Feasibility and sustainability
Several factors may limit the feasibility and sustainability of
extending nursing roles.
First, there is a high capital cost involved in moving from solo GPs
to large multidisciplinary teams, and nurses taking on new roles
must be trained for this work. The evidence base is small, but
research supports the view that clinical guidelines or protocols may
help to facilitate the transfer of tasks from doctors to nurses while
maintaining quality.27 Even so, the pace of service development in
England in the 1990s often outstripped the ability of training
programs to equip nurses for their new roles.2 A persistent challenge
is the lack of research into what level of training should be required
of a nurse undertaking extended roles in primary care. A systematic
review of worldwide research into nurses working as substitutes for
GPs found there was wide variation in nurses’ job titles and hence
their likely qualifications.8 “Practice nurses”, “nurse practitioners”,
“clinical nurse specialists” and “advanced practice nurses” were all
found in such roles. Added to this difficulty is the lack of consistency
among countries, and sometimes within countries, in the use of job
titles such as “nurse practitioner”.