Study claiming that substituting nurses for doctors is safe and effective is flawed, say experts

A study claiming that substituting nurses for doctors in a host of hospital settings is not only safe and effective but sometimes better for patients has critical flaws, experts have warned. Furore erupted last week when the results of a Cochrane evidence review1 were presented and then reported in the media. The review examined the effects of substituting nurses for doctors in a range of hospital settings. Researchers from Ireland, the UK, and Australia examined 82 randomised studies involving more than 28 000 patients across 20 countries. Their meta-analysis reported “little to no difference” between nurse led and doctor led care for critical outcomes, including mortality, quality of life, self-efficacy, and patient safety events. The studies included four types of interventions in different clinical settings where nurses of various seniority replaced doctors in specialties such as cardiology, diabetes, cancer, obstetrics/gynaecology, and rheumatology. The four interventions were: