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

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digitalis

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

monitoring is strictly pharmacodynamics rather than pharmacology

the use of PGDs does include pharmacology - because after all 'the level of skill of the ordinary man ... ' will include pharmacological knowledge of the method of action of the drug ...

Reply 81

puddlejumper

zippyRN

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 "

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?

A patient with COPD is more than likely already under the care of a physio based in that hospital. In that case it would be unlikely that they would ever refuse to see their patient with respiratory problems.

As for other physios, if they refused to see the patient and he was to die as a result of not being seen then they would have to answer to their professional body as to why they refused. I personally have never met a physio who would respond to a call out in the way that you describe and if it really is the case in your hospital then you should follow the guidelines for whistle blowers.

As COPD is among the top five diseases in this country a nurse would have to be completely incompetent to not know how to handle this patient and to know when to call for assistance from a physio.

Reply 82

Random.Girl

zippyRN

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).

Pharmacists are expected by the system to do that? Well I should hope so because that's their job!! Pharmacists are there to ensure the clinical appropriateness of each medication for a patient not to dispense them.

Anyway back on topic, I think a good specialist nurse is worth his or her weight in gold! And I have no problem with him or her prescribing in his or her speciality if they have undertaken the training a) to prescribe and b) to become specialised in the area. Why shouldn't they?

Reply 83

Democracy

zippyRN

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.

Is what he said untrue? NO

Remove the chip from your shoulder please, everyone except for a minority of insecure nurses knows that noctors are a disaster.

Reply 84

Phalanges

zippyRN

Would you mind showing this evidence base that proves that 'noctors' are a cost-effective sensible route?

Reply 85

InArduisFouette

Phalanges

Would you mind showing this evidence base that proves that 'noctors' are a cost-effective sensible route?

Reply 86

Subcutaneous

I actually had a bit of an experience with a nurse practitioner today, went to see a doctor 2 weeks ago with very dry, bleeding and tingling lips for a while, and waking me up at night..told me to carry on using vaseline and drinking more water and see how it is in 2 weeks....2 weeks on, the tingling just feels like a constant red raw and my lips are bright red and swollen! Only could get an appointment to see the nurse practitioner at clinic, agreed expecting to be told the same- feeling rather downheartned, and instead of being asked questions about the sensations, pain- when it flares up.

I got asked how uni was going at the moment, how i'm feeling with my relationships, family and even money worries- i just thought she was interested in how i was doing as a student nurse..and after 5 mins of chatting about nursing, work etc- she said, "anna do you realise, when discussing things that have been worrying you, you've been chewing or biting on your lips?" - My lips are like this as ive been stressed and using biting and chewing on the inside of my cheeks and lips when worried and anxious (aka all the time atm!) . I was really given a different perspective to what I had rather than a condition, she asked about me- and as a nurse she's had that indepth patient contact, communication and skills which gather with experience, and the fantastic therapeutic relationship nurses can build, yes doctors sometimes ask how i am at work...but i think her nursing skills, really helped me today!

Reply 87

Phalanges

I bet she's the great-great-granddaughter of Sherlock Holmes.

Reply 88

ThisLittlePiggy

Really, you actually had an encounter with a nurse practitioner that helps make a point about their usefulness? How fortuitous! How fortuitous indeed!

Well, I once had a run in with a nurse after, employing her diagnostic noctor abilities, decided that I was perfectly fine and was attention seeking. Thankfully, a Doctor worked out that I was actually going deaf and wasn't ignoring teachers just for the **** of it. :smile:

Reply 89

digitalis

zippyRN

there is no evidence proving 'noctors' are anything ...

while this may be deemed to be purely semantics it does demonstrate a strong bias and automatic assumption that past practice is inherently correct

a small sample from evidence.nhs.uk that provides evidence that outcomes are at least comparable if not better ...

http://www.library.nhs.uk/HEALTHMANAGEMENT/ViewResource.aspx?resID=246196
This study shows that nurses conducted significantly longer consultations with more investigations ordered and more patients asked to return for followup-lack of confidence in diagnostic skills perhaps?
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?View=Full&ID=22001000560
A very poor quality American study (please see the rife selection bias, unrepresentative study group, completely unrandomised, changing eligibility criteria, a "low power to detect clinically meaningful differences between the study groups"...so basically a waste of time for everyone's purposes.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?View=Full&ID=21997000002
Again, a dubious quality study-outcomes with p values in the region of 0.40 to 0.67?!
http://www.hta.ac.uk/fullmono/mon627.pdf
An interesting study, does show nurses have better communication skills BUT no improvement on health outcomes (no improvement on ETT, no improvement on FEV1, no FVC improvement) yet increased risk of infective exacerbations and hospitalisations with NP cohort!
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?View=Full&ID=22003000623
How can you compare outcomes from a minor injuries unit to a full blown A&E?! The study design forgot one small feature: A&E will see Minor injuries, plus Moderate and Severe and Trauma!

Above all, these studies are not longer than a year each which is hardly statistically significant now is it?

My lips are like this as ive been stressed and using biting and chewing on the inside of my cheeks and lips when worried and anxious (aka all the time atm!) . I was really given a different perspective to what I had rather than a condition, she asked about me- and as a nurse she's had that indepth patient contact, communication and skills which gather with experience, and the fantastic therapeutic relationship nurses can build, yes doctors sometimes ask how i am at work...but i think her nursing skills, really helped me today!

Do you realise how fail this is? For all about "EBM" you bang on about, you use this anecdote as if this "relationship" stuff is only exclusive to nurses! :rolleyes:

Oh and PS, it's a hard life with that fat bursary and no tuition fees isn't it...

Reply 90

digitalis

ThisLittlePiggy

Likewise.

I went to see my local noctor at the walk in centre (after waiting longer than it would have taked to go into the local A&E and get seen by someone I knew!) who advised me to take cod liver oil for my erosive gastritis. Even as a second year, I saw straight through her BS.

******* gobsmacked.

Reply 91

InArduisFouette

digitalis it does help if you look at the full summaries

conclusions from the first piece
"Author's conclusions
The clinical care and health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost-effective than general practitioners."

given the evidence request here was to disprove the assertion that Nurse practitioners provide a Worse service than doctors, your comments and concerns while valid are irrelevant to the discussion and the 'crippen hypothesis' of changing roles in healthcare delivery

the last piece compared minor injuries in both cases - which if you'd read the references correctly you would have noted

Reply 92

InArduisFouette

digitalis

now , now , I thought we weren't doing anecdote ...

Reply 93

digitalis

zippyRN

My dear, you would be wise to look at the minutiae of studies rather than overall conclusions and summaries. If that was all we had to go on, cod liver oil would be a valid treatment for my gastritis based on the "conclusions" of this paper: http://www.springerlink.com/content/r132016j8q832061/

Methinks you need to revise your critical appraisal lectures :rolleyes:

I am well aware that only minor injuries were studied in both cohorts, but you have to look at in context, a la my comments. MIUs see only minor injuries. A&E see a hell of a lot more. Hence staff pressures will be focused towards non-minor injuries as well as minor injuries, affecting outcomes. Can anyone say B-I-A-S?

And of course we are doing anecdotes...we are just not claiming nurses have some magical ability to communicate better just because they are nurses. :rolleyes:

Anything else?

Reply 94

InArduisFouette

digitalis

Methinks you need to revise your critical appraisal lectures :rolleyes:

perhaps you need to consider things in the wider perspective

here is my challenge for you - find any paper that actually proves the 'Crippen Hypothesis' regardless of how poor it is ...

not really the case in a large teaching hospital Emergency Department where staffing is protected between minors and majors

And of course we are doing anecdotes...we are just not claiming nurses have some magical ability to communicate better just because they are nurses. :rolleyes:

Anything else?

attempting to 'prove' your point with anecdote while criticising others for using anecdote is behaviour which as well as being unacceptable reinforces a stereotype which can have rather unpleasent consequences ... as the last Senior Doctor who tried such a stunt on me found out ... and resulted in him 'resigning' from a management role in a healthcare organisation ...

Reply 95

Phalanges

zippyRN

The important phrase in that conclusion is "if nurses are able to maintain...". That's not a conclusion, there's no conclusive findings there. It's the kind of phrase you'd expect to find in an article on the subject, not a scientific paper. And it's that phrase which shows the bias of the paper - notice that the same conclusion could be written as "It is unlikely that nurses will be able to maintain the benefits, and their consultation referrals are unlikely to be reduced, so GPs will be more cost effective".

A scientific study which allows for it's pivotal conclusion to be rewritten and completely reversed in order to suit the writers' own bias is not a good study.