Dowling S, Martin R, Skidmore P, Doyal L, Cameron A, Lloyd S
Department of Social Medicine, University of Bristol.
BMJ. 1996 May 11;312(7040):1211-4. doi: 10.1136/bmj.312.7040.1211.
The number of hospital based posts in which nurses take over clinical work previously done by junior doctors is growing. Accountability for the scope of such new roles and the standards of practice which apply to them are still unclear. When analysed together and compared, the regulations arising from the professional bodies (GMC and UKCC), civil law concerning certain wrongs to patients, and employment law are sometimes contradictory and hard to interpret. The resulting uncertainties about appropriate management for clinical roles evolving between the professions, coupled with an increasingly litigious public, put the nurses and consultants involved at risk of complaints and of disciplinary and legal action. Drawing on our current research into changing clinical roles at the medical-nursing interface, we suggest strategies to reduce risk. Doctors and nurses should be equal partners in planning and managing these new posts, patients should be informed adequately about the nature of the postholder's role and training, significant changes in the work of such postholders should be formally acknowledged by the employer and relevant insurers, individuals taking up new roles should have access to legal advice and support to cover legal risk, and national regulatory bodies need to work together to harmonise their codes of practice in relation to changing clinical roles between the professions.
由护士接管此前由初级医生承担的临床工作的医院岗位数量正在增加。对于此类新角色的职责范围以及适用于这些职责的执业标准，目前仍不明确。综合分析并比较专业机构（英国医学总会和英国中央护理、助产及家庭护理委员会）制定的规章、涉及对患者的某些侵权行为的民法以及劳动法时，它们有时相互矛盾且难以解读。由于专业间临床角色不断演变，在合适的管理方面产生了不确定性，再加上公众诉讼意识日益增强，这使得相关护士和会诊医生面临被投诉以及受到纪律处分和法律诉讼的风险。基于我们目前对医护交接中临床角色变化的研究，我们提出降低风险的策略。医生和护士应成为规划和管理这些新岗位的平等伙伴，应充分告知患者岗位人员职责及培训的性质，此类岗位人员工作的重大变化应由雇主和相关保险公司正式认可，担任新角色的人员应能获得法律咨询和支持以应对法律风险，而且国家监管机构需要共同努力，协调各自关于专业间临床角色变化的执业规范。
