'Nurses have become too important for basic care', and other nonsense

22 January, 2010 | By Gabriel Fleming

With a patronising nod and a proverbial pat on the bottom, nurses are put firmly in their place by an angry GP from the internet. As far as Beyond the Bedpan is concerned, this just got personal.

“Dr Crippen”, the prolific and anonymous Guardian blogger, is one jaded GP.

He scoffs at the swine flu vaccination programme, wags a finger at the British Medical Association, and generally laments the downfall of the NHS with a series of witty and often brilliant invectives against the government, nurses, and anyone else who would obscure the view of the medical profession’s all-seeing eye.

It’s not that he doesn’t like nurses. He just doesn’t like nurses who prescribe, study for degrees, become clinical specialists, or concern themselves with anything other than “basic care”.

A recent Nursing Times story, reporting the findings of a study published by the British Journal of General Practice, really made his blood boil.

The study found that GP practices with more nursing staff tended to have better quality and outcomes framework scores on COPD, heart disease, diabetes and hypertension.

For a start, Dr Crippen dismisses the QOF system as a shambles and attacks the government for daring to measure the performance of GPs in the first place. He is not the first to question the reliability of the QOF, and he does make some thought provoking comments about the true relationship between outcome measures and good medicine.

But the QOF is too “mind-numbingly repetitive” for doctors to bother with. “Because the work is dull, it is often handed over to nurses”. Thanks, doc.

And it is precisely this kind of dull work that nurses should stick to. Not only is the idea that they might improve care preposterous, but their very pursuit of such lofty ambitions is damaging health care.

“This is why Granny has bedsores. This is why there are no nurses on the wards. This is why the Macmillan nurses do not do hands-on nursing. This is why district nurses no longer do bed baths. These nurses are all ‘graduates’ now. They have their BSc (Bedpan) from the University of Formerpoly and have thus become too important to carry out basic nursing care”.

So what promises to be an interesting commentary on a key issue quickly descends into a blinkered tirade against the entire nursing profession. At least it keeps Beyond the Bedpan busy.

Readers' comments (49)

Anonymous | 23-Jan-2010 9:32 am
No surprise that he remains anonymous!
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jjjez@hotmail.com | 24-Jan-2010 4:26 am
Oh please the last thing we should care about is what a GP thinks. most outdated and poor practice in the communit stems from them and their clique of old geezer medics.
Nurses advancing , to him, is probably like his wife wanting to learn how to drive, or hi daughter getting married on a beach.

i can see the jowls wobbling.
he should worry about his own backside. GP's are crap. his experience is based on people coming in with probably less than 20 indivudual problems, all very easy to spot and the rest is referred on. His job could be done on a computer.

or he might just be annoyed that everyone like Nurse Practitioners more.
jealousy is an ugly thing. but with a name like Dr Crippen........
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Anonymous | 24-Jan-2010 7:55 am
I'm guessing that this poor GP feels incredibly threatened by nurses (mainly, perhaps, because 90% of NMC registered nurses are female??). But let's face it, there are many old-school, sexist (indeed, 'nursist') GPs around. Hopefully, they'll go the same way as the dinosaurs.

Meanwhile, must go and polish my BSc .....
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Anonymous | 24-Jan-2010 8:02 am
Interesting the comments that come from a GP who considers COPD, heart disease, diabetes management education etc too "dull" for himself to bother with. Isn't this the reason HE got a degree!!!

Is general practice not about looking after those in the community. He should be fortunate that there are Nurses who are expanding their education in order to care for those he considers not exciting enough.

The fundamentals of nursing care is "basic care" but when expectations and demand is increased to such that we [nurses] are also required to do the basic job of the doctors of 20-40 years ago and also battle with under-staffing the priority of basic care is often weighed against the priority of chasing up the doctors for a patient that has more acute care requirements.

Perhaps he needs to spend some time back in ED/ICU instead of his office where time is of his choosing
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Anonymous | 24-Jan-2010 8:50 am
Hmmmm! No doubt he will become a patient one day and in our care! Interesting thought, let's see what he thinks of us then as we tend to his needs and advocate for him.
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blands@btinternet.com | 24-Jan-2010 9:06 am
one of the reasons Nursing has been forced to take on degrees and be more diagnostic in it's care is because of the idiotic drs we have in this profession, who besides not being able to diagnose their own degenerative brain cells(Dr Crippin) in their emaciated spineless reasoning, project an all seeing all knowing facade of lies, which nurses see through clearly, and often rescue the patient from inconsistent poor practice. This makes dr's quite uncomfortable.
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Anonymous | 24-Jan-2010 9:24 am
Well he may have a point nurses take on more and more indeed But the real probleamatic/differential diagnoses will always land on the doctor's surgery Why cant you all work together We need our GP's
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Jennifer Losing | 24-Jan-2010 9:30 am
This made me feel a little bit sick, but I am hoping that he is due to retire soon.x
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Jennifer Losing | 24-Jan-2010 9:30 am
This made me feel a little bit sick, but I am hoping that he is due to retire soon.x
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Anonymous | 24-Jan-2010 9:56 am
I think I know this guy, Brian is that you!!
Seriously though, we all know Drs with this attitude. Either old school or young arrogant. Thanks to my qualifications and my knowledge I have bailed them out on several occasions (some serious).
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Stephen Johnson | 24-Jan-2010 10:04 am
I recently observed a GP auscultate a young woman with his stethoscope. I must admit I was very impressed as the young lady had her coat on at the time.

Perhaps I'm wasting my time studying my MSc in advanced practice and instead spend my hours working on my hand maiden skills instead eh?
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Emma Davey | 24-Jan-2010 10:59 am
I have to say, I've read some very thought provoking opinions for both sides of the argument. Having had to the option to study at both degree and diploma level and choosing diploma purely so I could obtain a non-means tested bursury and support myself financially, I was more of an advocate for keeping this option available to training nurses.

I think this GP is very brave or very stupid to throw around his unsupported opinions. Personally I became a nurse because I wanted to care for people. I am not saying I fully support degree level training only, but I can see the benefits of making potential nurses really think about the profession and WHY they want to become a nurse. At the end of the day, it is personal morals, values beliefs and genuine WANT to care, that makes a nurse, whatever their level of qualification.
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Anonymous | 24-Jan-2010 11:18 am
I wouldn't concern myself at all as to whether or not a blogg is annonymous or not. It's the message that is important. And the message is very true in some cases. Let me relate my own actual experience. I went on duty two weeks ago on the night shift to find that ALL the patients in my team had not either had the necessary pressure area care or had their pads/beds checked to see if they were soiled. You can imagine the state these patients were in. And in the worst case, one patients tracheostomy had not been cleaned for 12 hours. The late shift was fully staffed with FOUR R.N.'s for a 24 bedded medical ward. The normal mix is 2 RN's and 2 NA's. You see the dilema. I would/could not post this other than annonymously for risking the integrity of any ongoing enquiry. But this just goes to show that nurses are in fact becoming 'Too posh to wash'
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Anonymous | 24-Jan-2010 11:22 am
shouldn't the Nursing Times be concentrating on publishing academic articles to raise the quality of nursing instead of all this gossip which leads nowhere? What ever is happening to the professional media which should contribute towards nurse education and updating postgraduate nurses. What a waste of precious resources.
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Anonymous | 24-Jan-2010 11:31 am
Interesting comments and actually part of it I think he does a point. I do think nurses are now concerned about career progression and getting MsC's and the like (which i am not saying is a bad thing), but nurses don't wish to remain on wards doing bed baths and providing the basics and student nurses definately don't seem to think that basic care is probably the most important thing they need to learn

It is a real shame that he has such a low opinion of nurses though nut I wonder how many GP's/dr's feel this way??
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Anonymous | 24-Jan-2010 12:18 pm
I have found a very useful webpage for those who don't know how to spell definitely.

http://www.d-e-f-i-n-i-t-e-l-y.com/

Well, let's be honest, for those who haven't a clue they are misspelling it. Or why not just type your version into Google? I will always ask you,"Don't you mean....?" The most prevalent misspelling of definitely seems to be definAtely, which might be something to do with the way it is pronounced, with its emphasis on the thirds syllable. "Oh, defin-A-tely!".
And now to nursing: there seem to be two separate issues: [1] ward nursing, [2] GP nursing. Most people have exprienced both and who can deny that that the ward nurse is not what she/he was. But who can complain when ushered into a room in a G.P. surgery to be seen by a "super-nurse", who seems to be doing the basic work of a doctor very well?
Then there is the nurse in, for example, a DVT clinic in a hospital (where there are often no doctors to be seen...in the clinic, not the hospital): but where one might at first think there might be; yet after being done, one is quite happy for it to have been just nursy, because it is easy to see what the job entails: measuring, filling in forms and sending the patients blod off to be tested and the patient off to have an ultra- sound, dissemmination of information about the condition, explanation of the results from the lab., and wghat the patient is expected to do.
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Anonymous | 24-Jan-2010 12:26 pm
I know a Doctor with those very opinions - he never tires of telling me I am not a Doctor, nor have I trained for 5 yearsetc, etc. No, I am not a Doctor but I have been trained to assess and treat patients and refer when necessary. I must admit most Doctors do not have this archaic view of nurses - not openly anyway - and are happy to work alongside us. It's quite interesting to get the occasional 'old fashioned' view on nursing and it makes for geat debate!!
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Anonymous | 24-Jan-2010 12:28 pm
Poor Dr Crippen. I do feel somewhat sorry for this poor man. He seems to nurse (pardon the pun) an inbuilt dislike of a mere woman (as most nurses are) actually managing to provide a better standard of care for his patients than he does himself. He obviously dislikes the disease management part of his job, which he finds dull, and is happy to hand this over to the highly trained and skilled nurses he so despises. And then he criticises nurses for wanting to improve themselves and their skills in order to provide his patients with the care he is happy to relinquish. Why is this Dr Crippen? Is disease management not sexy enough for you?

Many nurses are perfectly happy to work on wards and provide an excellent standard of care to their patients. Others like to specialise. That's life. Some are content with their lot, others are more ambitious, it doesn't make them less of a nurse.

By the tone of his article, I imagine Dr Crippen to be approaching retirement and frustrated that the nurses who used to bow and scrape before him now have a voice and assertion and will challenge him. And boy do doctors need challenging sometimes. I have lost count of the times that nurses have saved the skin of a junior doctor on the ward. However, I don't wish to sink to Dr Crippen's level and start attacking doctors generally. In my experience, GPs are probably the least knowledgeable and expert of the lot, they make some very random decisions which then need to be put right, frequently by a nurse. And you don't need a lot of training to diagnose everyone with a viral infection and send them home. My friend's son nearly lost his life due to a GP who said there was nothing wrong with her son, only for him to be admitted to ICU the following day with bronchiolitis.

How about a bit of mutual respect Dr Crippen. Respect us, and the very valuable job that we do, and we will respect you.
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Anonymous | 24-Jan-2010 12:50 pm
Hey we know the qof is boring lets not do it. it was introduced for gps THE GATEKEEPERS of primary care to standardise their appalling practice as well as to enable them to earn in excess of £250,000 each. No wonder he feels threatened.....he should learn some manners including bedside ones and respect and support his colleagues.
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Anonymous | 24-Jan-2010 1:45 pm
His website is brilliant and should be required reading for anyone who has anything to do with the NHS and healthcare in general. Anyone who bothers reading it knows he has plenty of good things to say about nurses "on the shop floor". His comment that "lack of basic nursing care is killing far more patients than Harold Shipman" may ruffle feathers, but is true nonetheless. He is right more often than he's wrong, but because he enjoys offending some of the more po-faced members of the profession, he is an easy target. But where he is absolutely right is that the "promotion" of nurses to do some of the jobs of doctors is financially motivated. Why pay a doctor's wages when you can get a nurse to do it for half the cost.
Personally speaking if there's something wrong with me, I want to see a doctor and not a nurse unless a doctor, not a manager or a bureaucrat but a doctor, has decided my problem can be dealt with by someone with less training.
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