I refer an asthmatic to Secondary care they see the Respiratory Nurse Specialist.
If, I refer a diabetic to Secondary care they see the Diabetic Nurse Specialist.
If, I refer someone with Multiple Sclerosis to Secondary care they see the Multiple Sclerosis Nurse Specialist.
If, I refer an epileptic to Secondary care they see the Epilepsy Nurse Specialist.
If, I refer a prostate problem to Secondary Care they see the Prostate Assessment Nurse Specialist
If, I refer an person with crippling osteoarthritis to Secondary Care they see a Physiotherapist
If, I refer a schizophrenic to Secondary care they see the Community Mental Health team.
If, any of these people have a knowledge-base greater than my own I will eat Lord Darzi's (rarely dirty) surgical scrubs.
Wednesday, October 24, 2007
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Dr Rant
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60 comments:
yep youre right on this one
GP referrals for trigger finger operation being seen by a physio (after a long wait) is a fucking disgrace
and physio on looking at patient rushing off to get a surgeon and showing them how extreme it is
and surgeon saying "yes its very bad but still needs to go on the next waiting list"
and then when you get to the front of that other queue (long time) the surgeon saying "sorry you need an op on 3 fingers, youre GP referred you only for one finger, you need to go back to you GP and get your other fingers referred, I'm not going to operate until we get referrals for all 3 fingers (and gone through the physio and 4 month wait again)" is a fucking disgrace
Coventry PCT and Coventry and Warwickshire NHS hospitals YOU ARE FUCKING CUNTS OF THE HIGHEST ORDER, IF THERE WAS ANY JUSTICE IN THE WORLD YOU WOULD BE FUCKING HUNG DRAWN AND QUARTERED
no one
That's amusing, because if one of the patients at my placement surgery wants to see a GP, 9/10 times they get to see the GP prescibing nurse practitioner.
Hmm, so Patient Choice doesn't allow me to choose to be treated by an actual qualified doctor ? or for my GP to so choose on my behalf ? How on earth did this happen, and why did the medical profession allow it ?
its cheaper
gives a veneer of service
same problem proper coppers have with PCSOs
and teaching assistants running classes cos kids are not entitled to proper teachers either
dont remember voting for any of it
Fucking hell these mutant nurses must be awesome ?
According to RCN sponsored employment research [Ball, 2006] there are only 3,196 members of the Nurse Practitioner Association [NPA] - out of a population of 1/2mil+ registered nurses.
2,000 of them work in the community.
So, around a 1,000 of these mutants cover a multitude of diverse hospital specialties including endocrinology, psychiatry, respiritory, neurology [and lets not forget the cack handed ENPs cluttering up A&Es] up and down the country - the remainder work in MIUs or WICs.
Of course, a percentage of nurses will be working in advanced roles [usually with consultant supervision] who are not part of the NPA membership, so it is difficult to state definitively how many work in the NHS - but their numbers are pretty modest.
Looking at out our Trust [a London teaching hospital close to foundation status] autonomous quacks are relatively few and far between [when compared to both the numbers of junior doctors, and non-specialist nurses]- in fact the biggest group of quacks probably work in A&E, and I'm their self styled guru.
Which way to the firing squad ?
are the nurses running the 3rd world walk in centre in Coventry members of the Nurse Practitioner Association ?
Of course, the Community Mental Health team includes a psychiatrist, in case you didn't know. Yes - a proper doctor man!! So presumably, his knowledge base might actually be larger than yours because he is a doctor and doctors are right brainy innit.
a&e charge nurse
I think you will find that is part of the cause for concern. There is no register of NPs or any means to regulate them. Some nurses are "encouraged" by Trusts to work outside their capability and training, and the Trust can merrily label them NPs or specialist nurse when they have no formal additional training; this is particularly an issue with diagnosis of problems coming off the street as in the WICs where they are effectively unsupported. It is frankly dangerous for patients but also for the nurses' careers.
Trusts took this line to save money but they are wrong. The nurses are both relatively inflexible and cost significantly more than a doctor as some of the more astute finance directors are beginning to see
"if you think hiring a professional is expensive try hiring an amateur"
Charge nurse my understanding was that the nurse "specialist" and the Nurse Practitioner are a different set.
We have loads of nurse specialists in clinics in hospital. Most are great, they however cannot prescribe and are not autonomous.
diancecht
well said
no one
I work in a Community Mental Health Team.
I may or I may not have knowledge (of psychiatric matters) more than your own but what I do have is better resources to help manage things.
I've time (so spend longer with patients, typically an hour or so), I've ways of supporting folk (day hospital, day respite, daily input from Support Time Recovery workers, CPN input, home visits from myself) and we've people who can sort out broader issues (with social work, occupational therapy, and a pharmacist in the CMHT as well as nurses and myself).
One reason why I reckon private practice for psychiatry isn't flourishing is 'cause you really can't do better than a responsive Consultant lead CMHT.
So I'll concede that when you refer to Secondary Care you may know more about your patient and your patient's problem than I do, but I'd wager good coin that I've better resources to improve things :-)
oh yea the nhs has a great track record on psychiatric matters doesnt it, how many murders been done by people they are supposed to be looking after? how many times has the nhs even admitted it failed in its duties of care but not really changed much?
wot bollocks
diancecht - absolutely correct, it is unacceptable that an approved quack register has yet to be established, especially given how long they been around [10yrs in our department].
The NMC has been pushing hard to instate such a mechanism but the delay is due to the DoH, in part because of issues generated by the Shipman report[s], rather than intransigent nurse administrators
http://www.fifeprescribersforum.co.uk/?p=30
Quite right funny psuedonym: the terms quack and CNS are often used synonomously but they do, in fact, provide quite different roles - thank you for pointing that out.
My impression from the blogshere is that either role is profoundly problematic for doctors - curiously I have no objection to this position.
I just resent the endless [and unsubstantiated] accusations that we are a danger to patients, or provide inferior standards when compared, say, to junior doctors.
We aren't most of the time - I hesitate to raise these perennial points since doctors tend to become rather excitable when they are mentioned, but if the nurses are so dangerous why is there;
[1] no studies corroborating such accusations ?
[2] consultant support in many of the specialties ?
[3] growing evidence that these roles are increasingly utilised in other developed health systems including, Canada, Oz, and the USA ?
Basic common sense tells us that if Trusts or PCTs were continually writing fat cheques for damages after quack or CNS ineptitude both concepts would have been scrapped a long time ago.
The question in my mind is whether or not years of "hands on" experience, in conjunction with appropriate post-reg qualifications provides sufficient grounding for the nurses to do certain things with appropriate consultant supervision.
The research evidence [such as it is] suggests, in the main, that the answer is probably yes, but as I mentioned earlier it is another matter entirely as to whether or not this is acceptable given the obvious tensions around job demarkation.
The simple solution would be to have more docs of course but MTAS put paid to the aspirations of thousands of promising young doctors - I think the medical heirarchy needs to take a long hard look at itself for it's role in this debacle.
Right now the NHS is expected to deal with far too many patients all vying for vital medical expertise.
IMHO nurses can deal with some routine cases leaving that docs [in theory, at least] more time to get their teeth into the complex stuff without one eye continually flickering toward the clock.
so charge nurse do you support "walk in centres" with no doctors at all? only nurses
covering many gaps in health provission?
No, I don't, no one - even the SpRs in A&E turn to the consultant every so often.
The ENPs have the same safety net, good for the ENP, but more importantly, good for the patient.
you really can't do better than a responsive Consultant lead CMHT
agreed. I think (I glean from posts at Dr Crippen's and here) that some CMHTs are not responsive and not really Consultant led.
good charge nurse glad we agree
the walk in centre in coventry is crap in the extreme
i know they have recently opened some big nurse only walk in centres on the south coast, portsmouth or southampton somewhere like that (sorry i forget), was not at all impressed with the senior nurses explaining how great it was on the TV
i love this re nurse led walk in centres from the nhs web site
"by providing professional nurse-led care to match modern lifestyles that don't always make it possible to visit a GP during normal working hours"
so if you lead a modern lifestyle youre not entitled to a doc in the nhs
Of course they could always stump up a bit of cash, then people 'with modern lifestyles' could see a GP at their convenience.
Sent to a consultant but saw a nurse instead eh? You lucky, lucky people.
I was referred to a psychiatrist by my GP. Unfortunately the psychiatric nurse practitioner hadn't turned up for work so I was seen by a 'therapist' with no medical qualifications whatsoever. He misdiagnosed me and overruled my GP to put me on a waiting list to see a registrar.
Two and a half years later I was still on the waiting list so I offered to pay the psychiatrist £180 per hour to see me as a private patient.
As if by magic, a 10am appointment became available within 4 days. I was correctly diagnosed and hospitalised immediately.
How long before somebody is killed by a well meaning but clueless 'practitioner'?
If, any of these people have a knowledge-base greater than my own I will eat Lord Darzi's (rarely dirty) surgical scrubs.
******************************
Rant
I'll supply the knife and fork!!
Such arrogance! Shows just how some doctors have no idea!!
re "Dr Rant said...
Of course they could always stump up a bit of cash" my blunt answer to this is I'd love to see a situation where there is a private GP within reasonable distance of the majority of the population
at the moment there isnt
the nhs in this regard stops access for all regardless of how much money you have
and yes arrogance from dr rant is nothing new
I think something that often seems to be missing from these arguments is the context of the multi-disciplinary team. Are the nurse practitioners/specialists working in isolation or in conjunction with a doctor and other professions?
The last time I referred someone to the diabetes nurse specialist she made a point of booking him in to see the doctor as well as herself. Fine. That suggests that the DNS is working in conjunction with a doctor rather than instead of.
I'd be rather more concerned though about walk-in centres with no doctor present.
Some nurse specialists can make a compelling claim to be bona fide nurse specialists rather than simply doctor-substitutes. For example on our psychiatric wards we have a wound care nurse specialist who we can call on. Wound care is very much within the realm of nursing, though it's a part of nursing that RMNs tend not to be particularly skilled at. Hence it makes sense to have a nurse specialist on hand if we need advice on a particular wound and the best way to care for it.
Likewise nurse specialists in, say, infection control, child protection, POVA...if one can identify a specifically nursing approach to a particular issue, then it makes sense to have nurses who make it their speciality.
Though it's important to remember that these kinds of roles make up only a small percentage of nurses.
90+ patients, that we know of, already dead because of lack of proper hygene control resulting in negligence by nurses to do their jobs; NURSE the sick to good health!
When will those in charge wake up to the fact that all those quacktitioners will prove to be the most expensive mistake in the history of medicine?! ... Maybe, when a cholera epedimic breaks in our hospitals as "Busy" nurses tell old and frail patients to go "Soil their beds!" because they have no time to pass them the bed pan or take them to the toilet!
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/11/ncdiff611.xml
sam, all professionals working in a hospital are responsible for good hygiene methods, you can't just blame nurses. The structure of good basic nursing care starts with good upper and ward based managemt and having enough bloody soldiers on the front line. We are all culpable.
I'm missing the point here.
Is it that patients and relatives are being blamed for bringing infection in to the hospital and killing 90+ patients? The infection wasn't there before, ill folk are admitted with infections, now it is there?
Assertive risk assessment and positive health promotion leads us down only one avenue . . . ban patients and relatives from hospitals.
Or is it felt that the escalting infection is through fault within nurse practitioners? ;-)
Shrink, I'm suprised you didn't know - the housing crash in the United States was also caused by nurse practitioners [allegedly] ;o)
I have to say, I'm starting to get more than a little tired of every failure in healthcare getting lazily and gratuitously blamed on the NurseQuacks.
The failures at Maidstone Hospital were not due to NurseQuacks running around being silly with clipboards. It was due to (among other things) a basic shortage of ward-based staff nurses.
And no, before anyone says it, the one was not caused by the other. The reason so many hospitals are short of nurses right now is not because the staff nurses are off doing nurse prescribing courses. It's because of the redundancies and recruitment freezes (during which, incidentally, the NurseQuack and Nurse Specialist posts were often the first to get axed) that came about as a result of the targets culture and the NHS budget deficits crisis.
In my trust, we haven't been hit so hard by deficits, but one thing I've noticed is a marked increase in nurses from other areas coming to work in our trust because they can't get jobs in their own area.
Meanwhile, back on the wards....
Those of you who are fans of Nurse Anne's blog may have noticed that she said the nurse staffing on her 35-bed ward has gone from 4 RNs and 3 HCAs to one RN and 2 HCAs. That's an insane reduction. And if you reduce nurse staffing to such criminal levels then yes, patients will wind up getting left to shit the bed, because the nurse simply can't be in 15 places at once.
O.K. then.........
When I said:
Of course they could always stump up a bit of cash, then people 'with modern lifestyles' could see a GP at their convenience.
I was being deliberately non specific about who 'they' are. Here are they options:
a) The patient
b) The taxpayer
c) The employers
d) The GP
Firstly, it won't be the GP - extended opening hours increase practice costs (insurance, staff utilities, locum bills) and hence have a disproportionately negative effect on the income of the GP, who is after all a small business man as well as manservant to righteous worried well.
How about the taxpayer? Well we frankly pay enough tax as it stands, and fuck all of the extra chucked in by NuLabour seems to get anywhere near patients.
The patient? Most but not all could easily afford to contribute some if not all of the extra cost involved, but as already stated, they pay alot of tax already, and any system like this would require yet more legislation and 'reorganisation' and contracts - god help us.
The employer? Well, the only good reason to actually need to see a doctor in the evening or weekend for a routine appointment is that you are a full-time working, tax payer busily grinding the country's economic organ. Yet according to Sir Digby Fuckwit-Jones and the rest of the wankers at the CBI, they lose money when one of their employees comes to see a doctor!!
Correct me if I'm wrong, but in alot of other countries, employment contracts routinely go hand in hand with some form of health insurance - but not in the UK. Private GP insurance would cost less than what the CBI reckons they lose each year, and everyone would be the winner. They could also count on generating extra staff good will, thereby boosting 'productivity'.
Can you guess which option I favour?
And as for nurses and arrogant doctors:
Fact: There is medical underemployment for Junior doctors.
Fact: There are plenty of fully trained and enthusiastic nurses who can't get a job.
Fact: There are patients lying around in their own shit with nobody to help them go to the toilet or feed them, let alone nurse them.
We value good nurses, and fully support nurses doing nursing - it's a tough and often thankless task that is hopelessly under paid and over stressed. They fact that the term 'angel' is applied to the title 'nurse' by the tabloids is scant compensation for this.
Specialist nurses within teams works really well when the dynamics are correct and the team is integrated with enough medical oversight. Where it doesn't work is when an additional layer between primary and secondary care is formed simply to manage demand or appear to improve 'Access' if there aren't enough doctors on the team.
As an experienced GP, I refer to secondary care when I don't have either the resources or the knowledge to deal with the patient myself. In the latter case I need the patient to see a doctor - Increasing this is becoming impossible.
There is the capacity out there to have the correctly trained person doing the correct job. Lets employ some more management consultants to explore this concept shall we?
It is not arrogance. I expect the same for my patients as I would expect for myself and my family. That is honesty.
re "Correct me if I'm wrong, but in alot of other countries, employment contracts routinely go hand in hand with some form of health insurance - but not in the UK. Private GP insurance would cost less than what the CBI reckons they lose each year, and everyone would be the winner. They could also count on generating extra staff good will, thereby boosting 'productivity'." i really dont think many middle income earners would mind paying to see a GP, and probably it could become a staff benefit in many workplaces, maybe more problematic for folk with long term conditions
however you have to allow private GPs to write nhs prescriptions and refer to nhs consultants before there would be widespread takeup, and yes i know this SHOULD be possible, it isnt possible in pragmantic terms apparently for many private GPs to do this
many folk have medical insurance related to work, usual UK style however is only to pay for secondary care after referred by own GP, this is already changing with some employers employing their own GP in the workplace
yep i agree with your analysis there are the people to do the work needed, just too many of them are sitting in pointless office jobs and too few of them are cleaning the floors
and there are limits to which a good professional will allow dangerous practises, nhs management should not be able to force docs and nurses to do things which are clearly more dangerous for the patients, however the medical establishment appears to endorse much of this crap such as nurse only walk in centres, referral to physio not surgeon etc etc
actually the long waits in Wales are just as bad as the dirt in England, neither is the correct outcome!
actually the long waits in Wales are just as bad as the dirt in England,
we have dirt as well as long waits. There's been a row about it recently but I now can't find the details (I suspect a silencing of whistleblowers).
Private GP insurance
insurance to cover appointments only? or prescribing charges plus the cost of the prescribed items? plus the cost of any private consultant appointments etc.? (Employer-hired GPs make more sense but employees need to know such GPs can become hired guns in instances of work-related disability, so, people would need independent GPs too.)
also, which GPs are going to work night shifts so a (private) patient can see them any time? Which current private GPs offer a walk-in no-wait-guaranteed 24-hour service?
(Etc.)
I have just added up the number of posts available in the UK this year versus the number of medical school students in the final year about to graduate.
There are several hundred less jobs than students.
This is if no one from out of the UK takes a single post here. We are all guaranteed a job for 2 years after graduation. I suspect in the next couple of years graduating from a UK medical school will be no guarantee of a job.
Nurses and physios won't be the only ones who get trained for a sinlge profession that they can't then get into.
I'll supply the knife and fork!!
I'll bring the webcam!!
I do think, A and E Charge Nurse and Zarathustra, that dr rant's right to complain if he refers a patient to a consultant and the patient's seen, initially and only, by a nurse specialist (though I can certainly see situations where that would make sense). To complain about that is not to diminish nurses (including Nurse Specialists and NPs) at all. The fact that -- e.g. -- some CPNs may be better at some things than some people in the same field with doctorates and /or medical consultant status doesn't vitiate dr rant's point.
There is though a problem I don't see disappearing quickly: there is almost certainly a trade-off between reduced waiting lists and seeing a Nurse Specialist.
Absolutely Jayann - nurses can be extremely useful, but only in certain niches.
As I see it the EWTD & MTAS have both had a huge impact on the medical profession.
Since the EWTD a small proportion of work [traditionally associated with junior doctors] has filtered down to the nurses, but in some respects this is just a further example of how boundaries in medicine must always change in response to different demands [be they logistical, financial, etc].
Nowadays it is fairly common for nurses to perform tasks that where once the exclusive domain of the medics, such as administering IV drugs, inserting various types of cannulas, performing endoscopies, reducing fractures, requesting x/rays, giving out drugs etc, etc.
All of this work could be done by doctors, of course, but the simple fact is that there are not enough of them to do everything, and in some cases junior doctors are not quite as experienced as senior nurses in one or two of the specialised areas [including A&E, haemodialysis, ITU, etc].
Having said that I agree entirely with Dr Rant that sometimes there is no substitute for a consultant and I guess that's why he is so pissed off.
the simple fact is that there are not enough of them to do everything
Agreed (also agreed that junior doctors may not be as experienced/knowledgeable as some senior nurses); but still I am seriously concerned about the extent to which this is cost-led when the 'costs' are what they are because of mistaken government policies. (I feel a rant of my own coming on!)
and now, I'll return to 'nursing' my bad back! :)
jayann "also agreed that junior doctors may not be as experienced/knowledgeable as some senior nurses"
But nurses do not have a broad base of scientific knowledge and training as doctors do, this is why they do not bear the same responsibility for patients as doctors do, hence, hiring nurses to do doctor jobs is not only foolish and very expensive but can be very dangerous too
If you put "your life in their hands" when you go into hospital, it is then your right to ask "Whose hands?!" Right? :-)
Your comments are interesting but paint a picture that is VERY DISTORTED. Oh yes, how dare us Nurse's ever go above doing a bed bath. Why pray, the next time I have a patient with an MI, my simple brain must then surely explode with the horrendously complicated task of thinking about what's wrong, where the pain is and consider doing an ECG. No, your all right there Doctor's, I will just bleep my SHO and tell the patient to wait around for an hour or so for him/her to be free from the 1000 odd calls that are waiting. Be careful though, if you tell me to "keep an eye" on my patient, I will, just don't yell at me when I diligently do my duty and watch while they arrest and start with rigour mortis.
Because yes, all us Nurse's are just shit aren't we? Why, even unqualified members of the public consider them self’s are superiors. I mean, up their in your Ivory tower's the clear air must really, really, really help with your cognition. Because you all do SUCH a WONDERFULL job of it all without NURSE'S, I am surprised you just don't all sack us as manage with just a consultant.
Now, show me a research study where it show's NP's et al are all a bunch of murdering fucks and maybe I will agree. Until then, stop blaming nurse's for Medicine's fault. There are consultants and Doctor's available, and the last time I checked my hospital's consultant's lists were full.
Your moan is simple. You think that nurse's are taking the role of the doctor's and leaving you on the streets penniless and unemployed. We are not. The trouble is you’re all too arrogant to realise that.
Dr Rant.
Do you not think that there are enough problems with the NHS and it's staff without comment's like this?
Your post would suggest nobody ever see's a consultant anymore... I really find that very herd to believe. Come on, your better then this!
"I'll supply the knife and fork!!
Such arrogance! Shows just how some doctors have no idea!!"
Actually, knowing the person who wrote this piece, I think it would be very dangerous to bet against her in a medical pissing contest.....
I think the problem is not with senior nurses (except they seem to disappearing and disempowered these days)
Also specialised niche nurses eg chemo nurses, DM specialist nurses, BHF heart failure nurse are helpful both to GPs and patients. They work with consultants and become an extra means of liaision with the consultant.
Problem comes with "advanced practitioners" seeing referrals, and then patient bounces back to GP, original referral question still unanswered/MRI not done etc. These "advanced practitioners" simply block/bounce referrals and don't seem to work with a consultant. I've never seen one of their letters say "I discussed this with the consultant first." Their letters are twice as long and say much less than a good consultant letter. You can see their lack of diagnostic incisiveness.
They represent a way for trusts to claim waiting targets met whilst actually reason for referral is not properly dealt with.
Hence why Francis and I have a beef with these "advanced practitioners" who actually do not advance the "patient's journey" one iota.
Sam - nurses do not bear the same responsibility ?
Sorry, you're plain wrong.
Look again at the literature, it's very straightforward, nurses [quacks] are liable for mistakes to their employer, professional body, and the law.
If I screw up as an ENP [say missing a schaphoid fracture] - I cannot hide behind the consultants.
The guidance is perfectly clear, errors would be judged against standards provided by doctors performing similar roles, in other words the Bolam, or "good doctor' test.
These "advanced practitioners" simply block/bounce referrals and don't seem to work with a consultant. I've never seen one of their letters say "I discussed this with the consultant first."
I can only really speak for Community Mental Health Teams, but in the CMHTs it's usual for CPNs to assess the routine referrals (more urgent referrals tend to be seen by a doctor). However those assessments are then always discussed in detail at a multi-disciplinary team meeting including nurses, social workers, the psychologist...and yes, the consultant psychiatrist.
I think there may be an element of us starting to violently agree, since although I'm not opposed to extended nurse roles in principle, I'm of the view that these roles should always be in conjunction with rather than instead of a doctor. As far as I can gather from the above discussion, this isn't that far from the views of Dr Rant and Dr Blue.
Anonymous: " how dare us Nurse's ever go above doing a bed bath. Why pray, the next time I have a patient with an MI, my simple brain must then surely explode with the horrendously complicated task of thinking about what's wrong"
Diagnosis is the domain of those qualified to diagnose. Surely, you will find enough of them around to help.
When you decided to become a "Nurse" and applied to "Nursing" school, you knew that you will graduate to "nurse", you knew that diagnosis was not your domain and you, therefore was not trained for it. Why are you then not satisfied with the role you wanted in the first place?! Now that you are qualified; equipped to "Nurse" to a high standard, why waste this ability and meddle in doctor's work instead?!
If you wanted to become a doctor, you should have studied much harder all your life, went to medical school for six whole years followed by more and more training and left nursing to those who want and enjoy nursing! Those know that nursing is not about bed bath alone but is a hard yet very noble role in its own right; the reason why they went to "nursing" school.
"Those know that nursing is not about bed bath alone but is a hard yet very noble role in its own right; the reason why they went to "nursing" school."
Very true!
There will always be grey area's though where both the Doctor and Nurse in the team will work together. As for diagnosis, I take it you mean it in the term of a medical diagnosis e.g Acute Renal Failure. There exist's such a thing as a nursing diagnosis, though this term is based on looking at patients symptoms, so in my patient with renal failure I would note that as being "Low urine output, raised Creatanine levels".
I can understand both side's of the argument here, though surely we should concentrate on the greater good here of the patient, and remember out common enemy in the continued atrition of the numbers of our profession by the Government.
I was lead to believe the specialist nurse's were in a role to suppliment the GP/Specialist and link to Nursing services and support the patient. That's hardly a bad thing by itself.
These "advanced practitioners" simply block/bounce referrals and don't seem to work with a consultant. I've never seen one of their letters say "I discussed this with the consultant first."
I agree with Zarathustra that in mental health, nurses invariably discuss things as part of an MDT with a Consultant (and a medical one, rather than a Nurse Consultant).
Certainly in my corner every single referral is discussed with me, I meet with teams every afternoon to discuss patient visits and after every single letter that goes from a nurse to a GP only is generated after discussion with me. Otherwise it's unidisciplinary nurse work, not a Community Mental Health Team work.
Largely I agree with you, Dr Rant. I'm just wishing to point out that in mental health it's possible to have more collaborative nurse/doctor work and less nurse replacing doctors ineffectively sort of work.
Life's peachier in our corner :-)
Zarathustra
Yes, I agree with you. CHMT where CPNs and doctors work together and share workload sensibly work well.
What I am currently seeing in some other specialities is "advanced practitioners" acting on their own, and apparently without ready access to the consultant...so patients get referred twice for the same problem.
Hospital gets its access targets...and two new patient fees under payment by results. PCT is poorer and patient has been passed from pillar to post.
It's this second game that annoys me.
Yes, Dr Blue, I can see why that could be of concern.
As I said, I think we may have been violently agreeing at times.
"I'll supply the knife and fork!!
Such arrogance! Shows just how some doctors have no idea!!"
Rant said....
Actually, knowing the person who wrote this piece, I think it would be very dangerous to bet against her in a medical pissing contest.....
*****************************
Dr Rant, do you know something I don't know?
But nurses do not have a broad base of scientific knowledge and training as doctors do
sam sorry for the delay, I've got conjunctivitis (self-diagnosed, yes; and as this is the weekend, it will be self-treated -- it's mild, so far) and am struggling slightly. I agree nurses don't have the same training as doctors, and I am opposed to the substitution of staff trained in one way (e.g. doctors) by staff trained in another way (e.g. nurses) for reasons of cost. (I am pretty sure this is about cost, in the end.) But I stand by what I said to A and E charge nurse (and agreee with nursing student's 'grey area' point).
nWcwqC write more, thanks.
Please write anything else!
actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.
actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.
Wonderful blog.
Nice Article.
Wonderful blog.
Please write anything else!
Hello all!
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