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Interprofessional working or role substitution? A discussion of the emerging roles in emergency care

Hoskins, Rebecca


Rebecca Hoskins
Senior Lecturer in Advanced Practice


Aims. This article presents a discussion of emerging non-medical roles in emergency care against the current policy context and the issues of role substitution and interprofessional working. Background. Non-medical roles in emergency care have grown internationally in response to an increasing demand for emergency care services and to address the growing importance of the quality healthcare agenda. The blurring of role boundaries between professional groups has become more common. Data sources. Searches were made of three electronic databases; CINAHL, Medline and EMBASE. The literature relating to interprofessional healthcare roles, and new roles in emergency care was searched from 1980 to 2010 and underpinned the discussion. Discussion. A theoretical framework that has emerged from the literature is that task, role substitution and interprofessional working lie on a spectrum and evolving non-medical roles can be plotted on the spectrum, usually starting at one end of the spectrum under task substitution and then potentially moving in time towards true interprofessional working. Conclusions. There is still a great deal of progress to be made until non-medical roles in emergency care can truly be encompassed under the umbrella of interprofessional working and that a more robust critical mass of evidence is required to substantiate the theory that interprofessional working within teams contributes to effective, cost-effective care and better patient outcomes. Relevance to clinical practice. It is essential to understand the underlying motivation, policy context and key drivers for the development of new nursing and non-medical roles. This allows services to be established successfully, by understanding and addressing the key predicable barriers to implementation and change. © 2011 Blackwell Publishing Ltd.

Journal Article Type Article
Publication Date Aug 1, 2012
Journal Journal of Advanced Nursing
Print ISSN 0309-2402
Electronic ISSN 1365-2648
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 68
Issue 8
Pages 1894-1903
Keywords emergency care, emergency nurse practitioner, extended scope physiotherapist, interprofessional working, nursing, professional issues, role substitution
Public URL
Publisher URL
Additional Information Additional Information : Article published online before print: 9th November, 2011