RCN calls for more specialist nurses- good idea, or devaluing the role of nursing?

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ThisLittlePiggy

I was the 'muuust have' that annoyed me. Surely, you've heard on those conditions? Patients have them! :p:

Agreed, it's all to do with saving money for the government and little to do with patient care. It's something I think is a bad plan and is what I disagree with. This unfortunately extends towards nurse specialists when they can prescribe and manage and diagnose 'within their sphere of clinical experience'. It sounds potentially okay but I don't like the idea of a non medically trained personnel doing a job that used to be only done by someone with a medical qualification.

What, did patient care and diagnosis and treatment get easier all of a sudden and now a medical degree isn't needed?

I have actually heard of them, seen neuro asessment of the first- and read about it, can't remember the other two were called lol

In an ideal world it'd be fab for just nurses to run the ward, I actually think its worrying sign of the times that members of the public can come in have 2 weeks training and start delivering personal care to a patient with complex needs, and the HCA role is currently not regulated and they're under delegation and responsibility of the registered nurse they're working with- which is a huge stress and worry! I meet HCA's and wonder how on earth am I going to deal with the mistakes they make or discussing workload as an RN . However at the same time..with the increasing demand of roles, and treatment now, as an RN as much as it is my responsibility to make sure personal care is done (not necessarily do it, order of priorities) there are still 110 things on the list to be done! So in a way, without HCA's either patient care will drop dramatically, staffing levels will be inappropiate and jobs simply won't get done, as much as a thorn as they are sometimes..this isn't the majority of them and they are a massive help, in allowing the RN to focus on the high priority needs and patients. So you can see the analogy that, the whole hca-nurse role is still rather infant in its relationship- and only recently its being proposed hcas get regulated, it is slowly improving and becoming easier and safer as their training gets better

Reply 61

digitalis

Subcutaneous

As doctors take on more complicated, specialist cases, involve themselves much more in different areas than they would have- there is a gap there, which nurses with a good deal of clinical experience, education and nursing training in general can fill and support- with the change of nursing education in the past 20years, we not only know how to clean up diarrhoea but also know how to spell it too!

I don't think any nurse who goes into a role where they can aid patient treatment in asessment, diagnosis and prescribing considers themselves at the same level as a senior doctor- however these are people who are respected in their professional bodies, hand picked as capable, and have undergone appropiate training and also have a professional registration, and it's rather a shame what they can bring into a team is being devalued as just another 'noctor', when they work their asses of to get to a senior level in their career (yes the role in medicine may seem junior, but remember this is senior in nursing!).

The specialist nurse is something very valuable to the nursing team- and to the healthcare team and also very sepeate to the nurse who can diagnose etc, in that they work alongside doctors- triage patients (the nurses role is to asess a patient and decide whether to call for medical help or something they can manage within their own scope of practice)

Few points:

4 years is not senior. Neither is under a month of "appropriate training"

Why don't you read Dr. Crippen in more detail, especially the ones that Democracy posted about nurses talking about how the profession is going down the drain?

What's the relevance of having a professional registration?

"Assessing patients and deciding to call for medical help or treatment" is what doctors do every day.

when they work their asses of to get to a senior level in their career (yes the role in medicine may seem junior, but remember this is senior in nursing!).

Since when senior nursing blend into junior medicine? When was this acceptable? :confused:

Reply 62

digitalis

Subcutaneous

I meet HCA's and wonder how on earth am I going to deal with the mistakes they make or discussing workload as an RN

I worry about the same thing, except it's nurses killing my patients with pseudo-medicine.

Reply 63

John Locke

Subcutaneous

This is not forgetting the 3 year degree/diploma (which covers a lot of pharmacology anyway)

out of interest, and this is admittedly my own naivity, why do is it that nursing degrees contain pharmacology modules if RNs don't have the ability prescribe without further qualifications?

i'm not trying to imply that they shouldnt btw!

Reply 64

digitalis

John Locke

As nurses have the right to administer medicines, they should know something about what the drugs do and any likely side effects etc.

Reply 65

Subcutaneous

digitalis

I worry about the same thing, except it's nurses killing my patients with pseudo-medicine.

do you have any cases of nurse practitioners being solely responsible for the death of a patient? There are definately cases of nurses acting outside of their role and boundaries and harming a patient, however they're struck off and a rareity - you get the idiots in medicine too, who act out of their role, inappropiate care..however you seem to be 'worried' about nurse consultants and practitioners, so go on, please- any recent cases of these roles beign solely responsible for the death of a patient?

Reply 66

Subcutaneous

John Locke

administration, monitoring of patients on these drugs, having to decide whether to withold, and also the use of PGD too

Reply 67

John Locke

digitalis

As nurses have the right to administer medicines, they should know something about what the drugs do and any likely side effects etc.

Subcutaneous

administration, monitoring of patients on these drugs, having to decide whether to withold, and also the use of PGD too

ahhh, i see. cheers :smile:

Reply 68

digitalis

Subcutaneous

administration, monitoring of patients on these drugs, having to decide whether to withold, and also the use of PGD too

None of those are pharmacology topics darl... :h:

Reply 69

digitalis

Fortunately i've never seen any hostility, that some people on tsr hold, within the medical team with these nurses

Oh and please see here: my thoughts are not far and few between
http://www.pulsetoday.co.uk/story.asp?storycode=4010567

Reply 70

John Locke

digitalis

None of those are pharmacology topics darl... :h:

i dunno, i reckon increased admin has an effect on the synpases :p:

Reply 71

Subcutaneous

digitalis

None of those are pharmacology topics darl... :h:

http://www.amazon.co.uk/Nursing-Pharmacology-Made-Incredibly-Easy/dp/1901831043 - although it's american there i myself own this book with one of my modules and is a lifesaver, last time i checked pharmacology was the study of how drugs interact within a biological system and the bodys response, something touched on daily in lectures. Have a read of the book, may give you an idea of what is studied and expected to know to an appropiate level when administering and discussing a drug with patients

Reply 72

digitalis

And the use of patient group directives, for example is a practical skill which has nothing to do with the study of exogenous chemicals on biochemical systems.

Anyways, sleep time! Good sport as usual, anna.

Reply 73

Philosoraptor

That said - I've been into hospitals quite a few times, and always been seen by a doctor...

Reply 74

puddlejumper

Subcutaneous

It's not necessarily who..as many of the jobs nurse specialists do today weren't really around in the late 70's early 80's, you wouldn't have found a support group for cancer atleast, and clinics set up for those who've been 10 years clear, it's more whether or not the quality of care will decrease without nurse specialists

Sub you need to do more research. The Macmillan support group has been around since 1911!

Reply 75

puddlejumper

Subcutaneous

The physios have clinic till 11am, the physio maybe could have helped..who knows, however it was more the nursing care behind his condition we needed asisstance and advice with, it is the role of the nurse to act as an advocate- but these were all orthopaedic nurses caring for patient after an elective procedure, although they all had sufficent training, it didn't replace the knowledge and help the nurse specialist had, which helped educated nurses who were dusty in that area- and also gave the patient a contact, and i *think* when discharged it was organised for the nurses to come out and see him and see how he was afterwards as he wasn't getting this contact as much as he probably needed

Sub, physios have priorities when dealing with patients and their highest level of priority goes to patients with breathing problems. ANY physio would have left the clinic patients and gone to the ward to help your patient and really it beggars belief that you would not send for one.

The physio could have done practical things for the patient to help with their breathing and to clear his chest. They would certainly have been able to inform the nurses of suitable positioning and in most cases if the patient needed a home visit then they would have done that too!

Nurses don't rule the NHS, nor should they. There are other trained professionals ready, willing and able to deal with patient's needs and nurses should remember this instead of trying to creep into other professionals shoes. Nurses can't claim to be overworked and then try to take over the role of every other health care professional. What is so bad about being a damned fine nurse?

Reply 76

InArduisFouette

Democracy

You started bringing up the junior docs have less experience nonsense, so I only responded to that.

Also: I prefer to focus on real life experiences of health professionals (a junior doctor in this case) rather than all your DoH "studies". Typical New Labourite blue sky thinker.

As for "Nurse Specialists", I'll let Dr Crippen do the talking for me:

http://nhsblogdoc.blogspot.com/2008/12/nurse-specialists-tale.html

Even "nurse-specialists" themselves have realised this is just New Labour nonsense.

using Crippen as evidence ?

the man quite simply has not got a clue , he is threatened by any change to the status quo that sees Doctors as prima inter pares of the team

the whole 'noctors' thing is spin by those in the medical profession who realise that their sacred position is under threat and that they hope that appealing to emotion will hide the evidence base.

Reply 77

InArduisFouette

puddlejumper

But surely she was doing nothing that a physiotherapist couldn't have done? And to be honest, I think in that situation it would have been more appropriate to call in a physio.

a situation which historically would have been played out as such

respiratory physio " not my ward"

ortho physios " we don't do snot that's why we do ortho "

As for liasing with the medical team, surely ANY nurse can do that? I always thought that one of the major purposes of a nurse was to act as a link between the doctor and the patient. Are you seriously saying that if you are on a ward caring for people with measles you would want a nurse specialist to come and help if a patient developed chicken pox? Surely the principles of care are identical?

in that case why don';t we go back to there being just four types of doctors ? 'physicians' , 'slashers', 'carpenters' and 'gassers' ? as after all the principles are just the same ?

do you really expect Nursing staff on an elective ortho ward to be as fluent in Blood gases as critical care , emergency care or respiratory Nurses ? do you expect all health professional to have as good an ability to read an ECG as cardiology staff whether medical ,nursing or Healthcare scientist/ clinical physiologist?

Reply 78

InArduisFouette

ThisLittlePiggy

What is non medical prescribing?

'medical prescribing' is the prescribing of drugs , foods for special medical purposes, certain medical devices and dressings undertaken by Medical practitioners and Dental surgeons, it is an integral part of their pre-registration education and training

' non-medical prescribing' is the prescribing of drugs , foods for special medical purposes, certain medical devices and dressings undertaken by Nurses, Midwives and Pharmacists, it is NOT an integral part of their pre-registration education and training, the preparation for practice is at masters level and builds on the pharmacology and medicines management knowledge obtained pre-registration, in the period of clinical experience required post registration before applying to become a prescriber in addition to the the learning , supervised practice and assessments undertaken in the Masters level programme which , if successfully completed leads to prescriber status.

while certain posters in the thread seem to imply that it is somehow dangerous that non medical prescribers are given , in law, access to the complete formularly, the exact same concerns apply to FY2s and to Doctors of any grade without recent experience outside their own speciality ..

Reply 79

InArduisFouette

John Locke

because Junior Doctors (and even Seniors) have a horrid habit of making inappropriate prescribing decisions and the Nurses and Pharmacists are expected by 'the system' to spot , prevent and resolve these inappropriate decisions before harm comes to the patient, the person who dispenses or administers the medication has as much if not more accountability in the eyes of the law - and no excuse of inexperience).

I don't have the exact figures to hand but outside of intrathecal Chemo and anaesthesia the amount of medication actually administered by Doctors is vanishingly small compared to that administered (or whose administration is managed by e.g. PCA) by Nurses , midwives,and ODPs ...