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Whats the real difference between a Doctor and a Nurse?
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Original post by brutuswood
No personal attack intended. I am sorry I hadn't realised that you were male or a student nurse (the former makes no difference the latter probably does). Res ipse loquitor (COI Female doctor 50 + Cambridge graduate). Best wishes for your career as a nurse.
Apology, of course, accepted. Best wishes to you too
While i wouldn't feel comfortable saying that doctors don't care enough about the individual and don't have the same holistic care training as nurses do (maybe they do), i would think that perhaps a doctor's purpose is to provide the bulk if the medical, biological know how to prevent disease and life-threatening emergency and the nurse is there to observe changes in physical condition (or mental) and use more person-centred skills to care for the individual. In my experience, doctors come onto wards to check in with patients once in a while, whereas nurses are there all the time and can get to know the person behind the illness better.
Specialist nurses are amazing and know their area extremely well. But they don't have the same overarching clinical knowledge or clinical skill as a senior doctor.
But hospitals couldn't run without both nurses and doctors and we have to appreciate each other's skills and attributes.
I say this as both a nurse and a med student
Posted from TSR Mobile
But hospitals couldn't run without both nurses and doctors and we have to appreciate each other's skills and attributes.
I say this as both a nurse and a med student
Posted from TSR Mobile
Exactly. I have been closely involved in the regulation of both nurses and doctors at a senior level (NMC and GMC ). It is of genuine concern, not just to me I should add, that some (and it is a minority, often relatively junior) nurses don't fully understand their limitations. In my role I sometimes have to instruct nursing experts in clinical negligence claims and they will confine themselves to expertise in nursing care rather than attempt to be mini doctors. Most nurses do understand their limitations and are proud to be nurses rather than trying to be doctors (or some do go and read medicine)
Original post by Etomidate
Whatever happened to the pride in being a nurse and actually nursing patients instead of being a Specialist Advanced Nurse Consultant Practitioner?
Pride has nothing to do with it.
You can't really expect someone to remain a staff nurse until they retire, surely? There has to be a level of progression within the career, else you end up with dissatisfied employees. Progression in nursing traditionally meant working up to Matron, but really it becomes a managerial role and isn't attractive to all. I've found this to certainly be the case for those who enter nursing for the increased patient/clinical contact.
Both professions demand ambitious and determined people, to expect them to not progress in the career is farcical.
Original post by Etomidate
You're reading an american article written by a noctor. I would take it with a pinch of salt.
The rough and short of it is as follows:
Senior doctors
Make management decisions (starting/stopping non-basic meds, operations etc)
Request advanced investigations
Interpret said investigations
Perform various advanced practical procedures on the wards
Make decisions regarding discharge & follow-up
Make decisions regarding monitoring & hospital location (ward, HDU, ITU)
Run outpatient clinics/theatre lists/endoscopy lists etc etc
Junior doctors
Do initial clerking of patients
Instigate basic investigations (bloods, imaging)
Formulate an initial diagnosis
Initiate first few steps of management
Perform various basic practical procedures on the ward (cannulas, ABGs & catheters mainly)
Review blood results and manage/escalate accordingly
Organise the management requested by the senior
Organise notes and paperwork for all the above
Organise referrals, TTOs, drug kardexes etc
Firefight on a large number of wards overnight
Rearrange deckchairs on the titanic
Nurses
Responsible for administering medications & fluids
Responsible for basic care of the patient
Take vital observations of the patient
Recognise deterioration & know when to escalate care
Can also perform practical procedures here and there (bloods, cannulas, catheters, ECGs)
Often the ones who communicate with families the most & nitty-gritty of discharge planning
Probably many other unseen things which actually keep the wards together, but I am entirely ignorant of
However, in the UK, these boundaries are becoming increasingly blurred as we see more specialist nurse practitioners who are very skilled in their area of medicine/surgery and can act relatively independently with consultant input as needed.
The rough and short of it is as follows:
Senior doctors
Make management decisions (starting/stopping non-basic meds, operations etc)
Request advanced investigations
Interpret said investigations
Perform various advanced practical procedures on the wards
Make decisions regarding discharge & follow-up
Make decisions regarding monitoring & hospital location (ward, HDU, ITU)
Run outpatient clinics/theatre lists/endoscopy lists etc etc
Junior doctors
Do initial clerking of patients
Instigate basic investigations (bloods, imaging)
Formulate an initial diagnosis
Initiate first few steps of management
Perform various basic practical procedures on the ward (cannulas, ABGs & catheters mainly)
Review blood results and manage/escalate accordingly
Organise the management requested by the senior
Organise notes and paperwork for all the above
Organise referrals, TTOs, drug kardexes etc
Firefight on a large number of wards overnight
Rearrange deckchairs on the titanic
Nurses
Responsible for administering medications & fluids
Responsible for basic care of the patient
Take vital observations of the patient
Recognise deterioration & know when to escalate care
Can also perform practical procedures here and there (bloods, cannulas, catheters, ECGs)
Often the ones who communicate with families the most & nitty-gritty of discharge planning
Probably many other unseen things which actually keep the wards together, but I am entirely ignorant of
However, in the UK, these boundaries are becoming increasingly blurred as we see more specialist nurse practitioners who are very skilled in their area of medicine/surgery and can act relatively independently with consultant input as needed.
The other difference being a Staff Nurse will generally be responsible for one bay e.g. 8 -10 (can be less can be more obviously) on one ward whereas a junior doctor will be looking after all the patients for either one consultant/specialty and after 5 if you're on call can be much larger - e.g. on medicine on calls you may cover 100+ patients + bringing in new patients.
Original post by Zorg
Pride has nothing to do with it.
You can't really expect someone to remain a staff nurse until they retire, surely? There has to be a level of progression within the career, else you end up with dissatisfied employees. Progression in nursing traditionally meant working up to Matron, but really it becomes a managerial role and isn't attractive to all. I've found this to certainly be the case for those who enter nursing for the increased patient/clinical contact.
Both professions demand ambitious and determined people, to expect them to not progress in the career is farcical.
You can't really expect someone to remain a staff nurse until they retire, surely? There has to be a level of progression within the career, else you end up with dissatisfied employees. Progression in nursing traditionally meant working up to Matron, but really it becomes a managerial role and isn't attractive to all. I've found this to certainly be the case for those who enter nursing for the increased patient/clinical contact.
Both professions demand ambitious and determined people, to expect them to not progress in the career is farcical.
That's all well and good, but I don't understand the eagerness to distance themselves from the traditional nursing roles so readily and so aggressively, as demonstrated in this thread. Especially when the specialist uber-nurse roles compose a small minority relative to the general nursing population.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
(edited 9 years ago)
Original post by Etomidate
That's all well and good, but I don't understand the eagerness to distance themselves from the traditional nursing roles so readily and so aggressively, as demonstrated in this thread. Especially when the specialist uber-nurse roles compose a small minority relative to the general nursing population.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
Perhaps because nursing is no longer what it traditionally was. Roles have moved on from fast paced bed making and bandage washing skills to include some level of autonomy. Similarly doctors are not the pompous wealthy men barking orders at others.
Labelling it as lost pride or distancing themselves from their true role is to ill represent their role. There are aspects of a patient's care which most doctors haven't a clue about, yet the nurses co-ordinate them with little input.
Even in the traditional roles of a nurse, she/he may not be involved in the medical/surgical decisions of the patient's care, but to infer she has no autonomy is ludicrous. And I don't mean what colour blanket to make the bed with.
Original post by Etomidate
That's all well and good, but I don't understand the eagerness to distance themselves from the traditional nursing roles so readily and so aggressively, as demonstrated in this thread. Especially when the specialist uber-nurse roles compose a small minority relative to the general nursing population.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
To be fair, my backs that spannered form manual handling and long shifts that I walk like him at times
I'm a nurse, I'm proud to identify as one. I like being able to use "traditional" nursing skills, delivering personal care, spending times developing relationships talking to patients and their families. While I'm lucky in the environment I work in, unfortunately a lot of this work has been taken away from nurses and given to HCAs while nurses are sat at desks, doing risk scores for pretty much everything and then some risk scores to assess the risk of risk scores not being done (exaggeration). In a lot of ward environments, career progression means becoming a sister, ending up stuck in an office writing the off duty and dealing with complaints and other corporate stuff and rarely getting the opportunity to spend time directly caring for patients. I didn't go into nursing for that, so a lot of specialist roles start to look attractive to nurses who want to be able to keep hands on with patients.
Original post by Etomidate
That's all well and good, but I don't understand the eagerness to distance themselves from the traditional nursing roles so readily and so aggressively, as demonstrated in this thread. Especially when the specialist uber-nurse roles compose a small minority relative to the general nursing population.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
From some of the descriptions posted, if I were completely ignorant, I would assume that the day-to-day life of most nurses is something like being House MD.
eagerness to distance themselves from traditional nursing roles ?
how about eagerness to point out that RNs are not just 'bum-wipers who push pills' without the ability to carry out the full range of skills open to them from their current core competencies , never mind the expansion and extension of role away from core competencies at registration and things that are increasingly seen as core competencies for anyone with more than a modicum of post -reg experience.
the attitude displayed by some medicla students and junior doctors towards the importance of their role on call is laughable , altjhough interestingly some Organisations re-inforce this with the way in which they demand doctors 'prescribe' cannulas or tests rather than ensuring that areas where there is a problem with less than approoriate use recieve corrective teaching and reminders of the evidence base for certain things.
I would also suggest that people familiarise themselves with the following documents before passing judgement on what is and is not within the remit of the RN.
http://standards.nmc-uk.org/Documents/Pre-registration%20nursing%20education%20in%20UK%20FINAL%2006092010.pdf
http://www.nmc-uk.org/Documents/Standards/Standards%20for%20competence.pdf
http://standards.nmc-uk.org/PreRegNursing/statutory/background/Pages/introduction.aspx
Original post by zippyRN
eagerness to distance themselves from traditional nursing roles ?
how about eagerness to point out that RNs are not just 'bum-wipers who push pills' without the ability to carry out the full range of skills open to them from their current core competencies , never mind the expansion and extension of role away from core competencies at registration and things that are increasingly seen as core competencies for anyone with more than a modicum of post -reg experience.
the attitude displayed by some medicla students and junior doctors towards the importance of their role on call is laughable , altjhough interestingly some Organisations re-inforce this with the way in which they demand doctors 'prescribe' cannulas or tests rather than ensuring that areas where there is a problem with less than approoriate use recieve corrective teaching and reminders of the evidence base for certain things.
I would also suggest that people familiarise themselves with the following documents before passing judgement on what is and is not within the remit of the RN.
http://standards.nmc-uk.org/Documents/Pre-registration%20nursing%20education%20in%20UK%20FINAL%2006092010.pdf
http://www.nmc-uk.org/Documents/Standards/Standards%20for%20competence.pdf
http://standards.nmc-uk.org/PreRegNursing/statutory/background/Pages/introduction.aspx
how about eagerness to point out that RNs are not just 'bum-wipers who push pills' without the ability to carry out the full range of skills open to them from their current core competencies , never mind the expansion and extension of role away from core competencies at registration and things that are increasingly seen as core competencies for anyone with more than a modicum of post -reg experience.
the attitude displayed by some medicla students and junior doctors towards the importance of their role on call is laughable , altjhough interestingly some Organisations re-inforce this with the way in which they demand doctors 'prescribe' cannulas or tests rather than ensuring that areas where there is a problem with less than approoriate use recieve corrective teaching and reminders of the evidence base for certain things.
I would also suggest that people familiarise themselves with the following documents before passing judgement on what is and is not within the remit of the RN.
http://standards.nmc-uk.org/Documents/Pre-registration%20nursing%20education%20in%20UK%20FINAL%2006092010.pdf
http://www.nmc-uk.org/Documents/Standards/Standards%20for%20competence.pdf
http://standards.nmc-uk.org/PreRegNursing/statutory/background/Pages/introduction.aspx
There are numerous junior doctors and medical students contributing to this thread with great respect and awareness for the role of the nursing staff. You are being a little condescending in your approach. Both sides should be showing professionalism and respect, it's a no brainer. If you wish for more respect you must equally provide it.
Zippy comments that nurses aren't ''bum wipers who push pills''. Firstly, personal care is one of the most important aspects of nursing. I do hope that if Zippy is ever old or incapacitated there is someone to provide intelligent and compassionate care. Secondly, medication is hugely important and an area subject to significant error. Frankly the arrogance is staggering. I am a senior doctor married to a very eminent consultant surgeon. He would always involve himself in the very basic aspects of care if it wasn't being done, good compassionate nursing care is so crucial and important (I can recall him with cases where the patient didn't feel like eating helping them and finding them something tempting, an anecdote but important.) Personally I make a point of never asking someone to do a boring or unpleasant task I wouldn't be prepared to do myself, both in my professional life (and in my domestic life).
There is a real issue among some, mainly young, nurses that somehow they are too grand to do these things. It is very worrying.
To turn to the thread content I would take most note of Forest Cat who is a qualified nurse now a medical student. She is probably the most qualified person on this thread to comment on these issues having a dual nursing / medical background. She talks a lot of sense....Zippy listen to her.
There is a real issue among some, mainly young, nurses that somehow they are too grand to do these things. It is very worrying.
To turn to the thread content I would take most note of Forest Cat who is a qualified nurse now a medical student. She is probably the most qualified person on this thread to comment on these issues having a dual nursing / medical background. She talks a lot of sense....Zippy listen to her.
Original post by zippyRN
how about eagerness to point out that RNs are not just 'bum-wipers who push pills'
how about eagerness to point out that RNs are not just 'bum-wipers who push pills'
Nobody claimed this, so you shouldn't feel so eager to point this out.
This is kind of what I'm saying. There is no need to take a defensive position from the get-go. We all have great respect for nurses.
Original post by brutuswood
Zippy comments that nurses aren't ''bum wipers who push pills''. Firstly, personal care is one of the most important aspects of nursing. I do hope that if Zippy is ever old or incapacitated there is someone to provide intelligent and compassionate care. Secondly, medication is hugely important and an area subject to significant error. Frankly the arrogance is staggering. I am a senior doctor married to a very eminent consultant surgeon. He would always involve himself in the very basic aspects of care if it wasn't being done, good compassionate nursing care is so crucial and important (I can recall him with cases where the patient didn't feel like eating helping them and finding them something tempting, an anecdote but important.) Personally I make a point of never asking someone to do a boring or unpleasant task I wouldn't be prepared to do myself, both in my professional life (and in my domestic life).
There is a real issue among some, mainly young, nurses that somehow they are too grand to do these things. It is very worrying.
To turn to the thread content I would take most note of Forest Cat who is a qualified nurse now a medical student. She is probably the most qualified person on this thread to comment on these issues having a dual nursing / medical background. She talks a lot of sense....Zippy listen to her.
There is a real issue among some, mainly young, nurses that somehow they are too grand to do these things. It is very worrying.
To turn to the thread content I would take most note of Forest Cat who is a qualified nurse now a medical student. She is probably the most qualified person on this thread to comment on these issues having a dual nursing / medical background. She talks a lot of sense....Zippy listen to her.
Thankyee
You're right though. Nursing at its fundamentals is about personal care, getting to know your patient so you can spot the tiny changes that indicate a deterioration, care and compassion. So many of my colleagues miss being able to do personal care but are so snowed under with paperwork and bureaucracy that they do not get the time to do it that they should. That said I am all for nurses getting extended skills (cannulation etc) and knowledge but this should always be in addition to the fundamentals of nursing care not replacement of.
Original post by Etomidate
Nobody claimed this, so you shouldn't feel so eager to point this out.
This is kind of what I'm saying. There is no need to take a defensive position from the get-go. We all have great respect for nurses.
This is kind of what I'm saying. There is no need to take a defensive position from the get-go. We all have great respect for nurses.
Etomidate, I'm glad to see that you have great respect for nurses. It's a shame, however, that not everyone on this forum here has the same level of respect as you do. See brutuswood's post addressed to me on 04/01/15 at 22:47 where she brands an attitude she perceives me to have, to be causing my practice to be "Fundamentally unsafe". This is despite the fact she has never worked alongside me, and that no colleagues of mine have ever branded my practice anywhere near such. Although brutuswood has apologised, and I have accepted this and all is well between us, it remains that it was a very disrespectful comment to make. This is just one example of this attitude.
I am also disappointed to read that there is a perception that nurses (Especially the younger ones, apparently) no longer value the fundamentals of care we deliver. I obviously can't speak for anyone else particularly, however I, as a 20 year old student nurse am most certainly not "too posh to wash" or anything of the sort.
I came into nursing in full knowledge that this privelege to care for someone in this way, while promoting their dignity, gaining their trust, empowering them to self-care where appropriate, and make choices in relation to this care, was a key element of my role.
I think what ZippyRN may be trying to explain to you is this: The remit of a nurse has not moved upwards, and away from fundamental care, but has expanded upwards, still including and underpinning fundamental care, but also to now incorporate advanced roles such as prescribing, venepuncture etc.
(edited 9 years ago)
Original post by ForestCat
Thankyee
You're right though. Nursing at its fundamentals is about personal care, getting to know your patient so you can spot the tiny changes that indicate a deterioration, care and compassion. So many of my colleagues miss being able to do personal care but are so snowed under with paperwork and bureaucracy that they do not get the time to do it that they should. That said I am all for nurses getting extended skills (cannulation etc) and knowledge but this should always be in addition to the fundamentals of nursing care not replacement of.
You're right though. Nursing at its fundamentals is about personal care, getting to know your patient so you can spot the tiny changes that indicate a deterioration, care and compassion. So many of my colleagues miss being able to do personal care but are so snowed under with paperwork and bureaucracy that they do not get the time to do it that they should. That said I am all for nurses getting extended skills (cannulation etc) and knowledge but this should always be in addition to the fundamentals of nursing care not replacement of.
I'll be honest, I've not agreed with everything you've said on this forum, ForestCat, however that was absolutely spot on.
I need some of you guys in my hospital, because nurses who want to take blood, cannulate, site NGs etc are very few and far between here. They're all labelled as "doctors jobs", often to the detriment of patients. I've even heard of a few refusing to do ECGs, though i think that's probably more a case of the doctor asking for it not going about it the right way as i've never had a problem.
I've lost count of the number of times i've had a call on a night shift to cannulate a patient for IV antibiotics, and because i've been unable to get there soon enough they've missed a dose. And if you ask if anyone on the ward can do it it's always the same old "I'm not trained to do that" slogan, even though i know for a fact all the young SNs have done at least one at some point in their training.
I don't say this to have a dig at nurses specifically either, it's very much a cultural thing which has been referenced in this thread already. There seems to be an endemic rigidity in nurse training which promotes being extremely litigation conscious. The amount of minutely small decisions which even experienced staffs will come to me with to cover their own backs is just daft sometimes, but i can't show exasperation about it because A: I'd get a reputation as the "unhelpful doctor", and B: I don't want them not coming to me to ask advice when something genuinely important does come up.
The problem is, as with the cannulation/Abx example above, often patients can suffer as a result of this rigidity. The other night I had a guy known to have a GI bleed who was haemodynamically stable previously on an 8 hourly bag of IVT start to drop his BP. I get the phonecall to let me know, and when i ask for the IVT to be sped up before i come down to RV i get "I can't do that, it's written up 8 hourly, you'll have to change the chart and sign it". Despite my assurances that i would as soon as i got there, it still wouldn't be done beforehand, so that patient went without adequate fluid resus until i got to the ward. Is it me or is that just madness?
Sorry for the ranting nature of this post, and i know these are specific examples which don't necessarily represent all nurses, but this inability to show flexibility in the patients best interest is, to get back to the theme of the thread, often one of the differences i notice between Drs and nurses. But i recognise the irony in me complaining about this, whilst Brutuswood is talking about issues with some young nurses overestimating what they are competent to do (I could write a whole other post on that, administering the same dose of Fruse IV instead of oral because "it's easier" anyone?), but there's a balance to be struck there that seems to be being missed by many in my opinion.
I've lost count of the number of times i've had a call on a night shift to cannulate a patient for IV antibiotics, and because i've been unable to get there soon enough they've missed a dose. And if you ask if anyone on the ward can do it it's always the same old "I'm not trained to do that" slogan, even though i know for a fact all the young SNs have done at least one at some point in their training.
I don't say this to have a dig at nurses specifically either, it's very much a cultural thing which has been referenced in this thread already. There seems to be an endemic rigidity in nurse training which promotes being extremely litigation conscious. The amount of minutely small decisions which even experienced staffs will come to me with to cover their own backs is just daft sometimes, but i can't show exasperation about it because A: I'd get a reputation as the "unhelpful doctor", and B: I don't want them not coming to me to ask advice when something genuinely important does come up.
The problem is, as with the cannulation/Abx example above, often patients can suffer as a result of this rigidity. The other night I had a guy known to have a GI bleed who was haemodynamically stable previously on an 8 hourly bag of IVT start to drop his BP. I get the phonecall to let me know, and when i ask for the IVT to be sped up before i come down to RV i get "I can't do that, it's written up 8 hourly, you'll have to change the chart and sign it". Despite my assurances that i would as soon as i got there, it still wouldn't be done beforehand, so that patient went without adequate fluid resus until i got to the ward. Is it me or is that just madness?
Sorry for the ranting nature of this post, and i know these are specific examples which don't necessarily represent all nurses, but this inability to show flexibility in the patients best interest is, to get back to the theme of the thread, often one of the differences i notice between Drs and nurses. But i recognise the irony in me complaining about this, whilst Brutuswood is talking about issues with some young nurses overestimating what they are competent to do (I could write a whole other post on that, administering the same dose of Fruse IV instead of oral because "it's easier" anyone?), but there's a balance to be struck there that seems to be being missed by many in my opinion.
Original post by hoonosewot
I need some of you guys in my hospital, because nurses who want to take blood, cannulate, site NGs etc are very few and far between here. They're all labelled as "doctors jobs", often to the detriment of patients. I've even heard of a few refusing to do ECGs, though i think that's probably more a case of the doctor asking for it not going about it the right way as i've never had a problem.
I've lost count of the number of times i've had a call on a night shift to cannulate a patient for IV antibiotics, and because i've been unable to get there soon enough they've missed a dose. And if you ask if anyone on the ward can do it it's always the same old "I'm not trained to do that" slogan, even though i know for a fact all the young SNs have done at least one at some point in their training.
I don't say this to have a dig at nurses specifically either, it's very much a cultural thing which has been referenced in this thread already. There seems to be an endemic rigidity in nurse training which promotes being extremely litigation conscious. The amount of minutely small decisions which even experienced staffs will come to me with to cover their own backs is just daft sometimes, but i can't show exasperation about it because A: I'd get a reputation as the "unhelpful doctor", and B: I don't want them not coming to me to ask advice when something genuinely important does come up.
The problem is, as with the cannulation/Abx example above, often patients can suffer as a result of this rigidity. The other night I had a guy known to have a GI bleed who was haemodynamically stable previously on an 8 hourly bag of IVT start to drop his BP. I get the phonecall to let me know, and when i ask for the IVT to be sped up before i come down to RV i get "I can't do that, it's written up 8 hourly, you'll have to change the chart and sign it". Despite my assurances that i would as soon as i got there, it still wouldn't be done beforehand, so that patient went without adequate fluid resus until i got to the ward. Is it me or is that just madness?
Sorry for the ranting nature of this post, and i know these are specific examples which don't necessarily represent all nurses, but this inability to show flexibility in the patients best interest is, to get back to the theme of the thread, often one of the differences i notice between Drs and nurses. But i recognise the irony in me complaining about this, whilst Brutuswood is talking about issues with some young nurses overestimating what they are competent to do (I could write a whole other post on that, administering the same dose of Fruse IV instead of oral because "it's easier" anyone?), but there's a balance to be struck there that seems to be being missed by many in my opinion.
I've lost count of the number of times i've had a call on a night shift to cannulate a patient for IV antibiotics, and because i've been unable to get there soon enough they've missed a dose. And if you ask if anyone on the ward can do it it's always the same old "I'm not trained to do that" slogan, even though i know for a fact all the young SNs have done at least one at some point in their training.
I don't say this to have a dig at nurses specifically either, it's very much a cultural thing which has been referenced in this thread already. There seems to be an endemic rigidity in nurse training which promotes being extremely litigation conscious. The amount of minutely small decisions which even experienced staffs will come to me with to cover their own backs is just daft sometimes, but i can't show exasperation about it because A: I'd get a reputation as the "unhelpful doctor", and B: I don't want them not coming to me to ask advice when something genuinely important does come up.
The problem is, as with the cannulation/Abx example above, often patients can suffer as a result of this rigidity. The other night I had a guy known to have a GI bleed who was haemodynamically stable previously on an 8 hourly bag of IVT start to drop his BP. I get the phonecall to let me know, and when i ask for the IVT to be sped up before i come down to RV i get "I can't do that, it's written up 8 hourly, you'll have to change the chart and sign it". Despite my assurances that i would as soon as i got there, it still wouldn't be done beforehand, so that patient went without adequate fluid resus until i got to the ward. Is it me or is that just madness?
Sorry for the ranting nature of this post, and i know these are specific examples which don't necessarily represent all nurses, but this inability to show flexibility in the patients best interest is, to get back to the theme of the thread, often one of the differences i notice between Drs and nurses. But i recognise the irony in me complaining about this, whilst Brutuswood is talking about issues with some young nurses overestimating what they are competent to do (I could write a whole other post on that, administering the same dose of Fruse IV instead of oral because "it's easier" anyone?), but there's a balance to be struck there that seems to be being missed by many in my opinion.
I feel your pain! I have never understood the resistance to gaining skills such as this. The skills are not difficult yet they are so helpful and save time and effort in the long run. Yes we are already busy. But why wait several hours, run the risk of missing medications etc because you'd rather wait for a doctor? And doesn't having this skills mean providing better, more efficient care for your patient?
I don't know. I always had it drummed in to me to mind my limitations and I do. I ask for help, I ask to be shown, I ask to be trained and if I can do none of this I don't do it. But some of the limits placed on us seems frankly ridiculous (in terms of training, sign offs etc when compared to how much other AHP/medical staff are expected to do).
Maybe its just me.
Original post by hoonosewot
I need some of you guys in my hospital, because nurses who want to take blood, cannulate, site NGs etc are very few and far between here. They're all labelled as "doctors jobs", often to the detriment of patients. I've even heard of a few refusing to do ECGs, though i think that's probably more a case of the doctor asking for it not going about it the right way as i've never had a problem.
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I have never seen a doctor site an NG. It was always a nurses job where I trained and where I worked. Interesting.
(slightly off topic it always made me laugh on the junior doctors show where they made an amazing fuss about how difficult a procedure placing a ryles tube was.... in a fully conscious, able to swallow patient... hmmm)
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