WITH NURSE PRACTITIONERS, WHO NEEDS HOUSE OFFICERS

The boundaries between the work of doctors and that of nurses are chan ging, with nurses taking over important parts of junior hospital docto rs' clinical work. In 1993 an exploratory study was carried out to ide ntify the professional, educational, and management issues that such d evelopments raise. Interviews were carried out with a range of stakeho lders in three innovatory posts in which nurses were doing much of the clinical work of house officers. A complex picture of perceived benef its and problems for patients, junior doctors, and nurses emerged. The se seemed to be associated with (a) the extent to which the contributi on of professional nursing was valued in the new role and (b) the amou nt of clinical discretion which the postholder was allowed, this depen ding on the type of preparatory education provided and the management of the post. The study points to the need for strategic issues-such as the development of appropriate education and the professional recogni tion of these new clinical roles-to be addressed at a national and reg ional level.