boundaries between the clinical work of doctors and the role of acute sector nurses.1,2,3
The Greenhalgh report identified core tasks, which took a high percentage of doctors' time, particularly at night.4
The report considered the potential for shared responsibility among nurse and medical staff, and said there was no evidence to suggest that quality was compromised when nurses undertook these core skills.
In response to the New Deal and the Greenhalgh report, the UK Central Council for Nursing, Midwifery and Health Visiting is evolving new nursing roles, with nurses taking over parts of junior doctors' clinical work.
The new roles and the shift in responsibility for certain administrative and clerical tasks from doctors to nurses have proved successful. But research is limited.5
At University Hospital, Aintree, monitoring calls to junior medical staff between 9pm and 7am showed the main reason for contacting a doctor at night was to re-site intravenous cannulae (venflons). The role of the night nurse clinicians evolved as a result of these findings.
Three night nurse clinicians were appointed in 1997 in order to provide a nightly service covering all areas of the hospital, with the exclusion of maternity, accident and emergency, mental health and the high-tech areas of intensive care, high dependency and coronary care.
These areas were not accessed by the night nurse clinicians, due to the relatively high nature of medical cover. A call-screening process was established so that all calls, with the exception of emergencies, were made to the night nurse clinicians. Only those calls that required intervention were passed on by the night nurse clinicians. An evaluation was carried out to determine what junior doctors and night nursing staff thought about the introduction of the night nurse clinicians.
During one selected week, a confidential questionnaire was given to all the junior doctors and qualified night nursing staff who worked within the areas for which the night nurse clinicians were responsible.
Bank, agency and locum staff were excluded from the study.
The calls that were made to the night nurse clinicians from the nursing staff were also monitored in order to gain an insight into the activity of the clinicians.
Of the 112 questionnaires distributed, 64 were returned - a response rate of 57 per cent.
The result showed that all but three nurses felt the introduction of the night nurse clinicians was beneficial. The nursing staff listed the benefits of having the night nurse clinicians in post, putting the faster response and the assistance with cannulae insertion at the top (see table 2).
Advice for nursing staff ranked third in the perceived benefits of having the night nurse clinicians. This was supported by additional comments made by nurses who said it increased their confidence knowing that someone was available to contact. As one nurse said: 'At times, it can take some stress out of your work.'
Junior doctors said the main benefit of having the night nurse clinicians in post was that it gave them more time for patient review (see table 1).
One doctor stated: 'Night nurse clinicians allow us to get more sleep and we are fresher to see the very ill patients.' During the first six months of the scheme, all calls to the night nurse clinicians were monitored.
A total of 5,543 calls were made of which 2,175 (39 per cent) were referred to doctors. Of the total calls 1,674 (30 per cent) related to cannulae (venflons) and venepuncture.
Night nurse clinicians are clearly seen as extremely useful. They reduce junior doctors' hours, allowing more rest - one of the targets set by the New Deal. Nurses welcome the advice and support that the night nurse clinician provides.
Future plans include expanding the educational component of the night nurse clinician role, which will benefit nursing staff on permanent night duty.
Table 1. The benefits of night nurse clinicians: junior doctors' views
Increased time for patient review.
Prioritising for very sick patients.
Table 2. The benefits of night nurse clinicians: nurses' views
Assisting with cannulae (venflons).
Advice for nursing staff.