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Should nurses rather than doctors lead health systems of the future?

Should nurses, rather than doctors, be leading the health systems of the future?

The question is asked in this provocative article published by Lives, a partner publication of Scientific American that focuses on global health.

It has generated something of an international stir, not to mention a deal of vitriol.

Interestingly, not all of the authors were nurses, and they include Dr Richard Smith, former editor of the BMJ and a well known provocateur who is now Director of UnitedHealth Chronic Disease Initiative.

The article says:

Until now, healthcare systems have generally been dominated by hospitals and concerns with the “four Ds”—doctors, disease, drugs and death. Discussions on health have been led by what Nigel Crisp, once chief executive of Britain’s National Health Service (the world’s largest employer of health workers), has called “medico-academic-commercial-governmental” interests. These interests have combined to convince the rich world that it needs more doctors, hospitals, and technical treatments. This strategy worked well in the 19th century.

That was then. This is now. In the rich as well as the poor nations of the world, chronic, non-communicable disease is taking over from infectious disease, and health systems are failing to adapt. Health systems in poorer countries cannot afford to copy the systems that exist in rich countries, and it would be wise not to do so. Organizations like the world’s biggest non-governmental agency, BRAC in Bangladesh, for example, emphasizes the importance of community, family, lifestyles, culture, and behavioral and social factors in health, factors that are the foundation of nursing care. And Ethiopia is trying to build a system based on health, not disease.

The advancement of non-communicable diseases in developed and developing countries and the need for professionals who can implement health promotion and intervention strategies lead us to believe that there is a strong case for building health delivery systems led by nurses rather than doctors.

One reason for arguing this, the authors say, is the presence of nurses in underserved regions (that’s certainly the case in remote parts of Australia). The authors note that most people in low –and middle–income countries live in rural areas; the WHO reports that more than three quarters of doctors are concentrated in cities.

The article generated such a heated response that the authors posted a response saying they were “not arguing that doctors do not have a role in global health, rather that nurses are fully capable of playing a more prominent role and that these nursing resources should be more broadly used”.

The article – and the responses – are worth a read.

For those who might have been tempted to think of professional wars as a peculiarly Australian problem, clearly they are not.

Comments 5

  1. Puff, the Magic Dragon. says:

    Well that is one argument guaranteed to set the cat amongst the pigeons. There is great merit in the idea. It is the nurses who spend most time with the people, they go where doctors do not and they deliver the health programs which save countless lives and prevents or mediates disability from health conditions. They are no longer doctors’ ‘go-fors’.

  2. ron batagol says:

    All of that makes sense- greater use of nurses in primary care (provided they concentrate on triaging and don’t drift into medical differential diagnosis, for which only doctors are specifically trained!).

    Also, given that a 2009 NPS Literature Report(http://www.nps.org.au/__data/assets/pdf_file/0008/71675/09060902_Meds_safety_June_2009.pdf) showed that hospital admissions associated with ADEs (adverse drug events) ranged from 5.6% of admissions in the general population to 30.4% of admissions in the elderly, and paediatric ED attendances reported to be associated with ADEs 3.3% of the time, better utilisation of the skills and expertise of pharmacists, who are the acknowledged experts in optimum medication use, drug side effects, drug interactions etc., would help to lower the rate of expensive and life-threatening hospital admissions in the at-risk groups.

  3. Doctor Whom says:

    There is no argument that makes any one profession automatically better at “leading the health system” (whatever that means) than another.

    How about Epidemiologists, Population Health Practitioners, a Politician?

  4. Jenny Haines says:

    Truth is nurses already run the health system. They are there at work 24/7/365. Doctors can work around the clock too, but this is usually in their first years of practice, then as they move on into their professional lives they largely become day workers. But it is nurses who are the patient’s bedside for 8 to 12 hours per shift, day and night, in hospitals, and up to hours at a time when the patient is in the community. Doctors visit, but largely do not provide nursing care. So if you view the health system from the point of view of the 24 hour clock and presence at the patient’s side providing care, it is nurses who are always there.
    In terms of advanced practice, nurse practitioners have been highly successful in providing safe and competent patient care in hospitals, homes, and community services. They are well educated, clinically competent, aware of their boundaries, and willing to work collaboratively with other health professions including doctors and do so very successfully. As nurse practitioners numbers grow steadily in Australia, I am not aware of any cases questioning a nurse practitioners practice by any registering authority in this country.

  5. Professor Mary Chiarella says:

    I had the pleasure of putting together a compendium of nurse-led primary health care models for WHO about two years ago -it is available at http://www.who.int/hrh/nursing_midwifery/compendium_phc_studies.pdf
    What was pretty obvious about that study was that nurses and midwives were already leading a lot of PHC services in both developing and developed countries – they just weren’t getting the direct funding or the kudos and they seemed to have to spend a lot of time fundraising. But the message to me from those nurses and midwives was that, if we really want a sustainable health system into the future, the people who need to lead our health systems are the public themselves. They are the most important component of the health workforce and they already do most of the health work – as carers, parents or through their own self management.

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#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016