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‘While I am diagnosing, who takes the time to hold a grieving widow’s hand?’

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A motivational system based on monetary incentives is encouraging GPs to extend practice nurses’ skills. Joy Milligan is uncomfortable with how her role has changed

I suppose it had to happen. Disillusionment set in and changes in the nursing profession, which I once met with enthusiasm and pleasure, suddenly filled me with gloom.

Yet this is not a diatribe about how nursing care was better years ago. It certainly wasn’t. I can remember patients with sacral pressure ulcers that were as big as a baby’s head and I recall the petty feudalism where ward sisters ruled like latter-day Boadiceas.

This is more of a swansong from an old cynic whose enthusiasm about the future of nursing care has become a tad tarnished.

What has brought this on? What has made a visionary, enthusiastic carer turn into a world-weary person whose frequent sighs of despondency can be heard echoing from her practice nurse room?

Age may have something to do with it. Yet colleagues who are a few years older than me still accept the challenges of practice nursing with gusto and glee.

No, most of my discomfort is about changes in the role of the practice nurse in the last few years.

Now, if I could remain as a treatment room nurse, I would be very content to stay in the profession until retirement. But an HCA is now carrying out my treatment room roles, leaving me to manage long-term conditions.

It was obvious that, once the government started rewarding GPs for managing long-term conditions, things would change. The quality and outcomes framework (QOF) became buzzwords of general practice and points were given for meeting these outcomes. Points meant prizes in the form of monetary reward but who was going to do all this extra work to meet these targets? Step up the nurse – she is always keen to take on an extended role with no extra pay.

Now nurse practitioners and independent nurse prescribers are managing long-term conditions in GPs’ surgeries.

No one can deny that this has improved the life expectancy of many people. The close monitoring of patients with diabetes and hypertension has improved their quality of life and reduced many complications associated with these conditions.

The extended role of the nurse is just what recent nurse training has been designed for. The graduate nurse is able to fulfil these responsibilities with ease and confidence.

So why don’t I relish this part of my job? It’s not because I am a dinosaur or a Luddite. But I often wonder whether I’m actually enhancing patient care or just ticking boxes.

And, while I am diagnosing and prescribing, who is holding the hand of the recently bereaved widow for an extra few minutes and finding her the telephone number for the local bereavement group? Who takes the time to ask a young mother at a child immunisation clinic why she is tearful and depressed?

In short, just who is performing the routine nursing care tasks that filled my practice nurse days before managing long-term conditions became the raison d’être of general practice? The needs are still there – they haven’t disappeared.

I feel ill prepared for the role of long-term condition manager. I only want to go so far in advising the patient then I want to send them to the GP for a final say on medication, despite having attended many courses and study days on asthma and respiratory care.

It must be my basic nurse training that is causing me this anguish. When I trained in 1972, Dennis Waterman was a heart-throb on The Sweeney and Gary Glitter was famous for being a pop star. In our first week at nurse training school, we were given two commandments: thou shalt not diagnose; and thou shalt not prescribe.

This creed has become the stumbling block for my nursing career in 2008. I am tentative about diagnosing and hesitant with prescribing – the two tasks that I am expected to do so I can fulfil my role as a practice nurse.

But no matter. There are plenty of visionary nurses who will meet the challenges of practice nursing with zest and pleasure. And who knows, the government may eventually award much-coveted QOF points for giving solace to a grieving widow.

Joy Milligan is practice nurse, Hampshire

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The opinions expressed here are the author’s own.

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