Inaugural lecture: doing away with doctors? Workforce research and the future of nursing

Abstract

This paper based on Professor Griffiths inaugural lecture discusses nursing workforce research, focussing on skill mix and substitution, and considers how optimistic readings of research may ultimately be self-defeating for the professions, as well as dangerous for patients. Two core examples are used to illustrate these ‘optimistic’ readings. Research on nursing-led inpatient units – initially heralded as ‘proof’ of the independent therapeutic contribution of nursing – ultimately led to a less optimistic conclusion for the profession when early results were not confirmed. Research exploring associations of the link between nurse staffing and patient outcomes has been used to advance policies such as mandatory nurse to patient ratios even though stronger associations are shown between patient outcomes and the working environment. The implications of research showing associations between number of medical staff and patient outcomes have not been considered. Future developments in the nursing workforce are underpinned by assumptions about the potential cost effectiveness of substituting assistant practitioners with lower qualifications for registered nurses. Little evidence supports this and it is important that changes are regarded as experiments in need of careful evaluation. The evidence on the impact of workforce characteristics on outcomes presents a complex picture. The ‘easy’ answer is usually not the ‘right’ answer. While it may be that nurses are more threatened as a professional group than doctors, both professions need to adapt to future demands. It is clear that we simply don’t yet know what the best or right skill mix is. Nurses (and midwives) can substitute for doctors under some circumstances but “cheaper” staff does not necessarily equal cheaper care. We don’t know if assistant practitioners can safely substitute for nurses or whether such substitution is cost effective. The answer is likely to depend on exactly what substitution occurs and where.

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ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

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