Medical establishment prevents nurses from assuming new roles

Physicians still retain the bulk of decision-making power over nurses in Quebec - a situation that's detrimental to evolving nursing roles. According to a new study by Universite de Montreal researchers, published in Recherches Sociographiques, nursing functions are still very much assigned by physicians who often oversee family medicine groups (FMGs), specialised nurse practitioners (SNP) and oncology nurse navigators (ONN).

'MD power is legal, political and organisational and exercised through positions of managers and directors, which leaves nurses with the feeling of being underutilised. In FMGs, physicians decide the nature and extent of nursing roles such as whether nurses serve as assistants or follow-up on patients,' says co-author Danielle D'Amour, a professor at the Universite de Montreal Faculty of Nursing and scientific director of the FERASI Centre.

The influence of physicians has also shaped SNP training and job descriptions. The result is that the role of these nurses varies from consultant to first responder, depending on the establishment and depending on the will of physicians.

Oncology nurse navigators have fared better. Under recommendations from a renowned oncologist involved in several levels of the Quebec health-care system, physicians and managers have accepted ONNs as part of inter-professional teams.

Nurses in all three groups do feel underutilised and must still convince physicians that they contribute differently to patient care. The study reveals many physicians feel the new role of nurses is an unacceptable intrusion into their area of expertise, which could explain their resistance of sharing professional responsibility.

The research team found the current health-care system gives physicians control over the practices of other professional groups. That establishment of authority, the researchers argue, must be redefined to permit that nurses be increasingly heard in the public arena and provided with more decision-making power.

The authors of the study are Danielle D'Amour, a professor at the Universite de Montreal Faculty of Nursing and scientific director of the FERASI Centre; Dominique Tremblay, a postdoctoral grant holder (Canadian Health Services Research Foundation - Canadian Institutes of Health Research); and Michelle Proulx, a research professional at the Universite de Montreal FERASI Centre. Study results were based on data from three research projects.