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Are Nurses Underutilized?

Are Nurses Underutilized?


The shortage of doctors has long been a topic of conversation in medical communities. The National Rural Health Association claims this scarcity is especially prevalent in areas like western North Carolina where there is one doctor for every 4,400 patients. Hospitals are facing not only staffing problems, but also financial issues due to health care reform, adding to the burden.

A recent report issued by the Grattan Institute looks closer at staffing in hospitals. The report investigates how changing the work structure to better utilize other health care professionals could fix a number of problems in the hospital environment, and specifically whether administrators are underutilizing nurses.

The Grattan Report

The Grattan Institute describes itself as an independent think tank working to develop high quality public policy. The report titled, “Unlocking Skills in Hospitals: Better Jobs, More Care,” is authored by Stephen Ducket, the Grattan Institute Health Program Director, and Peter Breadon, a Health Fellow.

The goal of the study is to prompt reform in the Australian hospital industry, but it has international relevance when it comes to nursing. Ducket and Breadon claim the misuse of skill specialists like nurses is costing public hospitals more than 430 million dollars a year. Poor organization also affects safety and the quality of care in these facilities. While the report takes a comprehensive approach to the subject, one section focuses on nurses in specialist roles.

Nurse Specialists

Historically, the role of a nurse is centralized around patient care, leaving specialty tasks for doctors. The Grattan report suggests nurses with specialized training could perform many tasks reserved for physicians. Some aspects of care do require the extensive education and training a physician goes through. Diagnosis and surgical procedures, for example, require a broader scope than standard nurse’s training allows.

Studies show, however, that nurses can master complex tasks with proper education and supervision. In most hospitals, it is tradition that dictates who does certain medical procedures, not evidence based research. This report suggests that opening that door for nurses, monitored by physicians, would be a better use of hospitals assets. The study focuses on two specialties where nurses could play a bigger role: endoscopy and anesthesia.

Endoscopy Nurses

Both the United States and United Kingdom have practicing endoscopy nurses, but that is not the case is all countries including Australia. Research shows that with proper training, nurses provide endoscopies at the same quality level as physicians. A 2004 patient survey indicates a high satisfactory rating for nurses in this field. The patients participating gave the nurse practitioners that did their procedure almost 100 percent in every category including:

  • Adequate explanations before and after the procedure
  • Privacy

Most of those surveyed stated they would let a nurse do the test again. With nurses managing the basic endoscopy procedures, doctors would have more time to deal with complex cases.

Endoscopy is a field that will grow over the next decade as the baby boomer generation comes of age. This makes it a primary candidate for this type of nurse expansion. Candidates in the United States go through three assessment stages prior to advancing to endoscopy nurse. They must pass a test to prove they have the theoretical knowledge required for the field. Nurses get practical experience with a simulation device, and then finally train with a gastroenterologist before doing procedures on their own.


According to the Grattan report, to work as a nurse anesthetist in the United States you must have a nursing degree, up to two years of critical care experience and a master’s degree in anesthesiology. Some nurses work solo or under the supervision of a doctor.

In 2010, the American Association of Nurse Anesthetists conducted a study to confirm the quality of care standards were just as high for nurses in this field as they are for doctors. The study examined the likelihood of complications with a nurse providing sedation and found no difference.

As with endoscopy, putting nurses at the helm frees up doctors for more complex tasks. Evidence shows that nurses are able to provide the same level of care, even without the medical school training. Nurse anesthesiology education begins with sedation for patients who remain conscious, according to the report. This alone would relieve some of the pressure on medical anesthesiologists in hospitals.

Broader training would expand the role of the nurse anesthesiologist. Nurses advancing to this level would need at least two years experience in an operating theatre or intensive care unit.

The Grattan report concluded that expanding the role of nurses could effectively reduce the workload of physicians in a hospital without sacrificing care quality or patient satisfaction. In this age of health care reform, adding nurses in specialty fields is one way to reduce healthcare costs and relieve some of the physician shortage.


Duckett, Stephen & Breadon Peter, Unlocking Skills In Hospitals: Better Jobs, More Care. Grattan Institute, April 2014

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