Why not a nurse?

**little sonfica** · 14-05-2006, 07:18 PM

from what iv heard of the whole 'fat nurses' topic i think amandapollit, pillis etc etc really over reacted!

im with spk72 - he/she is funny!

**Murkey** · 14-05-2006, 07:22 PM

Originally Posted by dexter21

The slowly developing change in role boundaries takes time and there are bound to be glitches and problems that no-one would have forseen, but give it 5 or so years and as long as the patient isn't compromised, you'll be glad of nurse prescribing and so will the patients. Do doctors really have the to spend with patients in their home or in the ward to fully assess pain and prescribe analgesia? etc no. they generally don't. whereas nurses do. HURRAH FOR NURSE PRESCRIBING, EVEN IF GP'S HAVE TO COUNTERSIGN - ITS THE MED STUDENTS OF TODAY WHO WILL BENEFIT!

How does that benefit med students? It means they will get less experience in things like prescribing, which is going to be very interesting since it's going to be their asses on the line when it's found that the analgesia is inadequate.

Originally Posted by Varied A

The problem comes when part of caring for someone involves diagnosing and curing them - which, if you think about it, it often does. Similarly, part of curing someone often involves caring from them. Hence, whilst both professions are coming at the same patient from different angles, they're both aiming for the same result, usually with the same set of tools and techniques.

If a doctor needed to do a job typically viewed as a nursing role, then nobody would really kick up a fuss at them doing it; despite the fact that they are not trained or qualified to be a nurse. But suddenly when it's the other way, all hell breaks lose. Interesting eh?

I'm going to sound like a pompous git right now and I will admit that what I'm about to say is seriously oversimplfying the issue, especially as nurses do alot more than this.

But changing the bed pans in the wrong way has not and will not kill anyone. Prescribing the wrong medication can and will.

I'm all for nurse specialists, but after speaking to GPs and SHOs, I'm starting to get a little skeptical. Nurses without extra training should never be allowed to do anything that was not part of their job description, I think we can all agree on that. Perhaps after 20 years of experience they are indeed qualified, but without some form of examination we cannot know for sure. If a nurse does receive further training, then perhaps prescribing should be allowed, but going on a two week "this is what you give for this and this is the dosage, here, have a flow chart" course is not what I would want in the person deciding what drugs for me to take.

On a lighter note

Originally Posted by Dr Crippen

Nowadays, they [Atrial Fibrillation Patient] are assessed by cardiac nurse specialist. She is much cleverer that Dr Crippen because she can do this assessment by telephone. David has had a letter saying that he should be at home by the phone this afternoon, waiting for her call. He is puzzled. “How can she assess my cardiac status over the phone?” Beats me. I have to use a stethoscope, but then I am only a doctor.

Again, I am not nurse bashing, I am just cynical of this particular aspect of it.

**Varied A** · 14-05-2006, 08:00 PM

The continued assertion that doctors somehow retain responsibility even when the nurse is the one prescribing is not really the full case. Independent prescribers (the ones who have just been given the whole BNF, and who have caused this latest stir) are trained and qualified to prescribe independently (hence the name!). They carry a professional and legal responsibility for their actions which is exactly the same as a doctor's would be. The doctor is NOT responsible for anything they do (except during their training)

Supplementary nurse prescribing is a kind of mix of the two. These nurses have always been able to prescribe from the whole BNF (including all controlled drugs), however they DO have to work alongside a doctor, who writes a clinical management plan (specifying what drugs may be prescribed, and how often the plan must be reviewed). The nurse still remains, however, professionally and legally accountable (i.e. if the doc writes something on the clinical management plan which isn't correct (i.e. wrong drug/dose), and the nurse uses it to justify his/her actions, then they share responsibility for that with the doctor). This particular group are, in a way, yes, bound to "protocols" (ie the cmp) and will have to work with doctors.

As for the bedpan comment - yes, it is a huge simplification of the debate, one which really doesn't address the true issues. Patients have died from bad nursing care (as I'm sure you're well aware), and they have also died from bad medical care. I do not disagree that both the former and the latter have, and continue to, take place - do you? However, I'm not sure a "my profession has the potential to kill more people than yours" kind of debate is really going to help though, so perhaps we should leave that one alone.

Finally, I am well aware of the many problems that come with advanced nursing practice (a term, which, btw, I thoroughly dislike!). I am not seeking to defend the many somewhat questionable roles which have appeared; although I would suggest that they are few in number compared to the many nurses who persue these roles with a solid knowledge & skill base, and do so for the obvious benefit of their patients....

**jason1000** · 17-05-2006, 02:20 AM

I agree with all of Varied A's comments, and she makes them quite eloquently, but is her position not compromised somewhat by the fact that she herself tried many times over to become a doctor and only went into nursing as an insurance option/last resort.

It is not my intention to be mean spirited, I am only reflecting previous posts put forward by Varied A herself.

Jason.

**Varied A** · 17-05-2006, 11:52 AM

he applied to medical school only once, went into nursing in preference to his insurance choice (biomedical science), and is absolutely loving it

**jason1000** · 17-05-2006, 04:09 PM

Fair enough.

No offence intended.

Jason.

**Gizmo says -** · 18-05-2006, 04:49 PM

Originally Posted by Murkey

I'm going to sound like a pompous git right now and I will admit that what I'm about to say is seriously oversimplfying the issue, especially as nurses do alot more than this.
But changing the bed pans in the wrong way has not and will not kill anyone. Prescribing the wrong medication can and will.

who the F wrote this?

I'm all for nurse specialists, but after speaking to GPs and SHOs, I'm starting to get a little skeptical. Nurses without extra training should never be allowed to do anything that was not part of their job description,

the same goes for any job.

sure you're not a nurse basher, you're just ave a complete misunderstanding of 'ealthcare knowledge.

**louise0102** · 07-08-2006, 11:20 PM

Originally Posted by sheepie

To be completely frank, there seem to be so many similarities between nursing and medicine I still don't have a clue why I'd rather do medicine, save the fact that it's something I've dreamed of doing since I was little, and pretend-operated on my teddies.

Don't forget that to operate on teddies you need a nurse too! Teamwork is vital!!!!

There are similarities of course: you're both working towards the same goal: improved health status for the patient (and family unit)! But, ultimately the two must take play different roles in order to achieve that desired outcome.

For me practicing as a nurse means taking a more active role in 'hands-on practical care' with appreciation of the holistic needs of the patient. Practicing as a dr, one will be primarily be seeking to diagnose and determine treatment for patients (of course with appreciation for the practical hands-on care too: I will never loose the nurse in me!!)

I guess you will know what is right for you..... and if you can't decide go with your gut feeling; you can always change your mind!

Lou

**racheljane** · 08-08-2006, 01:04 AM

Example of the difference: during an unsuccessful resus attempt today, Consultant made the decisions and spoke to the relatives; SpR & SHO administered the drugs and discussed the decisions with the consultant; Nurses did CPR, cannulated, ventilated; HCA (me) timed, charted, fetched and carried, held things etc. Really good teamwork, everyone has their jobs/areas and work together well. Another one of my reasons for wanting to be one of the docs not one of the nurses... guess who had to deal with all the cleaning up and smelly bits while the docs moved on to the next case...

**pioneer22** · 08-08-2006, 02:07 AM

After having 2 ex girlfriends as nurses there are clear differences!

3 Years of training compaired to 5 years of training! Plus the exams to become Reg Consultant!

Entry criterias 5 GCSES for nursing
8+ GCSES plus A Levels at high standard for med!

Nurses do some very mundane unskilled jobs! Note I said some! Making beds, Washing bedpans, bed baths etc etc! But what the doctors do is far more skilled and takes much more training. They have a lot more of a responsability.

They do more caring/making patients comfortable I.e Help with incontinence (SP) Pain Mx

Doctors treat and solve as an oppose to nurses!

IMO of course! Nurses run the wards thou!

On ICU thou thier roles are reversed! They are amazing on there!

Nurses arnt autonomus are they?