Maintain pressure on reforms to protect NHSAdvanced nurses 'diluting' junior doctors' training
Advanced nursing roles are “diluting” training opportunities for junior doctors, an independent review has found.
The review, commissioned by Medical Education England – the body which oversees training and workforce planning for medics - calls for clarity over the roles of clinicians such as specialist nurses and advanced nurse practitioners.
The review investigated concerns the European working time directive was having an adverse effect on junior doctors’ training.
Its final report stated: “As other professionals take up more traditional trainee tasks, this is further diluting the opportunities for training of junior doctors.”
However, it says non medical clinicians “can reduce unnecessary demands on junior trainees” and “may be involved in their training”.
It found junior doctors were missing out because they had less time to train and consultants were often unavailable to train them, leaving other professionals to fill skills gaps.
The findings back results from a Nursing Times survey earlier this year in which two thirds of nurses said they felt more pressurised to make clinical decisions after the restrictions on junior doctors’ working hours kicked in last August.
The working time directive brought junior doctors’ hours down to 48 hours a week, in line with other health workers.
London Southbank University principle lecturer in advanced nursing practice Katrina MacLaine said, despite nurses’ heavy workloads, many were teaching junior doctors skills such as cannulation and patient assessments.
She added: “It’s not one profession against another but how are we developing our clinicians as a team and learning from each other?”
Joint training sessions involving doctors and nurses were a way organisations could address skills gaps within multi-disciplinary teams, she said.
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Readers' comments (9)
mike | 15-Jun-2010 10:13 am
I think this is an excellent thing that this is being looked at and different roles are being defined.
I do not think the fact that Nurses are now more advanced in their roles/skills is causing a lack of training within the medical role, I personally think that is solely down to the medical team and their own working practices (less hours, few nights/weekends for seniors, etc etc etc). They are the ones who need to redress this.
Yes the two professions are seperate, Nurses do a different job/have a different role to Doctors, but our roles do overlap a lot and our aim is often the same. But the fact that higher band 5, band 6 Nurses and above are now in roles that overlap with the medical teams, should lead to joint training, skills updates etc like the article suggests.
Perhaps then Nurses would get the recognition for the job we are already doing, making it easier to demand better pay, working conditions, etc.
But also this would lead to better training for both teams, with two sets of inputs learning from each other and adapting each others practices for the better care of the patients.
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Linda Hamblin | 15-Jun-2010 3:03 pm
Its no different to other similar contexts in aspects of Care accross the range of medical staff, that we should definately welcome. This is the changing and transitional period for the NHS in modern society today, as the structure and hierachical old fashioned tendencys are vanishing now, ensuring that Patients are properly cared for in a fine tuned manner, utilising staff to maximum intellectual capacity. Doing away with the trivial and getting on with the job and developing a truly aspiring and actualised workforce, where everyone is respected and paid for their true worth, with an Ethos of being there for the patients good only and Caring with true compassion. where, if we look in another extremely vital area and transitional time in the fact that HCA's are now becoming highly confident and much better trained accross the country qualified as virtual front line Nurses, very capable especially in aspects of understanding Dementia Care and Care of the elderly as reported in Nursin Times. Elderly Care where many people who have given their whole life are short changed at this end of life. People who are undervalued where funding has been less provided than for other areas of medicine. We could not do without their the HCA's fine tuned close watching abilities in this area of practice a welcome developement in many hospitals, This means that the HCA is naturally soon going to have a more respected status, many able to cope with a complete bay reporting any general Obbs changes to her Staff nurse very quickly, she or he the Staff Nurse and Sister, being close by therefore this enables the Staff Nurse to truly monitor te ward and strengthen over all Ethos of care and safety and security on the ward, especialy in terms of nutrition. So we must embrace the gaps that are closing and the osmosis if you like of roles. There should be a feeling of uniting and not being afraid to merge in thse roles. Seniority should not create a gap between something shared, this means dual and maximised and multiple strengths over all. Linda Student. Nurse.
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Alyson Davenport | 15-Jun-2010 6:27 pm
They can't have it both ways. Reducing doctors hours (which is sensible) leaves doctor shortages on the wards which have to be filled. If they are to be filled to an adequate level then Advanced Nurse Practitioners have to be working to such a level as to be able to do this to prevent delays in treatment.
The consequence to this is that as nurses and HCAs of all levels fill gaps left higher up the chain there is a lack of filling at the bottom end with basic patient care becoming a minimal priority.
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Anonymous | 15-Jun-2010 6:45 pm
Just think if advanced nurse practitioners and the like worked in a nursing capacity instead of a doctors role their wealth of experience would benefit the wards immensely.
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Anonymous | 15-Jun-2010 8:09 pm
As an Advanced Nurse practitioner in acute/emergency medicine my initial remit was to reduce the expected impact of the European working Time Directive as a 'medical clerking machine'. This involved undergoing 3 years of training and assessment by senior physicians, completion of the FY1 programme for junior doctors, and considerable self-directed learning, as I had to get myself up to speed in acute medicine rather than critical care (my original area of expertise). While a junior doctor can clerk a patient in 45 minutes (not very thoroughly), it takes me about 90 minutes to do the job properly (for medico-legal purposes it is essential to document everything, particularly for a nurse - if it is not documented it did not happen).
While I still clerk patients (more to maintain my skills than anything) the Trust adapted its medical staffing and the impact of the directive was not that great, the majority of my time is spent managing those patients with impending or actual organ failure (normally ARF), rather than doing the job for which I was originally employed - to let a junior doctor deal with such patients would be disasterous.
In relation to the subject of the article I think I can safely say that junior doctors are, in a way, de-skilling me. I have just adapted my practice in response to the service needs of the Trust. I predominately operate as a single-handed critical care outreach on the unit, concentrating on damage (and litigation) limitation, and it is somewhat mundane work at times, but necessary.
I help train 5th year med. students in taking ABGs and interpreting the results, cannulation, assessment of the acutely ill, etc, etc.
I would be happy to help train junior doctors but they usually have their heads up their ar**s because I am a nurse, and they are a medical professional - therefore superior. Just before they leave their placement they suddenly realise that I would, in fact, be helpful to their education after all.
Many nurses have an incredible amount of experience and knowledge and can help these individuals if they could lower themselves to actually acknowledge the fact. Do our roles interfere with their professional development? NO! They just can't bring themselves to admit that there are many nurses who could prevent them from killing someone because of their blissful ignorance of cognitive dissonance.
Until such a time as junior doctors can get a grip I will enjoy the sport of 'taming the testy know-it-all' through reasserting the, often, blindingly obvious.
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nursteph | 16-Jun-2010 0:42 am
That's why there are cases of doctors who again go back to school and studies nursing...Whew!
Truly,
Steph
http://www.pulseuniform.com
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adam WILLIAMS | 16-Jun-2010 12:59 pm
What a disappointing summary and headline for this piece of work.
Yes it is sensational headline which creates and continues the controversy of Advanced Practice roles. However, this is undone further on when the report acknowledges that Advanced Roles actually take some of the pressure off Junior Doctors, which surely frees up their time and allows them to deliver their care in a more calm and dedicated way, therefore creating a team and improving care?
I do feel, however, that the training/experience or potential experience for junior doctors is there for the taking and that these doctors and indeed medical students need to seize these opportunities just as nursing students, qualified nurses and advanced nurse practitioners have done for years. Training, development and learning opportunities are not always delivered on a plate and take careful determination and flexibility to achieve.
The one continued barrier to Advanced Practice roles is the continued lack of definition and regulation. How can we defend ourselves when there is no nationally recognised standards, training and regulation?
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Mike Paynter | 21-Jun-2010 8:55 am
I refer to the BMJ [2005] 330 [7499]:1084 Benger JR, Hoskins R.
Interdisciplinary teams, not doctors, deliver modern health care. Doctors bring their particular skills to the team but no longer sit at the apex of a hierarchy delegating to other professions. Although it may feel uncomfortable to relinquish the traditional notion of medical control doctors must embrace and support the development of better health care, regardless of the professional training of those who deliver it.
A strong case for interdisciplinary education [at both junior and senior levels] without diluting each others respective professional backgrounds.
Mike Paynter, Somerset
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Jamie Murphy | 17-Jul-2010 2:06 pm
"While a junior doctor can clerk a patient in 45 minutes (not very thoroughly)"
Of course, Junior doctors have just trained for 5 years to do clerk patients but you would be able to do it better with 3 years of training with senior physicians...exactly what form did this training take? An ANP day release course? Just because you have critical care experience does not mean that you have experience at clerking or do it better.
"o let a junior doctor deal with such patients would be disasterous."
Are you kidding? To let a junior doctor deal with ARF as opposed to an advanced nurse? Come on...We deal with ARF all the time...and it isn't disasterous. Your arrogance is ridiculous to suggest that after 3 years of dubious training and completing the FY1 program (exactly how did you manage this, as to my knowledge it is a legal requirement to have a medical license to complete an FY1 program...) that you are in a better position to manage patients than a Doctor. You have the exact arrogance that you accuse us of just without the medical qualification.
"I think I can safely say that junior doctors are, in a way, de-skilling me"
Mmmmm...but you are currently at the top of your game aren't you? They are at the beginning of theirs. You are there to provide a service, they however will go onto become registrars and consultants. You won't. Hence their training trumps yours.
"Many nurses have an incredible amount of experience and knowledge and can help these individuals if they could lower themselves to actually acknowledge the fact."
Agreed, some nurses have a huge amount of knowledge. Within their specialisation, hence your area would be critical care. But to suggest you know more than the new medical graduate about acute medicine or other areas of medicine which they have trained for 5 years would be as ridiculous as asserting that we know more about critical care yes?
"Until such a time as junior doctors can get a grip I will enjoy the sport of 'taming the testy know-it-all' through reasserting the, often, blindingly obvious."
You really are bitter aren't you? And I suppose we will keep enjoying the sport of reminding the ANP that they are the nurses, and we are the doctors ;-).
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