Monday, 14 January 2008

Who needs doctors?

A lot of information can be gleaned from having a quick butcher's at NHS Jobs, one can see just how advanced the role of nurse practitioner is becoming in certain areas and how the faulty logic behind these schemes works or doesn't work as the case may be.

Starting here with the 'Triage nurse practitioner', so how is someone without proper medical training going to do this job safely; "full competency based training will be provided to support development within the role". Competency based training has become the hallmark of the dumbing down of medical standards, proper qualifications and exams are no longer needed, all that is needed is a bit of on the job 'competency based assessment'.

Moving on to the 'Orthopaedic nurse practitioner', from the job description one learns that this specialist nurse is to 'provide expert orthopaedic clinical knowledge for the multi disciplinary team.' One wonders how on earth the nurse can do this, when they have taken no postgraduate exams in surgery or orthopaedics? Is the nurse meant to have magically osmosed 'expert' knowledge just from being around orthopaedics for a while? Many of the other jobs of this orthopaedic nurse practitioner are very simple mundane jobs that could be done by junior doctors, and I can tell you than junior doctors do not get paid £34,092 - £43,105 for a 37.5 hour week.

Strangely there are quite a few nurse practitioner jobs up for grabs in our wonderful Walk in Centres. These nurse practitioners have quite a tricky job on their hands, one could even say that this kind of job used to only be done by those with a proper medical degree:

"· To receive patients with undifferentiated and undiagnosed conditions in a unpredictable environment

· To work autonomously and give holistic assessment/ interpretation of results/ treatment/ advice resulting in discharge or referral of patients as appropriate.This requires wide range of expertise underpinned by competency based framework"

No surprise here then, this dangerous dumbing down is underpinned by a 'competency based framework', that typical excuse for this unjustifiable dumbing down. A few years ago people would have laughed at me if I had suggested that any old registered nurse should be let loose to do this kind of job diagnosing and managing medical problems in a completely unsupervised fashion. It's too late to laugh now, it's time to be very afraid indeed, there is no need for a medical degree and years of supervised practice, all one needs now is a nursing degree and a 'portfolio of evidence'.

This country has gone stark raving bonkers. We have thousands of junior doctors who will be out of training come August, in fact we already have thousands our of proper training; and at the same time nurses are being dangerously empowered to do the jobs of doctors, jobs that these junior doctors could do much better, and for a significantly smaller amount of cash. Ridiculously at the same time wards are dangerously short of proper nursing staff, meaning that patients are left wallowing in their own filth and hospital acquired infections are left to run amok. Ironically many nurses on the wards have been replaced by Healthcare Assistants, I wonder how long it will be before an experienced HCA is allowed to have a crack at diagnosis?

(I was inspired to write this little rant because I overheard a nurse on the ward bragging about her new job as 'Orthopaedic nurse practitioner', she was delighted that she was to get her own office with her name on the door, she also boasted about the fact that she was now going to be prescribing drugs. It was the way that she boasted about her new responsibilities, like a child boasting about their birthday present, that shocked me; she just saw everything as a bit of fun, there was no sense of the increased responsibility in her chatter. This is the way the role of nurse practitioner frequently works, nurses are handed jobs beyond their means and the buck does not stop with them, they get all the bonuses but none of the pitfalls of this extra responsibility. It is unaccountable dumbing down gone mad. Trust me, you would not want to hear the stories from the coalface of how unprepared these practitioners are for their extended roles.)


BenefitScroungingScum said...

New to your blog via Dr Crippen's. I think specialist nurses do have a role, but the direction things are going in really worries me. I was incorrectly triaged at A&E by a nurse specialist, partly because she didn't have the appropriate clinical skills and partly I think for her own personal reasons. The registrar on duty came and took me from the waiting room into majors after seeing the problems I was having whilst he was attending to other patients. I wrote about it here
I was lucky on that occasion, and I'm very grateful such a good doctor was on duty. I know it's routine for nurses to triage, but the danger came from her poor attitude as much if not more than lack of knowledge.
Bendy Girl

Garth Marenghi said...

Nice account of your trip to AE.

I agree that specialist nurses to have a role to play in some areas, when using their nursing expertise, but they are not good as doctor replacements.

None of us are perfect and it is impossible to be an expert on everything these days as everything becomes more specialised, however doctors are trained for the job of doctor and nurses are not.

More mistakes will continue to made if nurses continue to be empowered in this manner, they simply do not have the broad general training that doctors have to have.

Anonymous said...

Who was it who said that folk in the NHS get promoted until they find themselves incompetent in their position? Instead of having a load of efficiently run wards and well cared for patients we'll have a load of substandard expensive Dr wannabes.

william said...

So a corelation to these thoughts could be transfered to most politicians and other professions as well. Even medical training is basic to a point with experience and on the job training the building blocks for better provision of care. And as usual it's only the grumpy disenters who are complaining. NP in the States.

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