A GP asks you, a community or practice nurse, to make a home visit to see a child who is reported to have a temperature and is vomiting. Do you agree and, if so, what do you need to be aware of?
THE ROLE of nurses has expanded considerably in recent years as clinical nurse specialists, nurse consultants and other registered practitioners carry out many activities that were previously the preserve of registered medical practitioners. There are few laws that require an activity to be undertaken by a specified registered health professional.
If undertaking this activity, you must be aware of the extent of your competence and follow NMC guidance. Any such request should be preceded by a discussion in the group practice – and possibly with the PCT – on which activities could reasonably be undertaken by a registered nurse, the training required and the limitations on such delegated activities.
You should agree with the GP exactly what symptoms and signs to look for and what action you could take. You must also know the limits of your competence, so you know when the patient should be seen by the GP or if an ambulance must be called immediately.
If you fail to recognise any signs that would have alerted a GP to take urgent action and the child suffers harm as a result, you may be found to have acted negligently. Your employer would be vicariously liable for your actions and so be responsible for any compensation for the harm caused. The GP could also be accountable for delegating inappropriately and failing to ensure the necessary supervision and training is in place.
You may have been trained to prescribe medications. The concept of the extended formulary nurse prescriber has been abolished, and appropriately trained nurses can now prescribe medications that come within their competence.
If you were to visit in this situation, you should be able to detect whether the GP should visit the patient. Alternatively, you may detect symptoms that indicate an immediate referral to hospital.
It is a wise practitioner who knows the extent of their ignorance.
Bridgit Dimond, MA, LLB, DASA, AHSA,
is barrister-at-law and emeritus professor, University of Glamorgan, Pontypridd