Medical establishment prevents nurses from assuming new roles

November 16, 2009

Montreal, November 16, 2009 - 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 Université de Montréal researchers, published in Recherches Sociographiques, nursing functions are still very much assigned by physicians who often oversee family medicine groups (FMGs), specialized nurse practitioners (SNP) and oncology nurse navigators (ONN).

"MD power is legal, political and organizational and exercised through positions of managers and directors, which leaves nurses with the feeling of being underutilized. 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 Université de Montréal Faculty of Nursing and scientific director of the FERASI Centre.

Job description defined by physicians
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.

Underutilized nurses
Nurses in all three groups do feel underutilized 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 Université de Montréal 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 Université de Montréal FERASI Centre. Study results were based on data from three research projects.
About new nursing roles
FMG nurses work on the front lines and usually holds a bachelor's degree in nursing. SNP nurses work in hospitals and hold a Master's degree in nursing as well as a complementary degree in one of tree specialties: nephrology, cardiology or neonatology. ONN nurses, who usually hold a bachelor's degree, work in hospitals and collaborate on the front lines of health care.

About the FERASI Centre
The FERASI Centre is an interuniversity pole for training, research and knowledge transfer in nursing administration created by the Université de Montréal, the Université Laval, McGill University and the Université de Sherbrooke. It was created in 2001 to nurture the importance of nursing management in a changing health-care system and to fill the void of researchers in this field

About the study:
The paper, "Déploiement de nouveaux rôles infirmiers au Québec et pouvoir médical," published in Recherches Sociographiques (vol. 50, n° 2, 2009, p. 301-320), was authored by Danielle D'Amour, Dominique Tremblay and Michelle Proulx of the Université de Montréal.

On the Web :
About the cited study:
About the FERASI Centre:
About the Université de Montréal Faculty of Nursing:

University of Montreal

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