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

Abstract

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 nonmedical roles. This allows services to be established successfully, by understanding and addressing the key predicable barriers to implementation and change.

Development and regulation of advanced nurse practitioners in the UK and internationally

“…In this paper the umbrella term ANP is utilised to describe advanced nursing roles (Royal College of Nursing, 2012). Despite many recommendations for standardisation of role and educational preparation, there remains confusion and wide variation in using the ANP title (Pearson and Peels, 2002b, Marsden et al, 2003, Furlong and Smith, 2005, Hoskins, 2012; however a summary of key features of the ANP role is given below.…”

Interprofessional collaboration during an emergency ward’s rounds

“…Extracts 7-10), which was also noted by Krogstad and colleagues (2004). Boundaries between medicine and nursing -and the need to further break these boundaries down -were also remarked by Hoskins (2012). To physicians in this study, fluent collaboration mostly denoted obtaining medical information efficiently, which conflicted with nurses' idea of fluent collaboration (interactionally equal collaboration where both medical and non-medical information is exchanged).…”

“…A demand for even better collaboration among professionals has thus arisen (Hoskins, 2012), as it has been seen to improve the quality of health care (MacNaughton et al, 2013), in particular, patient safety (Baker et al, 2006) and patient-based, holistic care (McCallin, 2001;D'Amour et al, 2005;Baker et al, 2006). Characteristic of interprofessional collaboration is that work, its practices and the object of work are examined as a whole, combining expertise from different professional fields in a work community and work group (Housley, 2003).…”

Developing the Higher Education Curriculum

“…Co-facilitating IPE sessions is not the same as facilitating on your own, nor facilitating single discipline or other small group teaching. In the healthcare literature, it is well established that rivalries exist between the professions (Hoskins 2012;Ledger, Edwards and Morley 2013) and healthcare professionals maintain stereotypes that they may not necessarily be aware of (Joynes 2014). These rivalries and stereotypes are likely to influence the degree to which connections can be built between students and pose new challenges for facilitators who are experienced in teaching students within their own single profession.…”