Comments on Dr Rant: If............

Hello all!

2007-11-05T09:08:00.000Z

Hello all!

Please write anything else!

2007-11-05T08:38:00.000Z

Please write anything else!

Wonderful blog.

2007-11-05T08:05:00.000Z

Wonderful blog.

Nice Article.

2007-11-05T07:37:00.000Z

Nice Article.

Wonderful blog.

2007-11-05T07:06:00.000Z

Wonderful blog.

actually, that's brilliant. Thank you. I'm going t...

2007-11-05T06:29:00.000Z

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 t...

2007-11-05T04:40:00.000Z

actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.

Please write anything else!

2007-11-05T04:06:00.000Z

Please write anything else!

nWcwqC write more, thanks.

2007-11-04T21:24:00.000Z

nWcwqC write more, thanks.

But nurses do not have a broad base of scientific ...

2007-10-27T17:25:00.000+01:00

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).

"I'll supply the knife and fork!!Such arrogance! S...

2007-10-27T15:07:00.000+01:00

"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.....

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Dr Rant, do you know something I don't know?

Yes, Dr Blue, I can see why that could be of conce...

2007-10-26T16:56:00.000+01:00

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.

ZarathustraYes, I agree with you. CHMT where CPNs ...

2007-10-26T16:23:00.000+01:00

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.

These "advanced practitioners" simply block/bounce...

2007-10-26T12:41:00.000+01:00

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 :-)

"Those know that nursing is not about bed bath alo...

2007-10-26T10:44:00.000+01:00

"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.

Anonymous: " how dare us Nurse's ever go above do...

2007-10-26T10:30:00.000+01:00

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.

These "advanced practitioners" simply block/bounce...

2007-10-26T09:29:00.000+01:00

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.

Sam - nurses do not bear the same responsibility ?...

2007-10-26T07:46:00.000+01:00

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.

I think the problem is not with senior nurses (exc...

2007-10-26T07:37:00.000+01:00

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.

"I'll supply the knife and fork!!Such arrogance! S...

2007-10-26T05:58:00.000+01:00

"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.....

Dr Rant.Do you not think that there are enough pro...

2007-10-25T23:25:00.000+01:00

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!

Your comments are interesting but paint a picture ...

2007-10-25T23:22:00.000+01:00

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.

jayann "also agreed that junior doctors may not be...

2007-10-25T22:46:00.000+01:00

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? :-)

the simple fact is that there are not enough of th...

2007-10-25T22:29:00.000+01:00

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! :)

Absolutely Jayann - nurses can be extremely useful...

2007-10-25T22:00:00.000+01:00

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.