Saturday, 17 October 2009

Numpetry in the NHS; the Walk in Centre Quacks

"Am on call this weekend as a ENT reg and received a call from a "Senior Nurse Practitioner"(her words) in a local walk in centre. She had seen a chap in his seventies with hearing loss for the last week.She had examined both his ears and had found nothing abnormal.
Upto this point, no problems with the conversation. She then proceeded to tell me that she wanted me to admit him and arrange an urgent scan.
She did not have any idea of what type of hearing loss he had. She had never heard of Rinne's or Weber's and got very annoyed when I proceeded to question her further. According to her, she had been taught that sudden hearing loss required a scan as this could be an acoustic neuroma.
Before the usual Noctor supporters on DNUK jump up and say that I should have just accepted to see the patient, I did tell her that she could send the chap to the hospital and he would be assessed by my SHO and me.
But she insisted that he needed to be admitted and scanned. Oh and proceeded to ask for my GMC number.
I am normally a patient person when it comes to dealing with stupid fools but this really annoyed me. However I managed to stop myself from swearing at her down the phone and spoke to one of the doctors in the same centre. He was a locum chap who saw the patient and examined him properly and called me back.
The patient had actually had a cold and developed a conductive hearing loss over the last week.And he is going to come to the ENT clinic next week for an audio and review.What I can't understand is how these poorly trained idiots are allowed to work without supervision? What are the assessment criteria for them to be certified to work in a independent/semi-independent environment?And if they cause such trouble for small specialities like ENT, how much of a hassle do they cause other, busier specialities. "

The above tale is one of many that happen on a regular basis in the NHS. Before the same old trot is rambled out in defence of empowering the ignorant, I am not insulting anyone without a medical degree. I am talking of any worker who is empowered way beyond their means. This includes GPs who try to do the job of consultants after hardly any extra training, they then call themselves GPSIs and try to work as specialists. This includes several varieties of nurse specialist who are employed in roles in which they have to work as general physicians, they simply do not have the knowledge or training for these roles. Walk in Centres sum up the inefficiency of the new privatised NHS, there is no continuity for patients, there is precious little training for staff and these centres cost a hell of a lot of money for the appalling quality work they do.

At the same time as the ignorant are empowered and overpaid, we have people with a lot of training who are wasting their time carrying out menial tasks when they could be doing other more productive things. It certainly appears that a lot of proper nurses are rather appalled by what is going on, it seems that these days proper nursing is being completely neglected and basic standards are not being maintained on the wards:

"All of the above may be true for a minority of senior nurses but unfortunately the vast majority of band 5/6 nurses seem to have lost the plot. They can no longer prioritise work effectively, they cannot safely administer medications, they cannot measure and record patient observations correctly or add up simple MEWS scores correctly and they cannot recognise the signs of a deteriorating patient. Lets get the basics right before we disappear up our own backsides."

Quite right.


DHS said...

Isn't the answer (on the phone) to these people like the answer to a PRHO who wants to do something stupid? "Get your SHO/registrar/consultant to see the patient, then call me."

The problem is when people without adequate training are working unsupervised, so the answer is "to do that I'd have to call the consultant in from home, and then she'll yell at me". I think the yelling is justified:

Militantmedicalnurse said...

Band 5 and 6 nurses are general ward RN's like me..... otherwise known as run of the mill qualified nurses.

Anything below band 5 is not even a nurse but actually a health care assistant. The quacks are band 7 and above. We call them band twat.

Nurse Anne said...

Oh and there is no way to prioritize and work effectively, safely administer meds, do observations or spot a deteriorating patient when you ward is staffed with 2 RNs and a couple of 16 year old kids. It is physically impossible.

Militantmedicalnurse said...

Let me put it this way. If I am the only RN for 15 patients my enire shift goes something like this:

45 minutes out of every single hour of my shift is taken up with phonecalls and interruptions from relatives. 10 minutes out of every hour are taken up with phone calls from target driven managers.

In the 5 minutes of every hour that is left I have to hit the high priority stuff like implementing doctors orders.

If 11 of my patients are on IV antibiotics then every 4 hours or so I have to spend about an hour mixing, preparing and setting up and infusing them at the speed of light.

That is a normal shift.

Guess who is getting on with the obs, fluid balance charts and patient care? 16 year old illiterates who cannot add and do not realise that a pulse of 190 as well as shortness of breath and no urinary output is a sign of a problem. That is who.

The band 5 and 6 nurses want rid of the kids and the untrained. We want a manageable number of patients and we realise that we need to do total patient care in order to succeed. The only way to do it is to control staffing properly.

The nurses did not want it to get this bad. They fought against the idea of staffing the wards with untrained kids. They predicted that care would go down the drain when they started using untrained staff to do the care whilst the RN had so many patients that she is run ragged.

This is not how the nurses wanted it to be. We all hate delegating so much to the untrained but we don't have a freaking choice.

Night nurse said...

In my place of work, whenever a resident needs a prescribed wound dressing, a tissue viability nurse will be sent to the home by the GP practice. No problem with this - always eager to learn of new treatments. A minority of said nurses however, insist on overseeing us idiots dressing the wound for a week or two, to see if we are competent. Grrr - the resentment this brings.

Going off on a tangent here. OOH GP services are abysmal. If we are concerned about a resident, we contact this service. It is a rare occasion a GP will visit. We are told to ring the emergency services as it is OBVIOUS THIS IS NEEDED! We do this. Not always the case, but more often than not, grumpy ambulance men - sorry it is always the men - arrive in the belief that we are one of the homes that never contact a GP and just phone 999. Their manner and body language is atrocious.

Among the paperwork we send is information that WE DID contact the OOH service. The hospital doc will phone for further info and we again impress that we contacted the OOH service first. They tell us this is quite common. A carer must accompany the resident to hospital. This leaves the home staffing levels 20% down. Eighty percent of these residents return to the home in the same night shift.

Some social workers get on my wick too. Definitely ideas above their station and attempt to override a consultants decision about where he thinks his/her patient will be best placed.

Some GPs get on my nerves too, but I think I've ranted enough.

Uppity speciality nurses, lazy OOH doctors, ambulance staff with attitude, snotty social workers and some GPs make what should be a pleasant job rather stressful at times. Don't get me wrong, some of us common or garden nurses can be a pain too.

Garth Marenghi said...

night nurse and militant medical nurse,

i agree about OOH care, the fact that GPs don't cover their own patients anymore and have been replaced by cash hunting locums is not good for patients/and/or continuity of care

i feel for proper ward nurses, it's a complete disgrace how bullsh*t and the dumbing down have led to nursing being devalued and so many nurses encouraged away from what they are most skilled in

Anonymous said...

I think you should query any nurse who calls themselves a 'nurse practitioner' about their qualifications that merit an NP title. It is NOT a protected title and any ol' nurse can call themselves an NP. Often a name badge is sufficient to bestow the title. In some instances one or two educational modules (eg physical examination without any deeper pathophys,pharmacology etc) accessed in place of of the complete NP programme of education and training.
For info. its a further 3 years for a senior nurse plus clinical supervision with medical trainer. The NMC drags its feet on licensing the title so you have no way of checking + lol their mission mantra is 'protecting patients'. Elio