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Friday, 15 October, 1999, 03:19 GMT 04:19 UK
A&E nurses 'as good as doctors'
A&E units are facing increased pressures
Specialist nurses are just as good as - and in some ways better than - junior doctors in accident and emergency units, according to a study published in The Lancet medical journal.

The researchers - a combination of doctors and nurses - looked at the treatment of 1,453 patients with minor injuries who were randomly sent to a specially trained nurse or a junior doctor.

Nurses made 65 clinical errors in the 704 patients they saw - an error rate of 9.2% - compared to doctors who tripped up in 80 out of 749 cases - 10.7%.

Although not statistically significant, the figures show that nurses are just as good as junior doctors in an A&E setting.

Expensive option

Other findings showed that they were superior in some fields - they were better at recording medical history and fewer patients seen by a nurse had to make an unplanned return to hospital.

Nurses were skilled at handling injuries without a doctor's assistance
However, nurses took longer to assess patients and were more expensive to employ because junior doctors are paid less for overtime and weekend work, and half their pay comes from a regional training authority.

The findings come as workloads grow in casualty departments and the health service looks for new ways to relieve pressure on doctors.

One approach has been to introduce minor injury units run by nurses, but most patients who attend A&E are seen and treated by junior doctors.

The researchers, from Northern General Hospital in Sheffield, said nurses "can provide a safe alternative to junior doctors for the care of patients with minor injuries".

"We see no reason why similarly experienced and trained accident and emergency nurses in other departments should not achieve similar results."

National trend

Dr John Ryan, a consultant at the Royal Sussex Hospital and spokesman for the British Association for A&E Medicine, said the study validated the shift towards the use of nurses in treating minor injuries that was happening across the UK.

"Increasingly, nurses are working autonomously, and it's reasonable to think they would get things right - they are an important resource to A&E departments," he told BBC News Online.

Emergency admissions are increasing by 2% a year
However, he stressed that the study dealt with the treatment of minor injuries and warned that the introduction of specialist nurses would have to be carefully considered - especially as they cost more than junior doctors.

"If you go ahead with emergency nurses, we have to see this as an additional investment. If you simply pull nurses off the critical wards, who's going to look after those patients?"

Mark Jones, policy advisor at the Royal College of Nursing, said: "The research comparing nurse practitioners is interesting, but the results are not that surprising.

"The problem with comparing the two professions is that you are not measuring like with like. While some junior doctors may be relatively inexperienced, nurse practitioners are highly skilled experts with many years of experience."

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