Clinical Remit Research Articles

The acceptability of dually-qualified dental hygienist-therapists to general dental practitioners in South-East Scotland

Recent UK legislation allows dental therapists or jointly-qualified dental hygienist-therapists to work in the general dental service. This study aimed to investigate the extent of dentists' knowledge of the clinical remit of jointly qualified hygienist-therapists, their willingness to consider employing such a professional, and factors associated with these two measures. A postal questionnaire was sent to 616 NHS-registered dentists in South-East Scotland. Analysis and classification of responses to open-ended questions used standard non-parametric statistical tests and quantitative techniques. Following two mailings, a 50% (n = 310) response rate was obtained. A total of 65% of dentists worked in a practice employing a dental hygienist, while only 2% employed a dental therapist. Hygienists tended to work in larger practices. Dentists' knowledge of the clinical remit of the dually-qualified hygienist-therapist was found to be limited, reflecting a restricted and inaccurate view of the professional remit of a hygienist-therapist. The majority (64%) said they would consider employing a hygienist-therapist in their practice, rising to 72% amongst dentists already working with a hygienist. Reasons given by dentists who were negative about this prospect were sought. Those who worked with a hygienist tended to refer to lack of physical space, whilst those who did not tended to cite reservations on clinical skills, competence and responsibilities, or on the costs involved. This study identified considerable ignorance and negativity among dentists about the nature and clinical remit of this group of professionals. Dually-qualified hygienist-therapists will be in a position to treat much of the routine disease that exists within the population, and dentists may benefit from education in relation to the substantial contribution these individuals could potentially make to patient care.

The Acute Care Nurse Practitioner: challenging existing boundaries of emergency nurses in the United Kingdom

This study explored the opinions of nurses and doctors working in emergency departments towards the development of the Acute Care Nurse Practitioner service in the United Kingdom. Studies carried out in the United States and Canada suggest that the Acute Care Nurse Practitioner can have a positive impact on the critically ill or injured patients' experiences in the emergency department. This role is well developed in the United States and Canada, but is still in its infancy in the United Kingdom. A descriptive, exploratory design incorporating questionnaires (n = 98) and semi-structured interviews (n = 6) was employed. The sample included nurses and doctors from seven emergency departments and minor injury units. Respondents felt it was important for the Acute Care Nurse Practitioner to have obtained a specialist nurse practitioner qualification and that the Acute Care Nurse Practitioner should retain a clinical remit. While participants seemed comfortable with nurses undertaking traditional advanced skills such as suturing, reluctance was displayed with other advanced skills such as needle thoracocentesis. Three main themes were identified from the interviews: inter-professional conflict, autonomy and the need for the Acute Care Nurse Practitioner. Doctors were reluctant to allow nurses to practise certain additional advanced skills and difficulties appear to be centred on the autonomy and other associated inter-professional conflicts with the role of the Acute Care Nurse Practitioner. Nurses and doctors identified a need for the Acute Care Nurse Practitioner, but the blurring of boundaries between doctors and nurses can result in inter-professional conflict unless this is addressed prior to the introduction of such advanced practitioners. Relevance to clinical practice. As the role of the emergency nurse diversifies and expands, this study re-affirms the importance of inter-professional collaboration when seeking approval for role expansions in nursing.

Peripheral intravenous catheters: considerations in theory and practice

Inserting peripheral intravenous catheters is a clinical skill that is increasingly becoming part of nurses' remit because of a number of changes in the NHS, including a reduction in junior doctors' working hours and role development. To undertake this skill it is important that nurses receive the appropriate education and can provide evidence of training and competence. A hospital policy is essential to standardize practice and ensure an evidence base. However, all practitioners should be aware that it is their responsibility to maintain their practice and keep up to date. This article provides both the theoretical and practical knowledge to assist nurses who wish to include cannulation as part of their clinical remit.