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The role of the nurse is complex

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“What exactly do nurses do now?” a friend asked me last week. 

“Aren’t they mini doctors, administrators and managers now?”

I took a deep breath and then hesitated because there is no simple answer.

It depends on the specialty you work in, your role, staffing levels and skill mix. Nurses pop up in all sorts of jobs that would not traditionally be classified as nursing and the image of the nurse as a direct care giver is gradually being eroded. However, if you walk onto any ward and want to know something, you look for nurses. They are the people in the background, who are quietly and efficiently organising, coordinating and overseeing what happens to patients.

The role of the nurse in organising care is described as “invisible work” by the author of the first article in our archive issue. This article reports the implications of a large-scale study that explored the role of the nurse as an organiser of care. Around 70% of a nurse’s time is spent organising care and even though this work is often routine, it requires skilled problem solving and knowledge. The author suggests that this challenging role needs to be formally acknowledged so that nurses can be supported to meet these demands.

The second article in this archive issue is a useful update on weighing patients. As with many routine procedures, it appears straightforward – the patient sits or stands on a scale and the reading is recorded. However, weight is an essential part of nutrition assessment – it can be used to calculate drug doses and to assess fluid balance, so accuracy is vital. This article explains why regular calibration of scales is essential and provides useful advice on what to do if a patient cannot be weighed. The message is clear that weight is not a one-off procedure but an important part of ongoing assessment and should be carried out by staff with appropriate knowledge and training.

Abuse in care homes is a recurrent concern that often remains hidden because residents are unable or too frightened to speak out. Our third archive article reports on the results of a staff survey on the scale of abuse of older people in care homes. The anonymous survey was completed by 156 staff working at five nursing homes, who had recently changed job and were commenting about what they had witnessed in their previous work setting. It found alarming levels of cruelty including slapping, taunting and pinching. The research author suggests that the current safeguarding and regulatory processes are ineffective and until this is rectified abuse will continue. He goes on to suggest that we need more effective ways of assessing the suitability of staff for their caring roles.

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