Table 2
Studies comparing nurses and doctors in paediatric settings
| Place | Design, outcome measures, and results | Reference |
|---|---|---|
| Studies reporting better performance by ANNPs (or midwives) than doctors | ||
| Hull, UK | Design: compared SHOs with ANNPs in examining the newborn. Outcomes: detection of abnormalities of hips, eyes, and hearts. Result: ANNPs superior for hips and eyes; no significant difference for heart defects. | 17 |
| Charleston, USA | Design: retrospective study comparing cost and outcomes in two matched groups of infants; neonatal nurse practitioners (NNPs) compared with residents (medical house staff). Outcomes: quality of care and cost effectiveness. Result: equal quality of care; NNP cases had lower cost with greater continuity, consistency, and cost effectiveness. | 18 |
| Hertfordshire, UK | Design: RCT—newborn examination done by midwives versus SHOs. Outcomes: performance, parental satisfaction. Result: midwives scored higher but conclusions on performance limited by high number of exclusions required by protocol. | 19 |
| Great Ormond Street Hospital, UK | Design: RCT comparing nurses and registrars managing weaning from ventilator in neonatal intensive care. Outcome: median weaning time. Result: substantially shorter duration of weaning in nurse group with no increase in adverse events. | 20 |
| Liverpool, UK | Design: retrospective non-randomised comparison of ANNP led teams versus medical led teams in resuscitation of infants <33 weeks. Outcomes: major adverse long term sequelae; time to intubation and surfactant; hypothermia. Results: no long term differences; ANNPs shorter time to intubation and surfactant, less hypothermia. | 21 |
| Chicago, USA | Design: retrospective PICU chart review comparing ANNPs with residents. Outcomes: parent satisfaction, quality of care, nutritional management, and discharge planning. Results: no significant differences except better discharge planning by nurses. | 22 |
| Bronx, New York, USA | Design: economic and quality analysis during changeover from resident to NNP care in NICU. Outcomes: weight specific survival, adherence to guidelines, documentation. Result: quality preserved or improved with nurse led care; however, nurses more expensive than residents. | 23 |
| Studies reporting no significant difference between performance of ANNPs and doctors | ||
| Jacksonville, Florida, USA | Design: comparison between residents and ANNPs. Outcomes: length of critical care and hospital stay, ventilator and oxygen use, total parenteral nutritional use, number of transfusions, performance of procedures; incidence of air leaks, bronchopulmonary dysplasia, intraventricular haemorrhage, patent ductus arteriosus, necrotising enterocolitis, retinopathy of prematurity, and deaths; charges. Result—no difference between groups. | 24 |
| Hamilton, Ontario, Canada. | Design: RCT in NICU—compared NNP/resident team with resident-only team. Outcomes: mortality; complications; length of stay; quality of care; parent satisfaction; long-term outcomes (Minnesota Infant Development Inventory); costs. Results: no significant difference on any measure. | 25 |
| Hamilton, Ontario, Canada. | Design: comparison between graduating NNPs and second year paediatric residents. Outcomes: tested by multiple choice questions, radiographs, oral examination, communication skills (simulated assessment), expert observer assessment and clinical skills. Result: NNPs equivalent to second year paediatric residents | 26 |
| Norfolk, Virginia, USA. | Design: comparison between ANNPs and resident team. Outcomes: survival, length of stay, and total charges. Result: no significant difference. | 27 |
| Nottingham, UK | Design: comparison between registrars and ANNPs used interchangeably in a newborn retrieval service. Outcome: clinical condition on completion of transport. Result: no significant difference between groups. | 28 |
