The Real World
September 14, 2005 -- Today the CTV site posted a short unsigned Canadian Press piece about a New Brunswick government plan to start having emergency department nurses "assessing, treating and discharging patients who don't require the immediate attention of a physician." The plan to give nurses "a lot more responsibility" is reportedly intended to reduce waiting times in crowded EDs. The piece has good quotes from the provincial health minister and the head of the New Brunswick Nurses Association, though it might have included comment from an ED physician as well. It might also have explained more clearly the roles of ED nurses and physicians, since parts of the piece may suggest that nursing is merely a subset of medicine.
The piece, "N.B. gives nurses more ER responsibilities," explains that the new policy is based on practices in remote communities, where there are presumably few physicians. The piece notes that New Brunswick itself is facing a shortage of physicians, and that hospitals in some communities have had to scale back ED hours. However, New Brunswick Health Minister Elvy Robichaud gives assurances that the new plan "will not reduce the need for more doctors" and that it is "aimed only at reducing the wait times in emergency rooms for people with minor ailments." Robichaud notes that before, all ER patients had to be seen by a physician. But now, he says, nurses can handle cases such as cuts requiring cleaning, bandaging and tetanus shots, as well as fast-tracking patients for X-rays and lab tests. Obviously, the need for those tests is not confined to "minor ailments," and it also seems likely that the initiative will reduce the total amount of time ED physicians spend treating patients. Robichaud himself notes that the initiative means patients will "no longer have to wait to see a physician to receive care that can be offered by a nurse." Some readers may interpret this statement to mean that nursing is a subset of medicine; of course, nurses provide a variety of care that physicians do not. The piece says Sue Ness, the nurses association president, welcomed the plan and noted that it would give nurses the chance to use their full training. She is also quoted as reporting that "[p]rovincial reviews have indicated that over 60 per cent of patients presenting to emergency departments can be seen and treated by a registered nurse."
The piece highlights the central but under-recognized role that nurses play in modern EDs. Viewers of most popular hospital shows on television would probably be shocked to hear that most ED patients can be treated by nurses alone. With regard to the assurances that the only ailments at issue are "minor," the piece would seem to be more accurate in noting that the ailments in question are those that don't "require the immediate attention of a physician." This category might include some very serious chronic conditions that nurses are fully capable of managing. Of course, patients with serious emergent conditions generally do require the skills of ED physicians, though ED nurses still play an essential and unique role in caring for such patients. We're reminded of a comment by a character on "ER," the late and unlamented attending Robert Romano, who once remarked that nurses could handle 90% of ED patients but at the cost of killing the other 10%. No one on the show contradicted this oddly defensive assertion, but it's worth noting that comprehensive ED care requires nurses and physicians. Physicians could no more provide the full range of nursing care than nurses could provide the full range of medical care. Incidentally, this piece does not discuss to what extent the New Brunswick initiative will add to the workload of the nurses, and how that may relate to the current nursing shortage.
The Center commends CTV and Canadian Press for covering this important subject.