A comparative study focusing on the clinical decision making processes of nurse practitioners versus medical doctors using scenarios within a secondary care environment

Subjects This study was conducted from May 2012 to January 2013. Aim To investigate the decision-making skills of secondary care nurse practitioners compared to those of medical doctors. Background A literature review was conducted, searching for articles published from 1990 to 2012. The review found that nurse practitioners are key to the modernisation of the National Health Service. Studies have shown that compared to doctors, nurse practitioners can be efficient and cost-effective in consultations. Design Qualitative research design. Methods The information processing theory and think-aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality, and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. Results The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took three minutes longer to complete the scenarios. Conclusion This study suggests that nurse practitioner consultations are comparable to those of medical doctors within a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes. SUMMARY STATEMENT Why is this research or review needed? • The purpose of this research was to highlight the similarities in decision-making skills between nurse practitioners and doctors during consultations. • To highlight to other multi-disciplinary teams that nurse practitioners are equally as capable as doctors in making diagnoses and prescribing further studies or treatment. • To help provide clarity on the role of the nurse practitioner. What are the key findings? • Nurse practitioners and medical doctors used similar cognitive decision-making skills. However, medical doctors were able to chunk more information and used less cue acquisition (history taking) to reach a diagnosis and thus finished their consultations quicker than nurse practitioners. • The more experienced (> 2 years) nurse practitioners were comparable to medical doctors in their consultations. • The two professions showed different consultation styles; nurse practitioners were more holistic, whilst medical doctors were more paternalistic. How should the findings be used to influence policy/practice/research/education? • This study may influence government policy, as it provides more clarity regarding the nurse practitioner’s role and responsibilities. • This study may affect caring practices, as multi-disciplinary teams may acknowledge the nurse practitioner’s abilities, assign them a variety of patients and organize opportunities for further training. • This study contributes to the number of studies that have confirmed that consultations performed by nurse practitioners are comparable to medical doctors’ consultations.

This is the peer reviewed version of the forthcoming article, which will be published in final form at Journal of Advanced Nursing This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.