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Grounded theory
Nurses require confidence, knowledge and communication skills for referrals to doctors
  1. Renata Eloah de Lucena Ferretti-Rebustini
  1. Medical-Surgical Nursing Department, University of São Paulo, School of Nursing, São Paulo, Brazil
  1. Correspondence to : Professor Renata Eloah de Lucena Ferretti-Rebustini, Medical-Surgical Nursing Department, University of São Paulo, School of Nursing, Av Dr Enéas de Carvalho Aguiar, 419. 3o andar, sala 354, São Paulo 05403-000, Brazil; reloah{at}

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Commentary on: Trapani J, Scholes J, Cassar M, et al. Dual agency in critical care nursing: balancing responsibilities towards colleagues and patients. J Adv Nurs 2016;72:2468–81.

Implications for practice and research

  • Educational interventions to improve nurses' clinical decision-making skills and interprofessional communication are needed to advance nursing practice.

  • More research exploring interprofessional communication skills and clinical decision-making across countries and cultures is required.


Despite the well-established critical care nursing role and its importance to patients' outcomes and healthcare, nurses worldwide still face difficulties in clinical decision-making. Even in the presence of evidence-based nursing protocols and Advanced Nursing Practice (ANP), nurses tend to seek authorisation or advice (usually from doctors) to make decisions and implement different levels of care. Previous studies have provided evidence that nurses refer to doctors on a regular basis, but gaps …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.