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Logo of bmjThis ArticleThe BMJ
BMJ. 2005 May 7; 330(7499): 1084.
PMCID: PMC557269

Nurse led care

Nurses are autonomous professionals delivering expert care
Jonathan R Benger, consultant in emergency medicine
Emergency Department, United Bristol Healthcare Trust, Bristol BS2 8HW
Rebecca Hoskins, nurse consultant

Editor—It is true that non-medical healthcare professionals, mainly nurses, have recently taken on a variety of roles that are traditionally viewed as the province of doctors. Clinical evaluations have generally been positive, indicating that the skills of the healthcare team are being more effectively used and that similar patient outcomes can be achieved by different approaches.1,2 Unfortunately the thinking of some professionals has been slower to change, as exemplified by Cullum and Spilsbury's editorial on nurse led care.3

We object to the statement that doctors are “delegating” their work to nurses, and the subsequent implication that only simple activities will be appropriate for nurse led care. This statement reinforces the commonly held medical view that nurses are appropriate to fill in where junior doctors are in short supply and the required tasks menial, such as pre-assessment clinics and routine procedures, but not to act as autonomous professionals initiating and delivering high quality care. Such outmoded thinking returns nursing to the status of “handmaiden.” rather than accepting that nurses have a specific set of skills and their own professional accountability.

Experienced nurses have been undertaking a variety of “medical” tasks for many years, albeit often in a covert fashion. We welcome the acknowledgment of the diverse skills that nursing staff can bring to health care, and the formal introduction of posts such as the nurse consultant, which is able to develop the nursing role while ensuring that the essence of nursing as profession is not lost.

Interdisciplinary teams, not doctors, deliver modern health care. Doctors bring their particular skills to the team, but no longer sit at the apex of a hierarchy, delegating to other professions. Although it may feel uncomfortable to relinquish the traditional notion of medical control, doctors must embrace and support the development of better health care, regardless of the professional training of those who deliver it.


Competing interests: None declared.


1. Raftery JP, Yao GL, Murchie P, Campbell NC, Ritchie LD. Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial. BMJ 2005;330: 707-10. (26 March.) [PMC free article] [PubMed]
2. Sakr M, Angus J, Perrin J, Nixon C, Nicholl J, Wardrope J. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial. Lancet 1999;354: 1321-6. [PubMed]
3. Cullum N, Spilsbury K, Richardson G. Nurse led care. BMJ 2005;330: 682-3. (26 March.) [PMC free article] [PubMed]

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