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


  • Rebecca Hoskins

    1. Rebecca Hoskins MA RN Consultant Nurse and Senior Lecturer in Emergency Care Emergency Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, UK, and University of the West of England, Bristol, UK
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hoskins r. (2011) Interprofessional working or role substitution? A discussion of the emerging roles in emergency care. Journal of Advanced Nursing68(6), 1894–1903.


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.