title: Doctor-nurse substitution: the workforce equation.
abstract: OBJECTIVE
  This paper examines the historical background and context to the doctor-nurse substitution debate, and then addresses the sufficiency assumptions inherent in the new nursing roles.
  
  
  BACKGROUND
  The NHS Executive considers 'new nursing roles' as a means of substituting part of the doctors' skills. Whilst the literature abounds with professional debate related to the desirability of nurses extending their roles, the underlying assumption of a sufficiency of skilled nurses is not considered.
  
  
  METHODS
  The NHS hospital workforce data for the year 1994/95 were analysed and the changes in the overall numbers of doctors and nurses available for work were calculated as the doctors' hours were progressively reduced.
  
  
  RESULTS
  The changes in skill mix were compared; firstly, as a result of the estimated potential reductions in nurses available to undertake the nursing function as movements up the nursing skills spectrum occurs, and secondly, as a result of the alteration in the balance of available skilled staff.
  
  
  CONCLUSIONS
  The policy assumption that suggests that a sufficiency of nurses is available for doctor substitution, whilst still allowing the nursing element to function may be false.
authors.affiliation: School of Nursing and Midwifery, University of Sheffield, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Calpin-Davies
authors.forename: R L
authors.initials: RL
authors.lastname: Akehurst
mesh_terms: D002322:Career Mobility; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D007587:Job Description; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution*; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D017009:Professional Autonomy; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom; D016526:Workload