Unwanted medicine: the delegation of doctors' roles.

Abstract

With reference to delegation of med­ ical procedures to non-medically qualified health-care staff, the Joint Consultants Committee (JCC) of the BMA has issued a policy statement raising a number of issues that should be of great con­ cern to the nursing profession (JCC, 1996). The JCC aimed to outline protocol regarding delegation of medical practice such that patient safety is maintained. In so doing, the JCC revealed, if somewhat implicitly, patriarchal attitudes tow ards nurses and other health-care staff by making no differentiation between them. It was stated that there are a number of rea­ sons for the growth in the delegation of clini­ cal duties to non-meditally qualified staff, including the desire of many health-care pro­ fessionals to extend their involvement in all aspects of patient care. The JCC claims that this is advantageous, and will bring about improvement in some forms of clinical care by enlarging the workforce able to perform that care, and reducing junior doctors’ hours. The reduction of junior doctors’ hours is a non-nursing issue and is therefore irrelevant. The training of more people to undertake a given clinical procedure does not guarantee that the procedure is performed better or more safely. Even if nurses welcome the delegation of medical procedures, the concept of delega­ tion of doctors’ work to nurses is dubious. To delegate, by definition, is to give or com­ mit duties to another as agent or representa­ tive. Therefore, to delegate medical care to nurses means that nurses are acting as the agent or representative of the doctor in such circumstances where the doctor is unable or unwilling to be his/her own agent or repre­ sentative. Given that the BMA sees this as advantageous, there can be no clearer state­ ment that the BMA persists in seeing nurses and other health-care staff as merely an adjunct to the central role of the doctor. Clearly, patient care may improve when nurses undertake procedures that were once the sole domain of doctors. But it is impera­ tive that nurses do not undertake these pro­ cedures from a position of merely being trained by the doctor to do them. The JCC states that delegation is acceptable if it is practical for the doctor to offer suitable training, if the risk to patient safety is not too high, if the standard of patient care is not reduced, when the required degree of supervi­ sion is not too great and when delegation does not seriously interfere with the training of junior doctors. These parameters are unscien­ tific and do nothing for the advancement of the professional status of nurses’ practice. All nursing practice must be generated by nursing-based scientific research. If nurses are to abandon a medically centred model, then to accept medical delegation runs con­ tradictory to that aim. It is imperative that nurses tackle this issue, examining why they feel so eager to adopt the detritus of medical practice as their own without recourse to the scientific research that would make it good nursing and not unwanted medicine. ESB