Physician assistants

[M Clayton]

I imagine that we'll end up with something akin to the problem we have at York with pre-assessment clinics. The hospital is more than happy to have a nurse led clinic but they're not allowed (capable?) to interpret the ECGs and other tests that they organise so it comes down to a junior like me to sign off on these things. I didn't order it, I don't know the patient but it's my name on the form - dodgy, dodgy ground if you ask me.

[Dr Noodle]

Give the nurses the training, not create a whole new role.

[Touche]

Originally Posted by Steph8552

I'd much rather have a fully qualified experinced nurse who had be trained to do what a physcian assistant does working with me than these "half" a doctors. And i'm sure the patients would agree. It seems such a waste of a talented graduate, an extra 2 years in a GEP medicine course would be a much better use of there ability. like Dr noodle said, i'm sure there are nurses out there who would love the opportunity to do something like this. so why not offer ot to them.

I'd rather have a qualified experienced nurse doing the nursing. You cannot replace a good nurse with an HCA. You cannot replace a trained doctor with a nurse. Keep the nurses as nurses and the doctors as doctors. What's wrong with doing what you're trained to do? I'd make a crap nurse, so I wouldnt dream of trying, I have too much respect for their work to pretend I could just do it. If I pitched up for a nursing shift I'd feel very sorry for the nurses working with me having to pick up my considerable slack, not to mention the patients putting up with my dangerous 'nursing skills'...

Similarly, why would a nurse want play at being a doctor? If you want to be a doctor, go to medical school. These halfway quacks let loose on the public after short courses are just silly. Why are we training these PAs when we have unemployed doctors who could probably do a better job? Seems quite a waste!

These new roles stink of poorly planned, short term, cheap healthcare.

Originally Posted by Dr Noodle

Give the nurses the training, not create a whole new role.

...

[Varied A]

Originally Posted by M Clayton

I imagine that we'll end up with something akin to the problem we have at York with pre-assessment clinics. The hospital is more than happy to have a nurse led clinic but they're not allowed (capable?) to interpret the ECGs and other tests that they organise so it comes down to a junior like me to sign off on these things. I didn't order it, I don't know the patient but it's my name on the form - dodgy, dodgy ground if you ask me.

This kind of thing really gets on my nerves - all nurses are trained to record and interpret ECGs (here at least anyway), as well as other tests. Okay some aren't that great at it, but beefing up the training regime would soon see to that.

The trusts tend not to "allow" these things though (well I'm not so sure it's as much them not allowing as the nurses not believing they're allowed, but in any case it adds up to the same thing). RCN guidance for emergency nurse practitioners is that if they order a test they ought to be able to interpret it at least to the required level without supervision. I don't see why the same standard shouldn't apply to anybody else.

As you say, it's putting both them and the doctors on dodgy ground if one examines the patient and takes a history, and another interprets tests results, both blind of what eachother is doing. It's just plain bizarre!

[Muffin2]

Originally Posted by Touche

I'd rather have a qualified experienced nurse doing the nursing. You cannot replace a good nurse with an HCA. You cannot replace a trained doctor with a nurse. Keep the nurses as nurses and the doctors as doctors. What's wrong with doing what you're trained to do?
Similarly, why would a nurse want play at being a doctor? If you want to be a doctor, go to medical school. These halfway quacks let loose on the public after short courses are just silly. Why are we training these PAs when we have unemployed doctors who could probably do a better job? Seems quite a waste!

These new roles stink of poorly planned, short term, cheap healthcare.



...

I agree 100%. when i did a placement at the end of last year i couldn't tell the difference between the nurses and the health care assistants. if nurses would have wanted to be doctors they'd have gone to medical school, same with the health care assistants.
also junior doctors having to have responsibilty for PA's is stupid, they're only just qualified themselves.
its just another case of "i agree with Bush"

[yazoo]

Originally Posted by Varied A

1.This kind of thing really gets on my nerves - all nurses are trained to record and interpret ECGs (here at least anyway), as well as other tests. Okay some aren't that great at it, but beefing up the training regime would soon see to that.

The trusts tend not to "allow" these things though (well I'm not so sure it's as much them not allowing as the nurses not believing they're allowed, but in any case it adds up to the same thing). RCN guidance for emergency nurse practitioners is that if they order a test they ought to be able to interpret it at least to the required level without supervision. I don't see why the same standard shouldn't apply to anybody else.

2.As you say, it's putting both them and the doctors on dodgy ground if one examines the patient and takes a history, and another interprets tests results, both blind of what eachother is doing. It's just plain bizarre!

Point 1. I feel the same way when you write things like this.

ECGs are a simple extension of history and examination, and should NEVER be interpreted without a clinical context if a clinical decision needs to be made. Unless the nurse is trained to assess the situation clinically (history and examination), they should not be interpreting the ECG.

Edit: I imagine this is why very few of the nurses where I work interpret ECGs, nor feel any inclincation to - they just call me or one of my colleagues.

Point 2. I agree. It is bizarre to have nurses and Drs to do separate parts of the pre-assessment. I’d take it further – it’s potentially dangerous. It’s just another cost cutting exercise.

To quote TC on the recent nurses/resus/DNAR thread:

I do wonder what world you are living in - but it isn't the same one as most NHS professionals.

[Dr Noodle]

Originally Posted by Steph8552

if nurses would have wanted to be doctors they'd have gone to medical school, same with the health care assistants.

This is plain ridiculous. I know plenty of nurses who would have loved the opportunity to do this but mitigating circumstances prevailed. And I'm not sure what point you're trying to make about the HCAs.

With regards nurses interpreting ECGs, I've never seen a nurse do this and it doesn't sound like a nurse's role. The majority of nurses I work with don't even perform the test (though I know they are trained to, they just aren't allowed apparently). A cardiac technician or a doctor is called to do this.

[Eponine_hugo]

Noodle I have to say I agree with Steph, if a nurse wants to do medicine badly enough they can do grad med/ A Levels / foundation courses / bradfords clin sci etc etc etc there are lots of options out there to counteract any mitigating circumstances, I mean they wont get everyone into medicine but it will cut down the amount who want but cant have. I think the vast majority of nurses are content with being nurses and dont want to be doctors. They do a very good job and to assume that a lot of them aspire to be doctors is almost saying 'I cant see why they wouldnt want to be docs'. I know plenty of nurses who would never want to be docs cos they like the constant interaction and care with patients on a more intimate level. So yeah I agree with Steph, nurses should do what they are trained to do, just as pharmacists and docs should - this is what is safe for the patient and all others concerned. If some nurses want to go to med school and be trained to do doctors jobs there are options for them to do that.

Did all that make sense? I'm very tired.....

[blueberrypie]

Well, I have a couple of things to say on this issue ....

Firstly, with regards to the nursing taking longer than this course... there are accelerated courses (for grads) for nursing that vary in length depending on who you take them with. My friend done hers, in 18 months at Kings a while back, and I know of another that did theirs in 2 years not so long ago.

There are similar posts to this that don't require this two year qualification, and sound quite similar, but not with clerking and examining, etc, etc. I saw a job advertised for a clinician's assistant, this involved bloods, cannulations, catheterisations, ECG's, etc, etc...

Boundaries. Can we have some boundaries please??? Because this is just becoming a bit of a muddle!!!

[nicnac84]

Originally Posted by Eponine_hugo

If some nurses want to go to med school and be trained to do doctors jobs there are options for them to do that.

Did all that make sense? I'm very tired.....

Doubt that very much!!! unless you've never had a student loan before (which any Nurse with a BSc has) or you've got bags of cash stacked away, it is near impossible to go to med school in this country. (Unless you'd like an emormous loan strapped to your ankle for the next 15 years of your life). Have you seen how competitive GEPs are?????