Dear Dr Rant,
I feel I need to bring something to your attention.
I refer to this job advert on the stupid NHS jobs website.
I am/was a Plastic Surgery trainee, untill my medical career was modernised. I, and almost all of my peer group, have not obtained training posts. I know you have heard this before, but I know many people with 5-years at medical school, an extra two years of intercollated BSc, a Junior House Officer year, three years of basic surgical training, a three year PhD, and up to five years of plastic surgery experience who didn't get jobs. And yet, trusts are advertising for fucking nurses to effectively be surgical trainees.
Note the the advert clearly states that this will involve being first assistant during 'complex reconstructive operations' and will include microsurgery [fucking hell! - Ed.], as well as seeing patients in clinic. These are the unique features of a plastic surgery training system: this is what senior SHOs and junior Registrars are supposed to be for.
These jumped up nurses are being used to fill a perceved service gap. But this gap has been created my MMC/MTAS. Don't get me wrong, I fully subscribe to your stance that this is not the fault of the individual nurses doing these jobs, but the fault of the government, the trusts, the colleges, and that slimy bastard Liam Donaldson.
Further, this advert has a pay scale attached. These nurses aren't even going to be that much cheaper than us - and they will being doing fewer hours [By my calculation, that makes them more expensive - especially when you factor in their lack of training and experience, which will make them slower and more error-prone - Ed.]
Where will the doctors be while these pretend doctors are performing their fiftieth free flap? [Presumably some uberclever plastic surgeon technique. See how complex this stuff is - even Dr Rant has no idea what they do! - Ed.] We will be in the fucking ward, clerking in the patients, taking blood samples, and doing ECGs on perfectly health 20y olds because some nurse manager in a black SS uniform wrote a fucking 'Patient Admission Protocol'.
Where will it end.
Yours,
Dr A. Rantett
Friday, July 20, 2007
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68 comments:
it will only end when the end patient can take their business away from nonsense like this
i dont see this any worse than "nurse led" "walk in centres" dishing out anti biotics without any doctor being involved which will undoubtably miss that small percentage of folk who go on to die of something not listed on the idiotic protocol
now, how many senior labour figures been seen by a nurse rather than a doc recently?
The death of the British medical profession as we know it. I'm on my elective at the moment - should I just not bother coming back to the UK?
Why don't you apply for it then and see what happens?
Just imagine they had to buy their own dressings. How many would apply then?
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/20/wafghan120.xml
Just praise the Lord the MOD does not run the NHS.
Dear RantRebuttal,
In the personal spec for the job is 'current NMC registration'.
This particular surgical training opportunity is ring-fenced for those with nursing training.
As an asside, these practitioners are to recieve 'micro' training - it costs docs £1000-1500 to do a micro course at present.
Actually the advert states NMC OR EQUIVALENT so a junior doctor could apply. That would be brilliant.
stop whining and blaming the fucking nurses, get off your arses then and do something about it!
Anonymous 1 - gain some knowledge first before you talk about nurses prescribing antibiotics. Many GPs prescribe antibiotics for simple viruses, that can also kill!
There is only one post here that has had the intelligence or manners to give themselves a name, but having to think of a name might tax your closed minds too much.
A band 7 is an insult to any nurse with the relevant experience requested that may apply for that job!
It is the Trust that is disrespecting your years of medical and surcical training not the nurse with her ss uniform.
"NMC OR EQUIVALENT so a junior doctor could apply"
Being a doctor is no more the 'equivalent' of Nursing Madwifery Council registration than being a nurse is the quivalent of General Medical Council registration.
Nurses are nurses.
Doctors are doctors.
Fuckwits are fuckwits.
Changing names does not change the laws of physics.
Advanced Nurse Practitioner, wind your neck in please!
The following was part of the original email to us, and was not an editorial addition:
"I fully subscribe to your stance that this is not the fault of the individual nurses doing these jobs..."
I think this makes it absolutely clear who we think is at fault here, and it is not our brethren in front line nursing.
Advanced practitioner,
Please tell me how Rx antibiotics for a virus kills? unless you mean by oversight.
Go away read and try and live up to your title.
What should we do? getting the problem in the papers and protests on the streets didn't help.
Lots of my surgical friends are out of jobs next month.
Can't blame the nurses for taking the jobs but they shouldn't be available to them in the first place
"Many GPs prescribe antibiotics for simple viruses, that can also kill!"
If a GP is prescribing antibiotics for a 'simple virus' then they should be struck off.
Antibiotics should never be prescribed 'for' a virus.
They may be prescribed to:
1. Cover the possibility that this is not a virus, but a bacterial infection which requires treatment (where this is suspected - especially in those at high risk).
2. To prevent bacterial infection occurring on top of a viral infection (eg: in patients with COPD or severe asthma).
Funny pseudonym
Please tell me how Rx antibiotics for a virus kills? unless you mean by oversight.
Go away read and try and live up to your title.
*********************************
Antibiotics can kill if given inappropriately!
*************************
Dr Rant
If a GP is prescribing antibiotics for a 'simple virus' then they should be struck off.
Then there would be many GPs in my area struck off!
The nurses cannot get jobs on the ward. There are no jobs for them. 82% of our nursing graduates over the last 3 years have not been able to find nursing jobs anywhere in this country. They are only hiring health care assistants. These people (care assistants) are nothing like nurses.
I am a medical ward nurse with a BS degree and I enjoy ward nursing. I would really like to find a job in another area on another ward but there are NONE. None. NONE.
I have three options. Go the nurse specialist route, stay on the short staffed hellhole ward I am on and get made redundant never to find another job, or get the hell out of nursing altogether.
These are the only options due to the recruitment freezes that have been in place for years and are going to continue. On top of the freezes, they are cutting another 600 staff from my trust and closing three wards.
I am moving to the USA (used to live there and did my nursing degree there) and I am starting law school in September. I'll be working part time as a ward nurse there while I am studying and I am going to make big money.
Bye Bye Losers.
Advanced practitioner,
Unless someone is allergic (and not the " i get a dicky tummy on XYZ") to the drug then please tell me how antibiotics kill if given inappropriately.
Do you even know the mode of actions of antibiotics?
Most people most of the time would never even notice if you put antibiotics in their tea daily.
Give a decent reply, show me you know something and are not another of the under-qualified jumped up replacments for the doctors.
Advanced practitioner,
unless someone is allergic (and not the " I get a dicky tummy on XYZ") to the drug then please tell me how antibiotics kill if given inappropriately.
****************************
Funny pseudonym.
Both doctors and patients alike have come to regard antibiotics as a cure all for every thing from a bout of sniffles to more serious ailments like tuberculosis and meningitis.
The indiscriminate use of antibiotics has accelerated the process of bacterial resistance. It is very common for patients to visit a doctor and insist on an antibiotic prescription for minor ailments of unknown aetiology and many doctors and nurses I agree, have given in to this pressure and prescribe.
Some antibiotics like Chloramphenicol, can lead to severe blood diseases, use of streptomycin can cause ear and kidney damage, azithromycin use can induce acute interstitial nephritis, with some patients at risk of permanent renal injury.
Occasionally some people may be allergic to certain antibiotics, and as you know a full fledged allergic reaction can prove to be fatal.
******************************
Do you even know the mode of actions of antibiotics?
Antibiotics act in different ways; some of them break up the cell wall leading to cell lysis. Some antibiotics interfere with the synthesis of protein in the bacteria and still others damage the bacterial DNA.
*****************************
Most people most of the time would never even notice if you put antibiotics in their tea daily.
I have no argument with this, as you are right!
*****************************
Give a decent reply, show me you know something and are not another of the under-qualified jumped up replacements for the doctors.
On a personal note, antibiotic over-prescribing in children especially is exasperating to say the least especially in nurse-lead WIC. I along with my GP colleagues are working to reduce this badly informed behaviour. Patient Group Directives (PGD’s) are used in the majority of nurse-lead centres in my region and are no substitute for the knowledge gained as an independent prescriber.
Over the last 5 years I have seen a dramatic increase in complications of bacterial pneumonia such as empyema and lung abscess in children which were almost unheard of when I qualified. We regularly have to send children to our local specialist centre for thoracic surgury. These children will be damaged for life. I, and my paediatric consultant colleagues, attribute this to the fear GPs have in prescribing antibiotics because they are following the idiotic protocols dreamed up by people with their heads up their arses. Of course you shouldn't prescribe antibiotics for a virus; your don't need to be a nurse practitioner to know that but you do need to have the humility and breath of experience to know that not every child with a cough has a virus.
A little knowledge is a dangerous thing indeed.
Dr Ray
I am quite aware and do have the humilty to know that not every child with a cough has a virus, my training at Great Ormond street taught me that.
Your training was as a nurse not as a diagnostician. You don't ask a hairdresser to repair your car no matter how well trained a hairdresser
Dr Ray,
My initial training was as a nurse that is true, but as you are aware I have had further extensive training to enable me to diagnose, and not just a 3-12 week course. I know you disagree with extended practice but many GPs agree as they employ us, be it financial or for other reasons.
Love the way that advanced practitioner has plagiarised his/her answers on antibiotics from the following site:
http://www.infoholix.net/article_antibiotics_adverse_reactions.php
Googling the information is not quite the same as understanding it.
anoymousmedstudent
why re-invent the wheel, when it has been said better than i could ever say it!
Googling information to my knowledge is a regular habit or so i'm told by my GP colleagues.
I am a nurse and I agree that a nurse is not trained to diagnose. A nurse is a nurse, a doctor is a doctor, and an engineer is an engineer.
This doesn't imply that nurse training is easy. It is one of the toughest programs one can do at diploma/BSc level. It's many times more difficult than teacher training.
No doctor could handle working as a nurse for a 14 hour shift. They wouldn't know what to do or where to start.
Don't let the nurses act like doctors and for the love of god please don't let the doctors try to be nurses.
Nursing is not a sub-specialty of medicine. Nursing is a completely different discipline.
There has been a trend in the Phillipines where many of the doctors are switching into nursing to get to the USA. They will make more money as a nurse in the USA than a doctor in the phillipines. It is easier for them to get to the USA as a nurse than a doctor.
I am hearing from some of the nurses that work with them that many are useless and some are dangerous. They don't know how to administer IV therapy (only how to order it) or that you can't mix certain IV meds in the same line...stuff like that.
Let's all stick to what we trained to do.
'Lets all stick to what we trained to do'.
But thats the problem isn't it ?
Nurses such as advanced practitioner HAVE BEEN TRAINED to do certain things [give drugs, look after certain types of cases, etc].
And [according to the research evidence] gets it right most of the time.
As far as I can tell this argument boils down to whether or not nurses with years of experience in their specialty plus post-reg training [prescribing, minor injuries/illness courses, etc] validates the extended role they perform.
At any rates the quacks have been at it for years and if they were half as bad as some suggest I'm puzzled as to why this has not been demonstrated by any research papers, because to the best of my knowledge no such published data exists.
Incidentally 'anonymous' a great deal of what nurses routinely do nowadays would have been frowned on by doctors in the fairly recent past.
I can't help thinking docs who worry about quacks are a bit like King Canute - and given the way things are in the NHS I think it would be almost impossible to get the genie back into the bottle.
I'm a self-confessed quack and pretty good at what I do, for example I can pop an anterior shoulder dislocation back in with entonox, most of the junior docs go down the morphine/midazolam route because reduction is not the sort of thing you can learn in the classrom [irrespective of how many A-levels you have passed].
What is baffling is that wages for junior doctors and those so called "practitioners" are very similar! Then why throw junior doctors and all their expensive training and years of experience to the skip and replace them with nurses and spend money again to train them?!
First and most importantly, I'd like to express my disgust that high-achieving, highly experienced, innovative, talented surgeons are being made unemployed because the NHS would preferentially employ nurses who've been on a short course (and will inevitably pass the buck to the doctor when they come across something outside their protocol). Who does this benefit? Not the NHS, not the trust budget, not our patients, not the unemployed doctors. Nobody.
Secondly, I'd like to say there are some excellent comments here. My favourite is this one:
Nurses are nurses.
Doctors are doctors.
Fuckwits are fuckwits.
Changing names does not change the laws of physics.
...closely followed by this one:
Your training was as a nurse not as a diagnostician. You don't ask a hairdresser to repair your car no matter how well trained a hairdresser
And A&E charge nurse, I have to respectfully differ with you regarding shoulder dislocations. As an ATLS tutor and having a hell of a lot of experience relocating joints, I think I'm allowed to disagree with you on this basis without needing to brandish my MBBS, MRCS and surgical doctorate. But hey, what do I know compared to a pro like you? Perhaps I should enroll on a nursey course and learn to do it the proper way ;)
Thanks phoenix - care to elaborate as to why an obvious anterior shoulder dislocation should not be reduced immediately by a quack who is competent with modified Kocker, especially if the same joint has popped out several times before, providing;
* Fracture can be excluded by history.
* There is no evidence of distal neurovascular
insult or any other significant injury.
Incidentally I was tutored by our lead consultant who thinks quacks are OK.
If it were my shoulder I'd prefer somebody who reduces them regularly [such as an A&E practitioner] rather than somebody who has lots of qualifications but little PRACTICAL experience - by the way, nobody has ever paid much attention to shoulders on the ATLS courses that I have attended :)
care to elaborate as to why an obvious anterior shoulder dislocation should not be reduced immediately by a quack who is competent with modified Kocker, especially if
*the same joint has popped out several times before, providing;
* Fracture can be excluded by history.
* There is no evidence of distal neurovascular
insult or any other significant injury.
No reason at all, provided that (in accordance with your own rules):
a)the quacktitioner is present 'immediately'
b)the same joint has popped out before (and the patient gives an accurate, reliable history of the same thing happening again)
c)fracture has been excluded (and the quack is qualified to do this)
d)there's no distal NVI (and the quack is qualified to assess this)
I'd say that cuts down the number of shoulder disclocations you'd be allowed to reduce by yourself quite significantly.
Incidentally I was tutored by our lead consultant who thinks quacks are OK.
I can't deny that quacks have a valuable place in A&E, but it isn't to replace doctors, because they haven't been medically trained. They can 'diagnose' and 'treat' according to fixed protocols, but outside these, they need a doctor.
If it were my shoulder I'd prefer somebody who reduces them regularly [such as an A&E practitioner] rather than somebody who has lots of qualifications but little PRACTICAL experience
Luckily for me, I have plenty experience as well as being well qualified. I mentioned this above, but perhaps you chose to ignore it ;)
- by the way, nobody has ever paid much attention to shoulders on the ATLS courses that I have attended :)
You probably already know this from ATLS courses you've observed, but the courses are about leadership, responsibility, triage, assessment of injuries, recognition of potentially dangerous conditions, life support, etc... and they're centred on the whole patient, not just the shoulder.
I'm sure you ARE great at following your protocol and dealing with simple injuries within tight guidelines. Unfortunately the majority of patients fall outside those guidelines and need a doctor. They need someone who's both willing and qualified to take full responsibility for whatever or whoever walks through the front door of the hospital.
To A&E Charge Nurse, Advanced Practitioner and all other Nursing commentators or silent readers.
I sent the original e-mail to Dr. Rant, and would like to further state my position.
FIRSTLY: I have absolutely no issues or problems with 99.99% of nurses; there are a few lazy arseholes (notably entrenched ward staff nurses with non-specific anti-doctor grudges, rather than any NPs), but sadly probably proportionately less than the amount of dick head doctors that I have been forced to worked with.
I have had experience of working with NPs a number of times. Initially of a pilot of Hospital at Night, our night JHOs (this is pre-MMC) were suddenly replaced by NPs. These guys did virtually all of the tasks that JHOs had done before (including being first responder to sick ward patients, phlebotomy, ECGs, ABGs – pretty much everything apart from actual prescribing.) We as ‘senior’ SHOs at night had a particularly close relationship with these guys (and girls I do not intend to be sexist) especially as our role had much ‘on the job’ teaching.
My opinion of these specific NPs? – fantastic: some of my best memories of being a doctor (again this is pre-MTAS when I had a job, prospects and could pay my families mortgage) were nights shared with the team, sorting patients out, drinking communal coffee at six in the morning and generally having a good time. There is not a single nursing member of that team who I would not happily buy a pint. By the end of the two years spent in this job I both trusted these guys judgement and accepted that they were more use than a shit-scared JHO on their first week of nights.
Did I therefore approve of HaN? – Absolutely fucking not. Our JHOs went home at eight PM. Now I challenge anybody who has worked in an acute surgical/medical ward to remember a time when a patient got ‘sick’ during the day – ……anybody……hello….…nobody then? Hell no, it doesn’t happen, emergencies always happen when you are asleep and have to jump into ‘on’ mode instantaneously. During their year as JHOs this cohort got approximately no useful training at all.
Interestingly, some of the greatest proponents for ‘JHO training’ were the HaN nursing team themselves, because they were shitting themselves due to the knowledge that next year, the SHO who they had to ask for advice had never done a fucking night shift before!. It makes no sense. Don’t get me wrong, these NPs were very good, I could not have functioned without them – but this was two way. The HaN nurses (including some who had been doing surgical nursing for twice as long as I had even been alive) were able to recognise the limitation of their training and when to call for someone with different experience (not better, just fucking different right!), in the same way that I knew when to call my consultant. Interestingly, after many frank discussion with team members (we liked and trusted each other) I discovered that these nurses earned £10,000 per year more than the JHOs – so they weren’t even cheaper for the trust, future medical training had been completely sacrificed by a management that could not see past the end of the year.
SECONDLY: This advertised job in particular. Why I was so angry is that this is effectively a job advert for a senior plastics SHO. Go on try and argue: being first to see patients in clinic, being first operative assistant under consultant supervision, receiving training in microsurgery – THIS IS WHAT WE DO damn it. To any individual nurse that applies for this post, good luck to you, I wish that actual surgical trainees were being given the same opportunity. Medical and Nursing training is different, this is because we are supposed to be doing different jobs. I am all for fair opportunities, if I wanted to be a nurse I would re-train as one. ‘Anonymous’ I am sure after three or four years nursing training I would just about manage to scrape through a 14 hour shift – I have done to date uncounted 56h on call shifts (24h Sat, 24h Sun, 9-5 Mon) during which my sleeping time had been in single figures (whatever my EWTD form said). If a nurse wants to be a surgeon, fair enough, there are several express entry/post graduate entry medical degrees available – see how you guys get on with MTAS. See how you compete with us on level ground.
Yours respectfully,
Mr. Wandering Odysseus BSc(Hons), MBBS, PhD, MRCS.
Wandering Odysseus - like your HaN quack colleagues, I prefer to think of extended nursing roles as just that, a way to maximise years of specialty experience.
Clearly there is antipathy toward quacks from many docs and since MTAS these negative feelings seem to have mushroomed.
Like you I enjoy a close and supportive relationship with [in my case] senior medical colleagues.
The stuff we [ENPs] do in A&E is driven to a large extent by the huge increases in attendences [30% over the last I0yrs in our department] and by the recognition that senior nurses develop certain skills, particularly when it comes to minor injuries, an area rather neglected on the medical curriculum I'm told.
Criticism of NPs is perfectly valid because we all screw up from time to time and we can ALL learn from mistakes.
But it is the global stereotyping that tends to polarise debate - the sort of things I frequently read in the blogsphere [but curiously hardly ever face to face] are ;
You're not clever enough.
You have the same clinical approach as a dalek [protocol loving, unable to think laterally, etc, etc].
You have no insight into clinical risk.
And more recently;
You are too expensive [although my earnings after many years in the trade are far below those of senior medical colleagues].
One hypothesis I have fallen in love with is the notion that some of the generalised disatisfaction and understandable anger amongst [particularly junior] docs has been turned toward the quacks, even though they make up a very modest proportion of the nursing workforce.
Lets put it this way if all the quacks decided not to turn up to work tomorrow I hardly think it would be the end of civilisation as we know it.
well i think nurses being allowed to prescribe is bollocks, i think physios doing surgical consultations after GP referal (Coventry nhs you stink) is a national disgrace, etc
but i really do recommend all you docs to cut down this line of argument, the "im cleverer than you cos i have more degrees" crap is such a childish and ill thought out argument, you have more RELEVANT training - and that is the heart of the issue, you should have more training to question approaches, this is enough, pissing off most of the population who have fewer academic qualifications is not the way to go, and bits of paper from colleges have little corelation with genuine intelligence
Fascinating discussion.
I worked as an auxilliary nurse for two months before entering medical school, and I felt this gave me a much better understanding of how nurses worked. This was very useful in hospital medicine.
I also worked for two months with the first breed of Paramedic Response Units, which I found very useful.
Like the nurses that I know who are pioneering Hospital at Night, and like A&E Charge Nurse, these paramedics were the cream of the service, who had intensive experience and were excellent at what they did.
The problem I have is that this is not just about taking the top 5% of nurses who have the ability, skill, and experience to expand their role to maximise the service.
This is about dumbing down of the service. After the pioneers, less able nurses will be forced to move up to this level (and I've taught some of these 'follow on' nurses in ALS courses, and they are as scared as we are - although some of them express this fear by being aggressive, which is really unhelpful).
Health Care Assistants are already providing the bulk of nursing care in increasing numbers of units.
Meanwhile, the unwanted nurses and doctors are simply being dumped into a pool of unemployed skilled staff waiting for private companies to mop them up with poor terms and conditions and poor pay.
This is clearly wrong from a Kantian point of view, but might be acceptable from a Utilitarian point of view if it helped patients. But it doesn't. It makes care much worse.
The only people doing well out of all of this are the shareholders of the companies moving into health care provision as franchise holders for the new NHS.
So that's ok then.
Dear Anon on 23rd July above,
We doctors are made to jump through fire burning hoops of MRCS, MSc, publications, audits, run of the mill ward work, unpaid out of hours work, wiping fevered brows of NPs etc to get trained whereas a nurse can get the same 'responsibility' (note the inverted commas) and pay (no inverted commas) by being fast-tracked by a system that serves to divide and rule the medical profession.
A good example is the plastics micro course at £1500 for a doctor and being thrown in for free for the nurse surgeon.
We have more 'degrees' and letters after our names because we worked for them in order to prove to the powers that be that we are qualified/ motivated/ suitable/ keen/ good enough to be trained in the chosen field.
There is no baptism of fire for these fast-track NPs. How are they supposed to know how not to get burnt?
Fools paradise indeed.
Yours sincerely,
Ivy Bolas MBChB MRCS
(have relocated shoulders under entonox; also jaws, hips, wrists, ankle, hips; sewn tendons, done DHS, done hemis, done Ilizarovs, done pedical screws, taught students, doctors, nurses, done plastics, neurosurgery, vascular, A&E, paediatric and adult procedures,worked as a registrar in ortho, audits galore, published in the JBJS etc but NO JOB thanks to MMC... and cannot apply to nurse practitioner posts.
Interesting discussion. The nurse practitioner debate is usually one which can get hostile but nice to see polite responses here.
It is an emotive subject. As has already been alluded to, there are both pro's and con's to the NP. It is a shame to see the arguing between both Doctors and Nurses. It has been said the relationships between the two are better now then what they have been in the past 25 years, and to loose that would be a great shame.
MMC and the like have been a devestating blow to all Doctors, likewise though have been the cuts in Nursing posts. Our two professions while being inextricably linked share both the same opinions (as demonstrated on this blog) though both have their distinct differences perculiar to them. Nurses with experiance do have knowledge which may be of use. Doctor's undergo years of rigourous training, and have have knowledge they put to use. Nurse's and Doctor's are proberbly the two most allied professions due to the close working nature. A sensible dialogue between both parties and local agreements are the best way to proceed as agreed by both NP's AND Doctors. Why? As to do that will admitedly mean differences between hospitals I admit, though to thrash out a deal of the defined working of the NP to the department IN CONJUNCTION with the medical team will allow both parties to understand each other.
Nurses have never said they want to take over the role of the doctor. Such a thing was slammed by the Royal College of Nursing. The NP's and Nurse specialists I have seen are in a role which act's as an adjunct of the Doctor and enhances the Nursing role. I however appreciate the views of the Doctors, and why you are saying that. No competant nurse would ever not get a doctor if a patient needed one, and anyone who would do such a thing would be reckless.
did anyone see "treatment isn't working" page 21 of the daily telegraph yesterday? could have written it myself
http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/07/23/dl2302.xml
would like to ask the charge nurse "what is the SHO doing whilst your are putting in dislocated shoulders?"
are you covered if you stretch the axillary nerve or rodger the brachial plexus?
I have left surgery for general practice because I can't stand seeing the dole of Dr's in hospital being undermined and taken away.
Am I covered ?
Yes, through the MDU personally while the Trust accepts vicarious liability for the role performed by ENPs in A&E.
As you know it would be virtually impossible to externally rotate an anterior dislocation [excluding the use of significant force] unless the patient is relaxed - this requires a reasonably competent technique.
I have seen reductions [by medical colleagues] go smoothly, while on other occassions the humeral head is virtually yanked back into the glenoid using little more than traction and brute force[sheet under the armpit technique, foot up on the trolley, etc, etc] - obviously while the patient is anaesthetised.
I have only ever come across one wrist drop that resulted from manipulation, unfortunately the SHO who performed the procedure failed to document presence/absence of sensation at the regimental badge, or ability to actively dorsiflex at the wrist crease before relocating the shoulder [I appreciate there is no way for you to corroborate this anecdote..... but it is true].
In my experience junior doctors are not so much undermined in A&E as overwhelmed by the sheer demand of having to deal with so many cases - not for nothing are they referred to as clerking machines.
You ask what the SHO is doing [while the ENP plies his/her dodgy trade], well it could be assessing a psychiatrically disturbed patient, putting in a chest drain, dealing with bereaved relatives, sorting out a sick child......well I'm sure you get the general point.
I agree doctors are being unermined but perhaps it might be more productive to target your frustration toward the DoH as well as those senior medical figures complicit with MTAS rather than a few peripheral nurses who might cause the odd nerve injury by performing a procedure that is never without risk.
Going back to the original advert, I think both doctors and nurses should be angry at the way in which our knowledge and skills are being exploited for what in effect is a way of cutting costs. Qualified nurses cannot get jobs and are being forced to work in roles for those who are unqualified and guess what they will be paid less than they should. If heaven forbid a doctor should apply for this job then hey presto they are paid as if they were a band 7 nurses (as said before this is already criminally low as a salary for such a role). In my opinion once you have the qualifications, knowledge and skills to practice as a practitioner (of whatever type) then you cannot go back to being someone who is not qualified (or you would hope not). This advert stinks, but for different reasons to some of those expressed above!
To Julie above,
Of course one 'cannot go back to being someone who isn't qualified'. Unfortunately, there are times in life when one has to balance psychological death and pride with the need to put food on the table.
I am fortunate to have a husband to provide for me. However, a number of of my male colleagues are the sole breadwinners and they would have to take dead-end staff jobs for which they are overqualified and have to do the bidding of ortho NPs who would order them about according to the protocols of the tick-box sheets.
Perhaps our so-called doctors' leaders underwent voluntary castration to get to where they are now.
And I am someone who has, in the last round of reorganisations had to accept a demotion so that I can continue to pay my mortgage as the main bread winner of the family. What I am saying is that it is no more right to dumb down a medical job and sell it to a nurse then to dumb down a nursing job and sell it to a health care assistant.
>>>>Mr. Wandering Odysseus BSc(Hons), MBBS, PhD, MRCS.
++++
Doesn't the PhD supercede the BSc? It's one thing to have a whole quiver of qualifications, it's another thing altogether to document ones which don't need to be documented ;)
I don't think Mr Wandering Odysseus' PhD supercedes his BSc. You can do your PhD after med school, using that as your primary degree.
It's relevant that somebody is "BSc scientifically trained" aswell, as you can use your medical degree to do a PhD in all kinds of stuff that is more BA than BSc, such as international health or the socio-economic determinants of disease etc etc. Also, without wishing to reignite the old debate, the PhDs that many of the nurse practitioners I've worked alongside certainly don't require a scientific background (or any scientfic knowledge whatsoever in some cases). Also, people who have an MBBS and a PhD quite rightly put both after their name in order to distinguish themselves from a non-clinical doctor, even if they have used their medical qualification as their primary degree.
People who have an MD don't document their MBBS as the MD supercedes the MB, so they become MD BS
But PhDs do usually supercede the other degrees. If you have a PhD, you also have a basic degree which you no longer need to document unless you're an incorrigible narcissist.
I am of course referring to the documentation of one's name and qualifications on a daily basis. It's normal to document all qualifications on a CV, even if they've been superceded.
I've never seen MD BS after someone's name!!! Doesn't mean it doesn't happen though, I guess. Is anyone else familiar with this?
Like I said above, if you're a medical doctor it's neccesary to be Dr. Joe Bloggs MBBS PhD, rather than Dr. Joe Bloggs PhD, as otherwise there's no way of identifying that you are a clinician.
Lamest debate ever? You bet.
Isn’t bogging great, I knew I was tackling a controversial topic when I sent the e-mail to Dr Rant, this was of course the idea, a good general discussion and argument was expected and thoroughly enjoyed.
I was glad that the debate has evolved into much more than just ‘we hate nurses/we hate doctors’, because I genuinely feel that in most cases this isn’t the case.
A few more comments (to keep the fun going)
1 - Qualifications. I did not expect the issue of my qualifications to arise, but a good issue none the less. I put in all that I had, in general day-to-day life I would not use half of them, but it seemed to fit the rant.
2 - Pay. I had a reasonable understanding of the old nursing pay scale and rank system, but I must admit that I have not fully caught up with ‘agenda for change’.
On an aside, I have seen this abbreviated in official DoH literature as ‘A4C’!, if there was ever a more clear statement of the wish to ‘dumb-down’ the medical and nursing possessions look no further – bastards.
If I had realised that band 7 was shit money for the job it would certainly have been included in the rant.
However, this raises another issue. The pay-scale on the advert is about right for a year 2-3 SHO if you exclude unsocial hours on call. Now, given that this advert is (at least in my opinion) for a Plastics SHO job, and does not include on-call, does this mean that NPs expect to get paid more than Docs for doing the same job?
3 - Uniforms. I really expected more response from this! In several of the hospitals I have worked in, the nurse managers/ward managers did indeed ware black tunics, these look pretty scary on the ladies, but on the chaps they look exactly like an SS-Panzer Grenadier wrap. These scare the shit out of me, I wonder if this is good for patient’s relations. Answers on a postcard.
The clothing debate as a whole is one I have not seen tackled on Dr Rant, should Docs ware ties? Should Docs were uniforms? Does anybody know the historical precedent for uniformed nurses and suited +/- white coated Docs. An interesting topic.
Lets keep the debate raging. What is the most number of comments for a Dr. Rant entry?
Yours,
Mister Wandering Shrewd-Minded Odysseus, BSc (Hons) - Bachelor of Science (with Honours), MB - Bachelor of Medicine, BS - Bachelor of Surgery, PhD - Doctor of Philosophy, MRCS - Member of the Royal College of Surgeons, MAI - Martial Arts Instructor, CBQ – Champion Beer Quaffer, RCGP – Reasonably Competent Guitar Player, MM – Milk Monitor, Emeritus MTC – Member of the Tuffty Club, STTAB - Smarter than the Average Bear. Dogs Walked.
Re: Uniforms: No real historical facts as far as I know. The fact is much is lost in the mist of time when it comes to that. For example, the term "Staff Nurse" is practically unknown in it's origin. The best answer was that this was termed from the millitary direction of "Staff sergant" which would tie in with the original Florence Nightingale millitary hospital and th start of Nurse training. The uniform I would say almost certianly would seem like a principle of Nightingale (the well dressed woman nurse in a dress and apron- Not for me of course as a slightly podgy bloke in a dress would be more disturbing than comforting).
Today the nursing uniform varies. There are normaly white tunics worn for both gender of nurse. Some areas have staff nurses in blue (see end of post for more on that), while some critical care areas wear scrubs.
Generally, there is either yellow or buff eppauletts worn by Health care assistants, light blue by staff nurses, Navy by sister/charge nurse, Full navy tunic/trousers buy senior sister/charge nurse. Certainly my university home trust hospital encourages the above mentioned uniform to be worn on the grounds that it makes staff recognisable as nurses. They also consider it more presentable then scrubs in ward and critical care areas. I have only seen a few Doctors ever wear the white coat, and the majority of them were surgeons when they came to the ward direct from the operating theatre. The other two I recall were older so I imagine were from the days of the doctors always wearing white coats all the time. I was told by one that the white coat was seen to put a barrier between the patient so that was ditched, though not sure if thats true (personally I think it looks nice the white coat). One thing that annoys me is when you see private home care companies wearing the exact same tunic as qualified staff nurses walking around public areas (like supermakets). Except, guess who get reported in the media? You gessed right, the staff nurses!
As for your comment: I think your right with all you have said wandering odysseus. There is sometimes a penchant for Doctors and nurses to batten down the hatches and start trading insults. At the end of the day, our professions are not "Better" or "Worse". We have different knowledge and skills. Personally, I find the fact that a doctor would loose his/her job to be replaced by a nurse is an insult to both our jobs (as I would a staff nurse loosing to a HCA) Does that mean I hate HCA's? Of course not, they are the backbone, I would simply be defending my professional standing. To me, there will always be a grey area occasionally. To develop a nurses role so that an experianced nurse can do an extended role is certian tasks is logical enough. The knowledge, experiance and competance held will be good enough, it is hard in say that an extended trained nurse is any less competant in one proceedure if they have trained long and hard to get there, but all of us need to remember that the extended nurse role takes a lot of training, is done only by a small percentage of nurses and in the mainstay was designed to help both parties.
If a doctor is to loose their job, of course you'll be pissed. Anyone would and that is totally natural. I myself read a copy of Nursing standard last year which was bemoaning the increase in the HCA work into "Staff Nurse" territory.
There was only one place where the development into a full practitioner role ever went without too much protest and that was the Ambulance Qulaifed Ambulance Man (QAM) qualification to Paramedic (Bar a few alarmed A&E doc's). Of course there a) No body else used ambulances in the NHS and b) It was needed.
Any other profession will always be open season.
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