New Articles and Editorial in Diagnosis Recognize Important Role of Nurses in Diagnostic Process

Nurses Are Critical Members of the Diagnostic Team


December 1, 2017 - While much attention has been given broadly to the concept of teamwork in medicine, the concept of a diagnostic team is novel. Two new articles and an editorial in the latest issue of Diagnosis address the importance of involving nurses in the diagnostic process as critical members of the healthcare team.

In their article, Defining the Critical Role of Nurses in Diagnostic Error Prevention: A Conceptual Framework and a Call to Action, authors Kelly Gleason, RN et. al. define a framework for nursing engagement in the diagnostic process “to serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error.” It is estimated that diagnostic errors impact 12 million people each year.

The authors expand the concept of the triage function of nursing as “diagnostic triage,” where “nurses serve as sentinels for identifying diagnostic signs.” The authors cite one study in which greater nursing staffing in the emergency room was associated with a 50% reduction in time for diagnostic evaluation. The article also addresses the role of nurses in facilitating patient engagement and communication between patients and the diagnostic team. The authors identify many barriers to recognizing the unique and important role of nurses in diagnosis, including culture, education, and regulation:

Culture – The authors call on nurses to recognize their roles in the diagnostic process, and for physicians, who have sometimes been reluctant toward nurses having an equal voice in the process, to embrace them as key participants in the diagnostic team.

Education – “Education and licensure requirements need to be updated to include competencies specific to the diagnostic process.” The authors suggest that interprofessional education, which is already required by licensing bodies, should be leveraged to include content specific to the diagnosis process.

Regulation – “As nurses embrace their role in the diagnostic process, important scope of practice issues will need to be addressed.” The authors cite the Texas Board of Nursing’s Nurse Practice Act, noting that it stipulates that “professional nursing does not include diagnosis… and that nurses may not engage in activities that require the use of independent medical judgment.”

The Society to Improve Diagnosis in Medicine (SIDM), through a grant from the Josiah Macy Foundation, is working on developing an inter-professional consensus curriculum on diagnosis and diagnostic error. The competency-based curriculum will support all members of the clinical team—including nurses—involved in the diagnostic process. In addition, SIDM has established a working group, led by Gleason to ensure nurses are always included as an essential member of the diagnostic team.

In the seminal 2015 report from the National Academy of Medicine, Improving Diagnosis in Health Care, the first recommendation focused on the healthcare team: “In recognition that the diagnostic process is a dynamic team-based activity, healthcare organizations should ensure that healthcare professionals have the appropriate knowledge, skills, resources, and support to engage in teamwork in the diagnostic process.” But the roles and responsibilities of those team members were not clearly defined.

In The New Diagnostic Team, authored by SIDM President Mark L. Graber, MD, et. al., articulates those roles and responsibilities. “Through their unique relationship with both the patient and the physician, nursing staff are ideally situated to both support the diagnostic process and monitor its outcomes,” the authors argue.

Nurses provides input on the diagnostic possibilities, monitors whether communication was effective, contributes to care coordination, and observes whether the patient’s course is consistent or not with the diagnoses being considered.

The issue also includes a guest editorial by noted educator Julie Considine, RN, PhD. “Nurses can, do and should diagnose and have been engaged in these tasks for as long as healthcare has been in existence; the real issue is recognition of nurses as equal and legitimate members of the diagnostic team,” Considine argues.

Diagnosis is the official journal of the Society to Improve Diagnosis in Medicine. Diagnosis was launched in 2014, and was recently accepted for listing by PubMed.

About the Society to Improve Diagnosis in Medicine (SIDM)
SIDM is a nonprofit organization whose members include clinicians and other healthcare professionals, patients and every stakeholder in the diagnostic process. In 2015, SIDM established the Coalition to Improve Diagnosis, a collaboration of 35 leading healthcare organizations.

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