Nurse led-services protect patients from quirky clinicians?
8-Sep-2009 10:41 am
A leading professor has told Nursing Times that nurses should not be taking decisiond to change treatment, and criticised the “slavish” following of guidelines and protocols in nurse-led services.
But Queen’s Nursing Institute director Rosemary Cook responded: “Protocol-led care has vastly improved the lot of the patient, with clearly defined treatment pathways meaning that care is not left to the idiosyncrasies of the individual clinician”
What do you think?
Read the story here: http://www.nursingtimes.net/whats-new-in-nursing/primary-care/nurse-led-services-protect-public-from-medics-quirks/5005954.article
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8-Sep-2009 2:51 pm
What a surprise, medics want to safeguard their own jobs while patting the bottoms of obediant little nurses and telling them to get on with fluffing the pillows.
This is nonsense. Why shoudn't skilled and experienced nurses be able to change patients' treatment where feel it is necessary? Utter nonsense. Well said Ms Cook.
9-Sep-2009 5:42 pm
They can't unring the bell now can they? They have spent years - no decades- passing tasks that they felt were beneath them across to nursing domain. Naughty nurses for actually building a whole raft of knowledge, skills and services around these 'tasks' and making them safer, effective and evidence based. Yet they still fail to acknowledge the value to patients that nurses have added over those decades. No change there then!!
11-Sep-2009 11:48 am
Hear hear. I would like to formally apologise, on behalf of the nursing profession, for getting distracted by safer, more effective, evidence-based care and taking my eyes off the job. Silly us.
16-Sep-2009 12:50 pm
Isn't it interesting that this descussion follows on from one clinicians comments on the Liverpool Care Pathway, a protocol that must be actioned by THE DOCTORS, and then implemented by the nurseing staff. Hardly nurses making life or death desicions on their own, but making sure that the PERSON who is dying is provided comfort, analgesia tailored to their symptoms, and above all dignity in their last moments.
I am very fortunate that I work with some very good and open-minded doctors, most of whom value and respect nurse as an important part of the multi-disciplinary team. After all, when all is said and done it is often the nurse who provides the actual care, and more often than not, must liase with the family.
I feel there is still an undervalueing of the nurse as a professional by the Medical fraternity as a whole, and is proof that we may never shake this image of being the Doctors hand servants.
21-Sep-2009 9:00 am
I think we all have to be careful of doing things when we "don't know what we don't know". Doctors tasks were usually not passed over to nusing staff because it was beneath them but because the Trusts saw it as a cost cutting exercise.
As a community matron, I took a 6 month physical examination course, at the end of which my managers expected me to be able to diagnose and then treat patients' conditions. Whilst training on this course with my GP mentor he said they are expecting you to learn in 6 months what it had taken him 16 years. This became evident when in consultation with patients; symptoms which I felt were one thing (& in majority of cases were), the GP then asked alot more questions to rule out any other differential diagnosis, conditions I wouldn't have even thought of. As I said you don't know what you don't know.
Yes nurse-led services are excellent & the LCP is an excellent way of championing what nurses do great i.e nursing care. However we need to be aware that in some instances a 5 year medical training plus the years of refining this knowledge is vital for patient safety. I have met certain nurses who believe they know all there is to know & slate doctors' knowledge. Working together & valuing each others very different roles is vital, using both nursing & medical knowledge.
We need to be careful not to lose the essence of nursing. I have seen some nurses who see basuic nursing care as too lowly for their now "high status". I left being a community matron after 2 years. The pressure from managment if you called a GP out or admitted someone into hospital was too much. I now work with a geriatrican and we work as a team; both adding our own expertise and both learning new things from each other.
6-Oct-2009 2:43 pm
How very sad to hear this comment.
I am a specialist nurse who manages and runs cardiology clinics, I also lead on developing protocols of care/ treatment.I make no apologies for the later as there is enough evidence to support the use of guidelines and protocols.
Nurses that are suitably trained and experienced are capable of managing a caseload.
Evidenced based practice demonstrates that nurse -led services are efficient, effective and beneficial.
6-Oct-2009 3:21 pm
I totally agree with the above, nurses are capable for many role extensions; there are many roles when adding extra expertise benefits patient care.
However it is naive to think that the accountants in trusts look at how to benefit patients, they look at how to balance books & reduce costs, the biggest being Staff. We need to be able to see the wood for the trees and recognise our unique roles and also recognise when we are being used because we are a cheaper option not a better one. Working alone in the community having to know differential diagnosis could be dangerous.
With NHS cuts on the horizon, be careful because Band 6s and 7s will begin to look expensive to cash strapped trusts and then trusts will be looking at Band 5s to perform roles we currently perform.
Some trusts are already currently looking at HCAs to perform Urodynamics.
Location: Norfolk UK
7-Oct-2009 10:50 pm
I'm Sorry But i do find some Registered Nurses Donot take their chisen career seriously enough. I have come across many who see it as a9 to 5 mentality of once out the door thats it! and Lots of Not quite realising What they are supposed to be doing!
I will be slated for this But Nursing like Doctors is a Vocation if you ain't caring type then don't do it! and i do feel that sometimes and more ofte than not Registered Nurses can and should expand their basic roles if it improves the care and support they offer. I work in the Private sector and feel that i can offer more as a Registered Nurse with more out of scope skills than a run of the mill 'Doctors hand maiden' If i feel can do an extended Role to improve not just the care i offer But the skills have Surely its a good thing?
8-Oct-2009 8:49 am
What does "more out of scope skills" mean? No-one should be working outside of their scope of practice.
Some skills lend themselves well to be added to nursing skills but some do not. Doing an extended role is a good thing as long as you have had the full training, education, knowledge to back up what you are doing, not just 6 months consultation & physical examination course and be expected to diagnose with full confidence. If you do not know all diffential diagnosis which comes with years of training and experience, I can you diagnose with confidence.
There are many examples were poor knowledge & experience has caused problems. I use to work for CSCI inspecting care homes & agencies; these carers were doing the jobs HACs traditionally use to do, that use to be see as nursing but overnight became social. The standards were at times poor with many doing jobs without the understanding why. Consequently, moving & handling and basic care was poor. When you questioned them on aspects such as dementia care, they had had half a day training which ticked the standards box, but was totally inadequate to prepare them for the complex nature of caring for people with dementia. They were paid the minimum wage.
You need to know differential diagnosis, diagnostic shadowing and have extensive A&P, knowledge or advanced practice to support some extended "skills". Otherwise why not train anyone to do it, why pay Bnad 7 when a Band 5 could do it. Again as I have said before - you don't know what you don't know. Managers are under pressure to make cost savings and some can see some "skills" as just that - a skill that can be taught to anyone. "Why are we paying a doctor to do this when a nurse is cheaper?"
21-Jan-2010 2:38 am
What ever we say. as a nurse, We should take our job seriously because we are talking here about the lives of people. And nurses that has no enough skills or knowledge is never an excuse in this kind of field. I hope in our everyday job, it would be like a day by day training ground for us to have wider and advance knowledge or advanced practice this of course to ensure our patients life.
11-Aug-2012 9:40 pm
Its happening in America.
The American Medical Association, the American Osteopathic Association, the American Academy of Pediatrics, and the American Academy of Family Physicians are fighting against nurses having more authority and responisibility and doing what they are actually trained to do. This means doctors travelling for hundreds of miles to a clinic where there are trained nurses who are qualified to do the work.
This is from
In Colorado, where there are far too few anesthesiologists available for rural and critical access hospitals, the state's medical and anesthesiologists societies sued to overturn former Governor Bill Ritter's 2010 decision to allow Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia and pain management care in these hospitals. Instead, they prefer to make people travel hundreds of miles out of their communities to have a procedure that a CRNA is licensed and trained to carry out. They are also apparently fine with hospitals being forced to close as a result of a lack of anesthesiologists. This is a classic example of doctor-centric care trumping patient-centric care.
I trust nurses completely. Why arn't they allowed to be trusted by doctors? What are doctors afraid of?