Abstract
Aim: Patients often have long waiting time in the Emergency Departments to be seen, which in itself is considered a risk of less successful outcome. The aim of this study was to get the perception of how nurses in Norwegian Emergencies believe task shifts between physicians and nurses can influence the patients waiting time, and if the nurses are willing to take on more responsibilities. The study also aim to investigate how nurses in England, and who are practising task shifts, believe this has influenced the waiting time, and if they have managed to achieve their goal of improved access to care, higher treatment quality and lower costs. Background: A long waiting time in the Emergency Departments are associated with a risk of patients leaving without being examined as well as increased mortality. It s estimated that 85% of all visits to the Emergencies are made for non-life-threatening illnesses, and many of these patients are more in need of care than medical treatment. Estimates show that 30% of all patients coming to an Emergency Department could have been handled by a specially trained nurse to free time for the physicians to work with the more complex cases in need of immediate treatment. Available literature show there is a huge body of evidence saying nurses can deliver the same quality of treatment as physicians for a range of services if they are provided proper training and exposure, and that transferring tasks from the physicians to the nurses have resulted in decreased waiting times in many countries. Based on that task shifts can be seen as one way of solving the problem with long waiting times in the Emergencies. Nurses in England already have extended responsibilities, and tasks like requesting x-rays, ultrasound, stitching, cleaning wounds, relocation of limbs and plastering are some of the tasks they have taken over from the physicians. Their specially trained nurses see, examine, treat and discharge patients, and feedback from patient surveys show that patients are equally happy by being treated by a nurse instead of a doctor as long as they are experienced. Theoretical framework: Task shifts are transferring tasks from one profession to another to maximise the use of limited resources. Task shifts between physicians and nurses have been used in England and other English-speaking countries for more than 50 years to solve some of the challenges in their health care systems like long waiting times. For patients with minor diseases or injuries it s been proven both safe and effective. Despite of this, there is still a lot of resistance against task shifts in the health care sector both from physicians, nurses, other health care workers and patients. Methods: This study was conducted in 3 hospitals where 10 experienced nurses in Norway and 12 experienced nurses in England participated by answering 8 questions. Since the focus of the study was to collect information about what nurses knew, thought, felt and have experienced about task shifts a qualitative method with one-to-one interviews were chosen so the researcher could collect necessary information by talking directly to the sources. The study took place over a period of four months, and a post positive approach was used. Results: The results showed that all the participants in Norway perceived that a task shifts from the physicians to them would lead to reduced waiting time for low-triage patients, while almost all the English participants told they have experienced decreased waiting time after they took over some of the tasks that were earlier performed by physicians. All the nurses in Norway and the majority of the nurses in England were willing to take on new responsibilities as long as it would benefit their patients and they received proper training. It was suggested new tasks should be carefully introduced to avoid conflict with their role as nurses. The participants from Norway explained their waiting time for low-triage patients as caused by waiting for examinations or tests performed or requested by busy physicians. By taking over some of the physicians tasks they believed the waiting time would decrease as more examinations and tests would be ready by the time the physicians came to see their patient. The nurses from England told they have taken over more and more of the physicians tasks, and some felt they now have become more like mini-doctors than nurses, and expressed concerns of losing their role as a nurse. Even if the nurses in England could tell of decreased waiting times as a result of tasks shifts, they also told that task shifts alone is not enough to solve the problem of long waiting times. They said the hospitals have to address the challenge of crowding to avoid the waiting time to start increasing again. Conclusion: Based on the findings and the literature it would be recommended to start a project to look at tasks that can be transferred between the physicians and the nurses to reduce the waiting time for patients with minor diseases or injuries. It s recommended to start discussing a transmission of the best documented task shifts from abroad like requesting xrays, requesting ultrasound and to implement treatment lines for low-triage patients. It s also recommended that both professions participate in this work to make sure the quality will be equally good for the patients seen by nurses, and to reduce the chance of medical resistance that have caused a lot of problems for the transmission process in other countries.