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Substitution in nursing practice: clinical, management and research implications
1College of Nursing, Wayne State University, Detroit, Michigan, USA.
Journal of Nursing Management
|January 10, 1998
Summary
Market forces impact healthcare, leading to increased use of unlicensed personnel as substitutes for registered nurses (RNs). Research shows these substitutes generally cause no harm, but their impact on clinical outcomes needs better evaluation.
Area of Science:
- Healthcare Economics
- Nursing Practice
- Health Services Research
Background:
- Market forces are influencing healthcare delivery, prompting cost-effectiveness evaluations.
- This has led to scrutiny of registered nurses' (RNs) roles and responsibilities.
- A key outcome is the increased utilization of unlicensed personnel as substitutes for professional nursing staff.
Purpose of the Study:
- To review economic substitution concepts and assumptions regarding unlicensed personnel in clinical settings.
- To examine the impact of unlicensed personnel substituting for nursing services on hospital-based clinical outcomes.
- To identify methodological challenges in existing research on this topic.
Main Methods:
- Review of hospital-based evidence on the use of unlicensed personnel in clinical practice.
- Analysis of concepts related to economic substitution in healthcare.
- Critique of methodological approaches in published research.
Main Results:
- Unlicensed personnel substituting for nurses generally do not cause harm.
- The evaluation of clinical outcomes associated with unlicensed staff has been inadequate.
- Methodological issues are prevalent in current research concerning unlicensed personnel in nursing.
Conclusions:
- While unlicensed personnel may not cause harm, their contribution to client care is not well-established.
- Registered nurses (RNs) make significant contributions, particularly in advanced practice roles, often substituting for other professionals.
- Further rigorous research is needed to evaluate the clinical outcomes and cost-effectiveness of substituting nursing services with unlicensed personnel.