Do Doctors do it BEST?

Nursing Medicine

Academic

Procedural Skills

Corporate

Emotional

Academic

Procedural Skills

Emotional

Corporate

#1

Only doctors can lead resuscitation

2013

ICU Nurses Emergency Nurses

Medical Staff Medical Emergency Responders

92% 97%

2% 5%

Source Purporse Setting Design Findings

Gilligan et al. (2005)

Do nurses with ALS training provide good team leadership in cardiac arrests?

Five UK EDs Prospective quasi-experimental 57 participants in simulated scenarios

Nurse’s time to defibrillate were equal to those doctors with ALS training.Recommendation that experienced nurses assume the ALS leader role where a senior doctor is not available.

Lin et al. (2009)

Is a senior nurse more skillful at resuscitation?

1200 bed metropolitan medical centre, Taiwan

Cross-sectional observational study 55 head nurses

Age, work experience related to skills in assisting with CPR.

Kirk (2006) Review of the RapidResponse Team

10 acute care hospitalsU.S.

Literature review

13 papers

Nursing leadership ensures clear definition of roles and responsibilities.

Makinen et al. (2007)

Assess resuscitation skills to facilitate an educational program.

2 University Hospitals Sweden and Finland

Observational,convenience sample of 150 nurses

Nurses trained in resuscitation leadership had superior non-technical skills.

Clements & Curtis(2012)

Assess the impact of nursing roles in trauma and in hospital resuscitation

Australia Literature review

18 papers

Nurses involved in trauma and other resuscitations contribute to effective communication, leadership and teamwork, which ultimately impact patient outcomes.

#1

#2

Only doctors can prescribe ventilation weaning

Authors Method Purpose Setting Findings

Garrubba et al, 2009

Literature Review

MDT vs standard care for tracheostomy weaning

3 papersUK, Australia

Reductions in time to decannulation, length of stay and adverse events.

Blackwood et al, 2012

Literature Review

Effects of protocol ventilation weaning

11 trials (1971 pts) America, Europe, Australia

Reduced ventilation time, weaning time and ICU LOS

Ely, 1996 RCT Nurse led protocol vs physician judgment

300 Reduced ICU LOC

Kollef, 1997 RCT Nurse led protocol vs physician judgment

357 Safe, reduced ventilation time

Krishnan, 2004

Quasi-RCT Nurse let protocol vs physician judgment

299 No difference

Marelich, 2000

RCT Nurse led protocol vs physician judgment and standardised approach

335 Reduced duration of mechanical ventilation, reduced VAP

#2

O #3

Only doctors can insert central lines

Source Purporse Setting Design Findings

Alexandrou et al (2009)

Literature Review UK Integrative Literature Review

10 studies

No difference in rates of adverse event between a specialist nurse and a medical officer.

Yacopetti et al (2010)

Compare outcomes of insertions performed by a CNC or anaesthetic doctor

368 CVC insertions

Prospective audit No difference in rates of insertion complications. CRBSI rate was higher in the doctor group

Alexandrou et al (2011)

Patients outcomes or catheter placement services

760 CVC insertions

Descriptive statistical for comparison rates and proportions

Nurses who are formally trained and credentialed to insert CVCs can improve organizational efficiencies.

Alexandrou et al (2014)

To report characteristics and outcomes from an advanced practice nurse led CVC service

4 560 CVC insertions

Single centre observational study

Low complication rates

#3

Looking Forward

Do Doctors Do It Best?Teach

Empower

Ask

Mentor

Outline• Churchman JJ, Doherty C (2010) Nurses’ views on challenging doctors’ practice in an acute hospital. Nursing Standard.

24, 40, 42-47. Date of acceptance: March 5 2010.• Clements, A., & Curtis, K. (2012). What is the impact of nursing roles in hospital patient resuscitation? Australasian

Emergency Nursing Journal. • Eastwick-Field, P. (1996). Introducing nurse-initiated management of cardiac arrest. Nursing standard (Royal College of

Nursing (Great Britain): 1987), 10(26), 46. • Foot, C., Host, D., Campher, D., Tomczak, L., Ziegenfuss, M., Cohen, J., & Nunnink, L. (2008). Moulage in high-fidelity

simulation-A chest wall burn escharotomy model for visual realism and as an educational tool. Simulation in Healthcare, 3(3), 1-5.

• Gill, F. J., Leslie, G. D., Grech, C., & Latour, J. M. (2012). A review of critical care nursing staffing, education and practice standards. Australian critical care.

• Gilligan, P., Bhatarcharjee, C., Knight, G., Smith, M., Hegarty, D., Shenton, A., . . . Bradley, P. (2005). To lead or not to lead? Prospective controlled study of emergency nurses’ provision of advanced life support team leadership. Emergency Medicine Journal, 22(9), 628-632.

• Numata, Y., Schulzer, M., Van Der Wal, R., Globerman, J., Semeniuk, P., Balka, E., & FitzGerald, J. M. (2006). Nurse staffing levels and hospital mortality in critical care settings: literature review and meta analysis. ‐ Journal of advanced nursing, 55(4), 435-448.

• RPN, R., & Alberto, L. (2006). Consensus Forum: worldwide guidelines on the critical care nursing workforce and education standards. Crit Care Clin, 22, 393-406.

• Stein L (1967) The doctor-nurse game. Archives of General Psychiatry. 16, 6, 699-703.

References