Development of healthcare professionals’ roles – a physician’s perspective

Throughout the past decades, the traditional roles in the healthcare system have changed. There are several reasons for its development. The main reasons are digitalization with computerized medical reports, databases, specialised care for smaller groups of diseases/patients, and the use of special devices, diagnostic and therapeutic procedures.

In addition to physicians, there are many other healthcare professionals: nurses in inpatient and outpatient care, head nurses, ICU nurses, surgical and gynaecological nurses, specialised nurses (e.g. for gastroenterology or psychiatry). Nurses cooperate not only with physicians but often also with dieticians, social and rehabilitation workers, paramedics, speech therapists or occupational therapists. Psychologists are a separate category with some subspecialisations – e.g. clinical psychologists. Various laboratories employ laboratory technicians (radiological, biochemical, haematological, neurophysiological, etc.). Medical scientists work in laboratories, oncology departments, and in institutes for genetics, hygiene, and epidemiology.

Nowadays, new demands are being placed on specialised staff. As the hospital information data systems advance, there is a need for staff with both healthcare education and technological knowledge. Proper and detailed information is an important task for healthcare professionals. This information could include a patient´s time profile and results obtained through the use of various validated scales and evaluation tools. This is a new field for nurses as they work on developing and implementing schemes and scales in individual branches of medicine and health care. In neurological intensive care units, there are important scales regularly used by the staff: GCS (Glasgow coma scale) for disturbances of consciousness, Hunt and Hess scale for clinical evaluation of patients with subarachnoid haemorrhage, NIH Scale for an evaluation of deficits in patients with acute ischemic stroke, MRS – Modified Rankin Scale for an estimation of restriction of patients’ activities. Furthermore, the development of scales and standardized diagnostic tools are often the domain of nurses especially those who work in nursing research and academia.

A significant volume of laboratory examinations exists that is, to a certain extent, completed by physicians. However, in my specialty of medicine – neurology – there are methods of electrophysiology (electroencephalography, electromyography, and evoked potentials) performed by specially trained nurses. On the other hand, the physician engages in more invasive methods (e.g. needle electromyography), evaluates the findings, summarizes the results and completes a conclusion with recommendations.

The participation of all healthcare professionals in research projects from various grants is important for the team and especially for nurses. These projects require sophisticated methodology and fulfilling complex tasks. The data collection and documentation process is more challenging than simply entering patient information into hospital databases. Participation of nurses in research is an important way to achieve a new level of success in medicine and nursing.

In clinical trials and grant projects, there is a new activity-field for nurses. There are typical roles in clinical trials – the role of the principal investigator and sub investigators, study nurses, and the project manager (a nurse on site who plans and manages patient visits and investigation dates, gathers laboratory results, contacts patients or enters data into electronic databases). This presents new challenges for the nurse’s abilities. Communication in an international research teams is in English, nurses need to be able to use hi-tech devices, and they should to know how to collect a sample and how to submit it for analysis. Nurses should have strong and positive communication skills, as there are always challenges and issues they have to deal with.

My personal experience with the healthcare system began in a neurological department with a head sister, a ward sister, ward nurses, outpatient nurses, and physiotherapists. Over time, the work became more complicated and special outpatient clinics (epileptology, multiple sclerosis) and laboratories (EEG, EMG, sonography, cerebrospinal fluid) were opened. Thirty years ago, our ICU department was equipped with modern devices (e.g. ventilators and infusion pumps) and specialised care. It was staffed with nurses trained in intensive care and laboratory practices. Twenty years ago, new dedicated facilities and special centres were established: a multiple sclerosis centre, a stroke centre, and a neuromuscular centre. Ten years ago, new patient databases and registers were established. The registers are for patients with multiple sclerosis (Remus), for stroke patients (SIT, Rescue), for patients with neuromuscular diseases (AINSO – autoimmune neuropathies, muscle dystrophies, SMA, myasthenia gravis). These registers are used for an evaluation of the effect and safety of treatment. Dedicated nurses have specifically been trained for each area through post gradual courses and most of them attend seminars and conferences regularly.

Looking at the future, the demands placed on the healthcare professionals will always be challenging. Nursing education requirements are becoming increasingly higher. Therefore, a close cooperation with universities (with study programs that educate healthcare professionals) is a great advantage. In the future, special patient groups should be considered, and scales, laboratory examinations, procedures, databases and registers should be developed. However, the patient will always remain the focus of such challenges in the health care system. The nurse of the future should be able to create a positive and empathetic relationship with various types of patients, support them during difficult periods in their life, and assist them in their recovery.