Tuesday, 28 August 2007

The slippery slope

The government's drive to empower less trained professionals continues, as prescribing powers are being handed out to more and more non medically trained workers. Optometrists are the latest to be handed extended powers, strangely it seems that the government thinks this is a good move for patients. I fail to see how handing prescribing powers to people without proper medical training in diagnosis, basic science and pharmacology can be safe.

More worryingly the government is also intent on handed extended prescribing powers to nurses, another dangerous move given that these 'specialist' nurses only have a ridiculous 26 days training which then magically turns them into safe prescribers. The government's reasoning seems to be that this move will free up doctor time, however the evidence points the other way with it arguably being more likely that more time will be spent mopping up after the nurse's mistakes.

This incredibly dangerous dumbing down sees a nurse handed extended prescribing powers after a brief 26 day course. The safety mechanisms in place to monitor the carnage are surprisingly non-existent, as seems always the way when the government tries to convert nurses into budget doctors. It will simply be left for the nurses to assess and police their own competence, a bit like allowing an air hostess to fly the plane and only call for help when he/she sees fit. The nursing regulatory authorities seem to have no concern for patient safety, as they allow the under trained and undereducated to have a crack at things that they are not adequately prepared for.

There seems to be a recurring theme here, the government sees it as progress to continue to empower workers with lower and lower levels of education a and training. This is allegedly all being done for patients. It is rather obvious to anyone with more than a small cluster of grey cells that this is a very disingenuous line to take. More power and responsibility being handed down to those who are not as adequately prepared for it is not progress, it is a regression that shows only a contempt for the high standards in medical care that we should be aspiring too. Poly-clinics, walk in centres and all these gimmicky new schemes are all part of this dumbing down of standards; it is simply shoddy health care on the cheap.


the A&E Charge Nurse said...

Ferret, I see you continue to be haunted by your usual demons ?

Nurses have [in reality] been "prescribing" for years - the practice was simply dressed up as something else [patient group direction or PGD].
Under this regime a ?gormless, ?unethical, ?burnt out consultant would accept vicarious liability for the fiendish drug related activities of his/her quack underlings.

I have yet to see any evidence that patients have been harmed as a result of PGDs - although I would have thought that the research evidence would have been overwhelming if quacks were anywhere near as dangerous as Ferret suggests, but I digress.

Take A&E, quacks have PGDs for local anaesthetics, antibiotics, analgesics, tetanus, antihistamines, etc, etc, and pretty safe we are too, most of the time - in fact I can't even remember the last asthmatic I killed with an NSAID ;-)

The current guidelines on nurse prescribing will continue to restrict nurses to doleing at drugs that are particular to their particular sphere [see above for the A&E example].
Hospital Trusts determine what [nurse prescribing]practices will or will not be sanctioned, so perhaps they too are complicit with endangering patients ?

Relax Ferret, the quacks are merely grubbing on the periphery, nurses are quite content to let the doctors carry on bumping the patients off [joke, obviously].

Garth Marenghi said...

AE Charge Nurse, I agree to an extent, but there are some dangers.

True, many nurses are very wary of straying outside their small spheres of safe prescribing.

However the point is that if nurses are unsafe and lack insight into their lack of training, then they will be able to prescribe rather freely well outside of their small sphere of so called competence.

The majority may be sensible and relatively safe within small prescribing fields, the problem is that this new legislation opens up room for more clinical risk.

The argument for some specialist nurses to have small fields for prescribing is far stonger than the argument that these nurses should have full prescribing rights after very minimal amounts of training.

I see where you're coming from though.

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