Nurses allowed to prescribe drugs

eth0_

What do you all think of the announcement that nurses will be able to go on short courses soon that will give them the ability to prescribe certain drugs?

Personally, from reading blogs of various doctors in the NHS, it's likely this will be a bad idea, dangerous even, and doctors will have even more of their time taken up with checking up on the nurses and fixing their mistakes! It's also a bit offensive to doctors who spend twice as long training, that they can go on a small course and gain the ability to prescribe medication..

Vorsprung

I disagree, I think it's a good idea. Don't know what the list of drugs is going to be but I would be surprised if it's a long one. At the moment doctors have to chart OTC meds like paracetamol, which is a bit stupid.

Anyone know what they will be able to prescribe exactly?

Mitch Connor

lol - doctors fixing nurses mistakes.....its the other way round most of the time!

Nurses spend just as long in college as doctors these days, and they actually have to pass all their exams before being allowed to work on their own!

The amount of times i have heard of doctors prescribing overdoses, incompatable drugs or simply drugs that will not treat the condition is amazing. I know nurses who know just as much about medication as doctors, and i have know doctors to ask nurses what should be prescribed cause they don't know themselves.

wheresthebeef

nurses complete a 4 year honours degree. doctors complete a 5 year degree course. our training is quite similar in some respects. well trained, experienced nurses are highly competent to prescribe within their area of expertise. the reason why nurse prescribing in the uk is not working as well as it could be is because of opposition from the medical profession trying to protect their own sphere of authority.

Vorsprung

Here's the article from today's IT

Irish Times wrote:

Plan for nurses to prescribe medicines

Éanna Ó Caollai

The Irish Nurses Organisation has welcomed a move to allow nurses and midwives to prescribe certain medicines to patients under new legislation planned by the Department of Health.

Statutory provision for the move is provided for in the Irish Medicines Board Act 2006, and draft regulations have already been completed.

Under the regulations, nurses will be able to prescribe a broad range of drugs, although specific restrictions will apply on certain controlled drugs.

The European Commission has been notified of the plan, and it is hoped the regulations will be signed by Minister for Health Mary Harney at the end of a three month-notification period, providing there are no objections from other EU Member States.

Nurses will have to be employed by a health service provider to issue prescriptions and and will only prescribe the drugs relevant to the setting in which they are employed.

The move has been welcomed by the Irish Nurses' Organisation (INO), which said it had "huge potential to enhance patient care by significantly expanding the role of nurses and midwives."

INO general secretary Liam Doran described the move as "a tremendous milestone with regard to clinical practice. "The Minister is to be congratulated on her persistence, focus and determination to bring this positive development to the stage where it is now becoming a clinical reality.

"International research and experience has demonstrated that extending prescriptive authority to nurses and midwives enhances patient care outcomes and is shown to be cost efficient and effective," Mr Doran said.

Minister for Health Mary Harney said "Improving patient care is at the heart of this initiative on nurse/midwife prescribing. In particular, I believe that in services such as palliative care, care of the older person and in nurse-led clinics, patients will receive earlier interventions and therefore a better service.

"The basis of our health service should be that patients receive the right care from the right person in the right setting," she said.

Training will be provided to nurses, and funding has already been allocated to the Health Service Executive for this. An Bord Altranais is to introduce a set of rules and requirements in line with the new regulations.

Vorsprung

Tauren wrote:

Nurses spend just as long in college as doctors these days, and they actually have to pass all their exams before being allowed to work on their own!

Nursing degree = 4 years, Medical degree = 5/6 years. Don't get what you mean by the second bit, you think medical students are out there treating patients o_0?:eek:

But you're right, nurses would know a lot about drugs but anyone who prescribes a drug should do a course on the mechanisms of the drugs too, especially if they're going to be prescribing the broad range of drugs described in that article. Not unreasonable I think.

wheresthebeef

bigjimthefirst, nurses study the pharmacokinetics, pharmacodynamics, modes of action, interactions, indications and contraindications of drugs used to treat the diseases that we are educated about in our advanced A&P modules. currently, nurses administer medication to patients as prescribed by doctors and as a result nurses already need to have a good understanding of the drug they are administering in order to ensure that the drug is appropriate, that the dose seems appropriate for the patients condition, and that the drug will not produce any unwanted effects and as a result nurses can withhold medication which is prescribed if they feel it would be detrimental to the patient. with the advent of the nursing degree, nurses are more and more aware of the pharmacological interventions that we perform. the new nurse prescribers will have to take a supplementary education programme, and will be kept on an additional register at the Nursing Board.

Jimoslimos

Good thing IMO.

Not sure how similar its going to be to the NHS system but I reckon eth0_'s fears are unfounded. Athough a broad range may be prescribed a nurse will probably only prescribe within their own speciality - psychiatric drugs by psychiatric nurses, drugs to children by paediatric nurses, etc.

In addition the vast majority of these will probably be repeat prescriptions where the inital prescription has already been done by a qualified physician. Therfore saving unnessecary paperwork for the doctor.

eth0_ wrote:

Personally, from reading blogs of various doctors in the NHS, it's likely this will be a bad idea

The biggest gripe these NHS doctors might have is the financial loss in not being able to claim expenses for every patient that comes requiring a quick signature for a repeat prescription.

John

I think it's a great idea. For one thing, nurses are just as qualified to prescribe most drugs. Anyone who thinks that nurses know nothing about drugs is hideously mistaken, for safety reasons they're required to know about the various drugs so they can spot any problems with patients in their care or double check that the doctor has put the right drug/dose down. Obviously things like Warfarin and stuff like that is best left in the hands of specialists but look at it this way, doctors and nurses are overworked as it is. Why? Mainly beaurocracy and lack of resources and staff. With this in effect it means that there are not the same amount of people hanging around hospital wards needlessly while waiting for a doctor to come and sign a form.

DrIndy

Its not quite that simple as nurses being able to prescribe. To look at this more clearly is to see the fundamental differences in the training of doctors and nurses.

Medical training is theoretical training with founding layers being biochemistry, anatomy and physiology, then adding the layers of pharmacology, therapeutics, microbiology and pathology. Finally, doctors are educated in clinical medicine, surgery, obstetrics and gynaecology, psychiatry and paediatrics.

This layering of knowledge gives understanding of diagnosis and treatments and is theoretical training.

Nursing training is fundamentally different with impetus on vocation and practise basis. This is why nurses leave college fully trained, gaining additionaly continuing practise training as they progress through their career. Medicine requires 1 year pre-reg training (when almost ALL the errors in prescribing are made by the way, now I make only occasional prescribing errors and usually when on call and sleep deprived), then at least 2 more years general training and finally at least 5 more years of specialist training.

When you have substantial years of pharmacology knowledge (2 years) plus 2 years of medicine before even the intern year when all this is put together - this equals the total length of the nursing degree.

There are very specific areas where nurse prescribing can work, with CNS or clinical nurse specialist, where nurses go back to college for a Masters. Nurses do many warfarin clinics for example. These would need to be very specific areas where there are few possible interactions between those prescribing rights interfering with other body systems or other medications.

This is because medicine has a much more global training in the human body than the nursing training.

Fluids can kill someone who has heart or renal failure. Paracetamol can kill someone who has liver failure and mask a lethal infection in someone who is receiving chemotherapy until they are shocked and hours from expiring and simple painkillers like nurofen can kill someone with kidney disease and interfere with a whole range of drugs. We learn this as doctors in a very broad way based on very broad theoretical training over many years.

Nurse prescribing does work in a very specific care pathways where there is no possible interference with other body systems or drugs. Examples are:

Prescribing painkillers and local anaesthetics for suturing injuries in A&E
Warfarin clinics
Infectious diseases clinics where you are treating chlamidia and gonorrhea and other simple STDs (Not HIV)
Titrating heart failure drugs under medical supervision

None of these examples are likely to cause an adverse clinical event provided sufficient pharmaceutical training is provided to nurses in their masters course.

If nurses want to prescribe with full rights, there is a simple option, become a doctor. We have very specific roles within the health care sector and in delivering care to our patients - diagnosis and treatment versus holistic care of patients (which many doctors simply don't have time to deliver and make nurses so invaluable in the health care team). Both these are very important and honoured greatly by the public. Blurring the differences makes everything a shade of grey and just causes problems. Nurses will also have to have high medical indemnity insurance just as doctors do.

The argument has also been made by pharmacists that they also want to prescribe drugs - but if they do, then they will need a private consulting room, need to know how to clinically examine a patient to make sure the disease is as it is and not something quite different and also pay high medical insurance premiums - then they will simply become a GP with less training and more likely to miss a serious, malign disease. Why not instead simply do medicine?

Vorsprung

wheresthebeef wrote:

bigjimthefirst, nurses study the pharmacokinetics, pharmacodynamics, modes of action, interactions, indications and contraindications of drugs used to treat the diseases that we are educated about in our advanced A&P modules. currently, nurses administer medication to patients as prescribed by doctors and as a result nurses already need to have a good understanding of the drug they are administering in order to ensure that the drug is appropriate, that the dose seems appropriate for the patients condition, and that the drug will not produce any unwanted effects and as a result nurses can withhold medication which is prescribed if they feel it would be detrimental to the patient. with the advent of the nursing degree, nurses are more and more aware of the pharmacological interventions that we perform. the new nurse prescribers will have to take a supplementary education programme, and will be kept on an additional register at the Nursing Board.

Sorry, wasn't aware of that

wheresthebeef

DrIndy, your point is very valid, and thanks for the detail of your reply. I agree that nurse prescribing should be and will be confined to certain area's of practice where the nurse prescriber has intimate knowledge of the condition and of the patient. Each nurse and midwife is accountable for their own practice, from talking to many nurses i believe that nurses who prescribe will be extremely cautious and vigilant in how they prescribe. No-one is suggesting that nurses prescribing rights be the same as the rights doctors have. Correct me if i am wrong, but a registered medical practitioner can practically prescribe anything for a patient irregardless of that practitioners area of expertise (i think some restrictrions apply for psychiatric medications), we are talking about nurses in specialist area's prescribing for patients with the specific conditions that these nurses are expert in. And possibly prescribing rights for OTC medications for a wider range of staff who have taken the Nurse Prescribers course.

Wishbone Ash

Joe Public can walk into a pharmacy and purchase an array of 'over the counter' drugs and self dispense, but if he is in hospital, a nurse can't give him a Disprin without it being prescribed by a doctor.

Traumadoc

Wishbone Ash wrote:

Joe Public can walk into a pharmacy and purchase an array of 'over the counter' drugs and self dispense, but if he is in hospital, a nurse can't give him a Disprin without it being prescribed by a doctor.

Aspirin can be a fatal drug in certain circumstances- in asthmatics for example. If Joe public self administers a fatal drug society accepts it, if its given to him by medical staff it is negligence.

chuci

the new law regarding the nurses using drugs is that nurses are allowed to dispense drugs when they are deemed competent which will be decided by ward sisiter or line manager. they must then take a year long course to further their knowledge on drugs and side effects etc.then a list is going to be made out by the ward which will bw reviwed by doctors and nurses so at the end of all that the only thing that we will allowed be prescribe is panadol and laxatives.

as for the comment that asprins can caused undesired effects we know than much why is it put on prn side of the chart and is gen given in 4 hourly gaps if required by the atient.the ammint of times iv seen an intern prescribe morphine and zydol paracetamol in the reg drug chart and then again on the prn chart is act a worry. so i think its not such a bad thing for nurses to be unleashed upon the patient population we would pay a lot more attention to some stuck up intern who thinks nurses are below them.
rant over

tallaght01

I'm mostly against the idea of nurse prescribing. My conflict of interest is that I'm a doctor.

I work in the UK. We've had nurse prescribing for a while. The reason I'm posting on boards is that the current situation over here started exactly like it's creeping in in ireland.The nurses go on a 38 day course, and then can prescribe virtually any drug they like from the BNF, for any patient. 99% of the prescribing rights of a doc.

It's not as simple as just prescribing. Along with prescribing rights comes the "nurse practitioner" or "nurse consultant" status. You see, it's no use allowing people to prescribe when they're not able to diagnose. Therefore, the nurses go on a "masters degree" course where they learn to diagnose aswell.

It just doesn't work.The course is not rigorous enough. I wouldn't be able to become an occupational therapist, a nurse, or a physiotherapist by doing a short course. End of story. I don't have the training. I can accept that.

Nurses do a 4 year course. That does not mean that they just need to spend an extra year at college to become a doctor. People keep mentioning the amount of time at college as if it's relevant.
You can spend 5 years at college training to be an architect. That doesn't mean that you could walk into a hospital and do what a doctor does because you spent the same amount of time at college as the doctor.

Physios, speech therapists, nurses, all allied health professionals are trained in their field. Doctors learn huge amounts more than nurses about anatomy, physiology, pharmacology, diagnosis and treatment than nurses do. Nurses learn lots more than doctors do about nursing when they're at college. It's diferent training. We spend up to a hundred hours per week as juniors covering medical emergencies in 10 or 12 wards at a time, listening to hundreds of chests, examining hundreds of abdomens etc. Even then our theoretical and practical training isn't finished.We then have to sit our specialist exams, which are some of the hardest exams you could ever do.

If you have private medicine you don't see the "nurse practitioner". You see the doctor. If you're public, you will see a nurse practitioner, becuase they're cheaper. It's as simple as that. It is a system designed to dupe the public and cut waiting times.
It's not a safe system.

At the risk of waffling, I'll give a few examples of the kind of things that can go wrong....

1) There's a large clininc in Canary Wharf that was essentially run by nurse practitioners. It was a pilot scheme, which has already run into problems. It was essentially staffed by nurse practitioners, who were "acting up" as GPs because they had "done the course". The clinic had to bring in a medical doctor to investigate after a number of failings, such as a lady with a swelling under her armpit being sent home without having her breasts examined.....a kid with glass in their foot being sent home without an xray.....nurses examining children who had never worked in a children's ward and had zero paediatrics training etc etc. Management hired these nurses because they were cheap. The practitioners didn't know what they didn't know. This is the danger.

2) I was once on a ward when the "pain practitioner" came along and prescribed my patient pain relief for his sore abdomen. She swans around the wards giving "advice" to doctors, and prescribing for their patients without really knowing the patient. When I heard my patient was in pain I went and examined his abdomen. I found some worrying signs, and we got him to theatre for his burst bowel. The pain practitioner doesn't examinine abdomens. She's not "been on the course yet". The point is the doctor is the person trained to examine the patient. Again, the nurse did not know what she din't know.

3) When I did adult medicine I had an elderly patient who had a heart condition that caused his heart to beat very fast. He was seen by the nurse practitioner, who increased the amount of the drug I'd put him on for his high heart rate. I knew nothing about this. The sudden rise in his heart rate would have alarmed me. I would not have just "upped" his medication. I would have examined him properly. When I found out about this later, I did examine him. When I listened to his chest, I couldn't hear any air getting into the left base. The xray showed a huge pneumonia. It was the pneumonia that made his heart rate suddenly jump up. Intravenous antibiotics sorted it out. Because he was examined properly, by somebody trained to examine patients ie a doctor.

Somebody above paints a picture of nurses saving dosctors' bacom on a daily basis in hospitals and mopping up our mistakes. This si something nurses have telling me about for years. I have never seen any evidence of it, except for isolated examples which work both ways. If the original poster is a nurse and doctors are asking her what drugs they should be prescribing, then she should be reporting them to their consultant, as they are incompetent. If you do not report incompetency, that makes you complicit.

I could go on, but I'm sure nobody is still reading lol

I know I'll be called cocky. It's the first line of defence when nurses get criticised. I'm used to it. However, a good nurse is worth her weight in gold. A nurses who wants to nurse is an invaluable asset to any unit. A nurse who wants to play at being a doctor is a liability. OUr nurses get treated shoddily by the govt, and maybe if we paid them more, they wouldn't take these "practitioner" (or nurse quacktitioner, as we call them in the UK) jobs.

I'll jut post a few links from the UK where the system has been in place for a while, so you can see doctors reactions over there.

http://www.bbc.co.uk/london/content/articles/2006/11/24/walkin_clinic_feature.sht

http://nhsblogdoc.blogspot.com/search?q=anila+reddy

http://nhsblogdoc.blogspot.com/2005/12/who-is-flying-up-your-backside.html

http://www.drrant.net/2006/10/nurse-ratchet-takes-kicking.html

http://nhsblogdoc.blogspot.com/2006/01/role-of-nurse-specialist-in-modern.html

You'll see that if you follow the link through "Dr rant" to nurse ratched's blog you'll see the OTT reactions of the doctors ont he site to what we all see every day....under qualified, over confident nurse practitioners acting as though they know it all. It's a result of frustration that that argument boiled over.

Anyway, I'll leave it there. At the end of the day, the public gets what the public accepts. The public will accept nurse practitioners becasue the public likes nurses and don't understand the difference in training between a nurse and a doctor. That is fine. People have commented above about how the medical establishment is set to loose out financially over this, which is nonsense. I work in a hospital, like most doctors, so will see no drop in earnings. I spend a lot of my time sorting out nurse practitioner errors, but we get used to that. GPs can hire nurse practitioners, pay them a nurses wage, and cream off the extra for themselves. You will still pay to see the nurse at your GP surgery. Nurse practitioners have the potential to make us docs a lot of money.

I don't care about money. If I wanted money i'd have been a lawyer or an accountant. I just care about providing safe care to my patients. My friends and family will never accept being treated by a nurse practitioner. I have ensured that. Whereas I can't speak highly enough of the nurses who cared for my dad when he was in hospital. These were nurses who nurse, and they should be paid an enormous salary for doing what is a job I could never do, regardless of wheter or not I'd "been on the course".

eth0_

So that's two doctors who've shown concerns over it on this thread.
As tallaght01 says, this isn't a measure by the government to make the nurses feel better about their status, it's PURELY to save money and f*ck the patient!

I wonder how much the malpractice insurance is going to cost for the nurse practitioner?

I would *not* want to be examined, diagnosed and given treatment by a "nurse consultant". Give me a break. It's only a matter of time before the NHS has huge lawsuits on their hands from these under-trained nurse consultants. They've already had many law suits from people who's relatives have DIED as a result of blatantly bad, dangerous advice given by the nurses on the NHS 24 hour phone line.

Hire more doctors, make them work less hours, instead of sending nurses on a part time course for a few months and unleashing them on the public. Or make it easier for nurses to re-train as doctors. There is a vast difference in the amount of hours worked by a junior doctor, and a nurse. You can't make up all that diagnostic experience by sending a nurse on a 38 hour course.

Captain Trips

wheresthebeef wrote:

nurses complete a 4 year honours degree. doctors complete a 5 year degree course. our training is quite similar in some respects. well trained, experienced nurses are highly competent to prescribe within their area of expertise. the reason why nurse prescribing in the uk is not working as well as it could be is because of opposition from the medical profession trying to protect their own sphere of authority.

Surely it working well is dependent on the competence of those doing the "working" and because of some "opposition from the medical profession", which has far far less influence than nursing unions over there.

So if it's not working well, it's because it's not working well, and not some conspiracy theory.

chuci

its not the nurse who are specialised in their field that are in question here.its gen nurses who are on the wards who are stressed enough as are doctors with the way the health system is in this country. its to save time and try to decrease the amount of stress on the wards. its not as if nurses will be able to go out prescribing tomorrow plus we are not going diagnosing patients at all wherever that idea came from that is still down to the doctor noone else. they will have to do a year course and competent nurses do know their drugs they have to if they are newly prescribed drug to be aware of side effecs.
as to a poster above i will report the intern to his consultant im sure you would have been very pleased if a nurse had done that to you. you did admitt that you made most of your mistakes in the first year.

tallaght01

chuci wrote:

its to save time and try to decrease the amount of stress on the wards. its not as if nurses will be able to go out prescribing tomorrow plus we are not going diagnosing patients at all wherever that idea came from that is still down to the doctor noone else. they will have to do a year course and competent nurses do know their drugs they have to if they are newly diagnosed drug to be aware of side effecs.
.

It isto save money, nothing else. In practise, it just adds to our time burden.

Nurses WILL "be able to go out prescribing tomorrow" if they have passed "The course".

How can you prescribe a drug if you can't diagnose what the problem is? ie if a patient comes to me with chest pain, I need to know hat's wrong with them before I can treat them.

The course will not be a year full time. The course in the UK "lasts a year", but only equated to 38 days of actual training. As far as I know, it's the same course being talked about in Ireland.

LIke I said, the public gets what the public accepts. This change WILL happen. Won't affect me or my family, so I'll live with it.

Kind regards.

wheresthebeef

tallaght01, a very interesting read. i am shocked to hear of the blatant incompetence in some of the stories you have recounted.
i think maybe the problem here is that nursing is in the middle of a period of flux and maybe this nurse prescribing thing came a little too soon. we have only just received our first batch of nursing degree graduates here into the health system. i truly believe that the degree in nursing will have significant improvements to nursing care and patient outcomes and that degree trained nurses are much more competent practitioners of their science. research from the USA on surgical wards has shown a significant decrease in post procedure complications, and mortality on wards which have higher percentages of degree trained nurses. its possible that there are still dangerously incompetent nurses out there, just as there are persons in other healthcare fields who have questionable practices. but i dont think its right to generalise that all nurses are incompetent of understanding and gaining the neccessary knowledge to integrate signs, symptoms, history and clinical findings into a diagnosis and then prescribe treatment be it pharmacological or otherwise.
nurse practitioners are cheaper because of a societal perception that nurses are worth less than doctors, and because of our larger numbers (supply and demand). medical practitioners have built up a superiority complex worldwide that see's them at the apex of the medical world with everyone else subordinate to them. we work in a multidisciplinary care team, as long as the doctors are always the boss. i know you'll say i am biased, and i am. I am an advocate for nursing.
I am not saying that all of your claims are unfounded. I do however honestly believe there is an element of protectionism going on here. The area of medicine is constantly being eroded by other professions such as physiotherapists, ot's, clinical nutritionists, speech and language therapists, radiation therapists, nurses, midwives and the scope of practice of these practitioners is increasing. Why shouldn't nurses be allowed to manage pain medication (if properly trained), why shouldn't clinical nutritionists be allowed to prescribe nutritional supplements.
whether you like it or not, nurses and other professions will continue to encroach on territory that was once seen as the preserve of doctors. If you feel you have specific problems with some nurse practitioners, you should report them to their professional regulatory authority instead of tarring the entire profession with the same brush and preventing competent practitioners from reaching their full potential of providing a truly holistic approach to patient care with the knowledge, clinical skills, communication skills, and nursing ethic to do so along with the legislatory and regulatory support to do so.
Over two hundred years ago, doctors vehemently opposed the regulation of the profession of midwife as they believed a woman could never be educated to the same level of knowledge as a man and could never comprehend the complex processes of the human body.

tallaght01

wheresthebeef wrote:

i truly believe that the degree in nursing will have significant improvements to nursing care and patient outcomes and that degree trained nurses are much more competent practitioners of their science. research from the USA on surgical wards has shown a significant decrease in post procedure complications, and mortality on wards which have higher percentages of degree trained nurses.

1) I'm not hugely au fait with nursing training in Ireland, but my friend, who's a charge nurse in Ireland has had a degree in nursing from RCSI for many years, as have most of the nurses in their 20s in Ireland that I know socially. It was probably optional for them though.

2) The fact that degree trained nurses may make better NURSES, does not mean they will make good mini-doctors. All of the nurse practitioiners over here (UK) have a masters degree.

its possible that there are still dangerously incompetent nurses out there, just as there are persons in other healthcare fields who have questionable practices. but i dont think its right to generalise that all nurses are incompetent of understanding and gaining the neccessary knowledge to integrate signs, symptoms, history and clinical findings into a diagnosis and then prescribe treatment be it pharmacological or otherwise.

I'm not calling any of these nurses "incompetent" in terms of their nursing ability. I'm sure they were all excellent nurses. They are, however, not trained doctors.

medical practitioners have built up a superiority complex worldwide that see's them at the apex of the medical world with everyone else subordinate to them. we work in a multidisciplinary care team, as long as the doctors are always the boss. i know you'll say i am biased, and i am. I am an advocate for nursing.

You are biased. Very biased. There's not a line of health professionals lining up to carry the can for mistakes on the ward. That's why we "are always the boss". It's because we have ultimate responsibility. Nurse practitioners insist that they always operate under the supervision of a named consultant. This consultant does not train nor employ them, yet he/she is responsible for their actions somehow. Saying that we have socially engineered a situation where "everyone else" is "subordinate" to us paints us out to be megalomaniacs, when we're just normal people. Plus it suggests that we like having to carry the can for everything that happens outwith our control. Being an advocate for nursing doesn't mean you should try to paint other healthcare professionals in a bad light.

I am not saying that all of your claims are unfounded. I do however honestly believe there is an element of protectionism going on here. The area of medicine is constantly being eroded by other professions such as physiotherapists, ot's, clinical nutritionists, speech and language therapists, radiation therapists, nurses, midwives and the scope of practice of these practitioners is increasing.

Where is your evidence for the protectionism theory? I rarely leave work less than 3 hours after I'm rostered to finish. I never ever get a lunch break. I would love some extra help. I have no vested interest in being exhausted all the time. But the patients are my number 1 concern. I won't willingly sell the patients out to cynical cost cutting measures.

Why shouldn't nurses be allowed to manage pain medication (if properly trained), why shouldn't clinical nutritionists be allowed to prescribe nutritional supplements.

I have no problem with clinical nutritionists prescribing nutritional supplements. They do it in my unit. Thery are experts in this area. I have no problems with many extended roles of other healthcare professionals. I have a problem with people doing jobs they're not adequately trained for ie I have a problem with nurses prescribing pain medication, when they are unable to diagnose the cause of the pain. If I have a pain in my right lower abdomen, I dont need paracetamol, I need someone to examine me for signs of appendicitis, and to have the clinical acumen to rule it out if neccesary. Then I need them to decide whether to operate tonight, or whether I can be left til the morning. I need a doctor, who has the training to do this. It's not as simple as "being allowed to manage pain medication".

whether you like it or not, nurses and other professions will continue to encroach on territory that was once seen as the preserve of doctors.

Yes they will. I work with them all the time. They're cheaper, so they're attractive. I have long accepted this point. LIke I said, they're not going to be treating me, my friends or family, but the public will get cheaper, less qualified care.

If you feel you have specific problems with some nurse practitioners, you should report them to their professional regulatory authority

There is no regulation of nurse practitioners. There is not even a register. Any nurse can call themselves a nurse practitioner. It is truly dangerous.

Over two hundred years ago, doctors vehemently opposed the regulation of the profession of midwife as they believed a woman could never be educated to the same level of knowledge as a man and could never comprehend the complex processes of the human body.

I really don't get the point your making here. Because doctors had stupid views 200 years ago on something, everything we say now must be wrong? I'm only 30. It wasn't me :P

wheresthebeef

A degree in nursing studies is now a requirement for registration with the regulatory authority for nursing and midwifery in ireland. I never used the phrase mini-doctors, you did.

Clinical Nurse Specialists here are required to have a Higher Diploma in their area of practice, but preferable have a masters. An ANP is required to have a masters, and other qualifications are desirable.

Nurses and Midwives are solely accountable for their own practice. I cannot see a situation whereby a consultant or doctor is somehow responsible for the practices of a nurse or nurse practitioner. Each nurse and midwife is accountable for their own professional practice, and is liable to disciplinary action from an bord altranais. Doctors do not "carry the can" for nurses, at least not in this country.

You must be dramatising things when you say that a nurse practitioner found a patient with pain in the abdomen and simply prescribed paracetamol. I am only a second year student nurse, and i'm not even that stupid. I don't know how the nurses you work with are trained, but we are taught evidence based care, not task orientated. I find it hard to believe that someone so obviously stupid could rise past the level of staff nurse, to become a Nurse Practitioner.

I don't know how nursing and midwifery is regulated in the UK. But you claim that Nurse Practitioners are not regulated, that anyone can call themselves a NP. I find this hard to believe as there is surely a code of professional conduct which applies to all nurses and covers area's like working outside of ones scope of practice, accepting the limitations of ones scope of practice, doing no harm etc..... And under these regulations, these Nurse Practitioners would surely be subject to some scrutiny. Here, i believe, one has to complete a masters degree in "Advanced Practice" (a course regulated by the national council for the development of nursing and midwifery), before one can apply for a position as an Advanced Nurse Practitioner.

I'm disappointed that you feel the way you do about Nurse Practitioners. I have no experience of working in the NHS, and so don't know how your NP's operate. But if what you say about them is accurate, its quite worrying and maybe you should act rather than simply condemn the ideology of nurses in advanced practice roles. Perhaps we won't suffer the same problems you experience in the UK. And as we move forward with the degree in nursing, perhaps the clinical acumen of nursing will improve. From my limited experience, my education teaches me to assess signs and symptoms and history and make diagnoses, to examine other possible causes and rule out possibilities, to plan treatment, to implement that treatment and to constantly assess and evaluate the ongoing effect of my interventions. I don't know how nurses in the UK are trained, or how non-degree nurses were trained so i can't comment on their focus of skills. I don't plan on being a doctor, but I do plan on knowing what is going on with my patients. I plan on being able to contact my patients doctor and say "i think he is experiencing X because of signs and symptoms X,Y and Z". I Plan on being able to initiate some level of treatment whilst awaiting the arrival of the doctor, or further guidance from same, and if the legislation and my level of knowledge and scope of practice allows me to prescribe medications that would otherwise be unduly delayed, i would like the ability to give the patient a timely response to their needs (again i re-iterate, that this is dependant on my level of knowledge of the condition, and my clinical competence). There is obviously a hive of unprofessional nurse practitioners in your hospital who don't know their own scope of practice and cannot accept the limitations of that scope of practice, but i find it hard to believe that a trained nurse, obviously experienced and educated enough to rise to NP would blindly prescribe analegesia without performing some kind of assessment, and that then if the NP still had no idea as to the cause of the pain did not contact a doctor for help.

tallaght01

wheresthebeef wrote:

A degree in nursing studies is now a requirement for registration with the regulatory authority for nursing and midwifery in ireland. I never used the phrase mini-doctors, you did.



Clinical Nurse Specialists here are required to have a Higher Diploma in their area of practice, but preferable have a masters. An ANP is required to have a masters, and other qualifications are desirable.

I think your focus on the degree is misguided. All our nurse practitioners have masters degree. They, however, do not have a medical degree. That is what you need to safely diagnose and treat patients.

wheresthebeef wrote:

Nurses and Midwives are solely accountable for their own practice. I cannot see a situation whereby a consultant or doctor is somehow responsible for the practices of a nurse or nurse practitioner. Each nurse and midwife is accountable for their own professional practice, and is liable to disciplinary action from an bord altranais. Doctors do not "carry the can" for nurses, at least not in this country.

Doctors do not carry the can for nurses. They, however, carry the can for nurse practitioners. Nurse practitioners must always work under a "supervising doctor". My consultant is responsible for my actions, aswell as me. But he hired me. He knows my CV. He knows I've been to medical school. He knows I've examined thousands of patients in my career. He has seen my references. Therefore he trusts me. You cannot say the same for the nurse practitioners. Hence the consultants' resistance to them being part of their teams.

wheresthebeef wrote:

You must be dramatising things when you say that a nurse practitioner found a patient with pain in the abdomen and simply prescribed paracetamol. I am only a second year student nurse, and i'm not even that stupid. I don't know how the nurses you work with are trained, but we are taught evidence based care, not task orientated. I find it hard to believe that someone so obviously stupid could rise past the level of staff nurse, to become a Nurse Practitioner.

I can't prove that any of the above stories are true. You can believe me or not. It's all the same to me. They're only anecdotes, and even if they didn't happen to me, we're still talking about people treating the public when they're inadequately trained to do so.

wheresthebeef wrote:

I don't know how nursing and midwifery is regulated in the UK. But you claim that Nurse Practitioners are not regulated, that anyone can call themselves a NP. I find this hard to believe as there is surely a code of professional conduct which applies to all nurses and covers area's like working outside of ones scope of practice, accepting the limitations of ones scope of practice, doing no harm etc..... And under these regulations, these Nurse Practitioners would surely be subject to some scrutiny. Here, i believe, one has to complete a masters degree in "Advanced Practice" (a course regulated by the national council for the development of nursing and midwifery), before one can apply for a position as an Advanced Nurse Practitioner.

There is no register of nurse practitioners in the UK or Ireland. Any nurse can call themselves a nurse quacktitioner or a nurse consultant. Like I said before, this is one of the many reasons why the whole idea is flawed. They are regulated as nurses by the nursing and midwifery council, but there is no minimum standard to be a nurse practitioner. You and your line manager decide if you are competent! That's just crazy. I'm not allowed to decide if I'm competent!

wheresthebeef wrote:

I'm disappointed that you feel the way you do about Nurse Practitioners. I have no experience of working in the NHS, and so don't know how your NP's operate. But if what you say about them is accurate, its quite worrying and maybe you should act rather than simply condemn the ideology of nurses in advanced practice roles.

Most docs int he Uk have fought the introduction of nurse practitioners. It's a loosing battle , because they are cheap, and the public are unaware that they are getting a lower standard of care. Therefore the government has pushed though their training, despite opposition. Do you really, genuinely, in your heart believe that the government are hiring nurses do do doctors jobs because they believe the nurses will be better at it? Or do you believe it's because they're cheaper. Honestly?

wheresthebeef wrote:

Perhaps we won't suffer the same problems you experience in the UK. And as we move forward with the degree in nursing, perhaps the clinical acumen of nursing will improve. From my limited experience, my education teaches me to assess signs and symptoms and history and make diagnoses, to examine other possible causes and rule out possibilities, to plan treatment, to implement that treatment and to constantly assess and evaluate the ongoing effect of my interventions.

You are not trained like a doctor though. A doctor can examine any part of the body better than you can. They can diagnose better than you. They understand disease better than you. They understand the method of action of drugs better than you. You can nurse better than a doctor. That's becasue we've done different courses, with different training. I've said it before...i couldn't be a physiotherapist tomorrow, just because I have some training in that field

faceman

tallaght01 wrote:

You are not trained like a doctor though. A doctor can examine any part of the body better than you can. They can diagnose better than you. They understand disease better than you. They understand the method of action of drugs better than you. You can nurse better than a doctor. That's becasue we've done different courses, with different training. I've said it before...i couldn't be a physiotherapist tomorrow, just because I have some training in that field

Here here. No arguing with that.

wheresthebeef

That is what you need to safely diagnose and treat patients.

obviously one does not require a medical degree anymore. the experts have spoken.

and even if they didn't happen to me, we're still talking about people treating the public when they're inadequately trained to do so.

so what your saying is that it doesn't matter whether your telling the truth or not, as long as you get your point across that nurse practitioners are not competent in their role of diagnosing and treating. scare mongering me thinks??

They, however, carry the can for nurse practitioners. Nurse practitioners must always work under a "supervising doctor".

I have never heard of a Clinical Nurse Specialist working under the supervision of a consultant, and have little experience of working with ANP's. However the NCNM in Ireland describes ANP's as autonomous practitioners, and so in the absence of information to the contrary (it does not say anything about working under the direction or responsibility of medical staff), i would assume that here in ireland an ANP is an independant practitioner within their own field. This answers the carrying of the can issue.

There is no register of nurse practitioners in the UK or Ireland. Any nurse can call themselves a nurse quacktitioner or a nurse consultant. Like I said before, this is one of the many reasons why the whole idea is flawed. They are regulated as nurses by the nursing and midwifery council, but there is no minimum standard to be a nurse practitioner. You and your line manager decide if you are competent! That's just crazy. I'm not allowed to decide if I'm competent!

The use of emotive negative terms like quacktitioner only serve to show your own unprofessional attitude towards your colleagues. I believe the nursing and midwifery council (NCM) in the uk regulates the registration of ANP's and has specific criteria as to who may use the term ANP to describe their clinical competence. See below for irish regulations.

National Council for the Development of Nursing and Midwifery IRL wrote:

Criteria for ANPs/AMPs

The following criteria apply for accreditation as an ANP/AMP
An ANP/AMP must:

Be a registered nurse or midwife on An Bord Altranais’ live register;
Be registered in the division of An Bord Altranais’register for which application is being made (inexceptional circumstances which must be individually appraised, this criterion may not apply)
Be educated to masters degree level (or higher). The post-graduate programme must be in nursing/midwifery or an area which is highly relevant to the specialist field of practice (educational preparation must include a substantial clinical modular component(s) pertaining to the relevant area of specialist practice)
Have a minimum of 7 years post-registration experience, which will include 5 years experience in the chosen area of specialist practice
Have substantive hours5 at supervised advanced practicelevel
Have the competence to exercise higher levels of judgement, discretion and decision making in the clinical area above that expected of the nurse/midwife working at primary practice level or the clinical nurse/midwife specialist;
Demonstrate competencies relevant to context of practice; and
Provide evidence of continuing professional development.

National Council for Development of Nursing and Midwifery IRL wrote:

In order to use the title ANP/AMP the nurses or midwife must be appointed to a particular post and accredited as an ANP/AMP by the council.

ANP's must also re-accreditate with the NCNM on a periodic basis.
Nurses are responsible for their own competence. However there is a difference between whether i feel competent, and whether I actually am competent. In advance of performing a procedure, i am responsible for judging if i am competent to proceed. However if something goes wrong, a panel of my peers in nursing or midwifery will examine whether my actions were deemed to be in line with what would normally be expected from someone of my level of training and experience. The book ultimately rests with our regulatory authority.

Do you really, genuinely, in your heart believe that the government are hiring nurses do do doctors jobs because they believe the nurses will be better at it? Or do you believe it's because they're cheaper. Honestly?

Obviously governments are going to be financially motivated. My point is that nurses are perfectly able to perform some of the functions that doctors currently provide. And for a lot of patients this represents a good quality service, which provides accurate assessment and diagnosis and treatment. Obviously a key skill of a nurse practitioner is knowing when to ask for help. This is an individual issue for each ANP to consider themselves.

You are not trained like a doctor though. A doctor can examine any part of the body better than you can. They can diagnose better than you. They understand disease better than you. They understand the method of action of drugs better than you. You can nurse better than a doctor. That's becasue we've done different courses, with different training. I've said it before...i couldn't be a physiotherapist tomorrow, just because I have some training in that field

You're right. A doctor does know more about the body as a whole, a doctor knows more about the diseases of the body, and more about pharmacology. The Advanced Nurse Practitioner is someone who works within a highly specialised area. ANP's dont need to know how to examine the whole body, or know every pathology in existence. They are highly specialised experts in their own specific areas. Similarly to the fact that some patients can be adequately treated by less experienced doctors due to the nature of their condition, it would only be logical to expect that some patients can be effectively treated by an experienced ANP (bearing in mind the minimum criteria set out by the NCNM that i outlined above).
We could go round in circles and we'll never agree. But i feel its important to respond to what your saying.

Jimoslimos

Seems to be a bit of snobbery wafting around here.

tallaght01; if we were having this debate a few decades ago I can imagine you being opposed to nurses doing anything other than turn down beds and change chamber pots. Administer medicines, take blood? - you must be joking, surely you need a medical degree to do that :rolleyes:

tallaght01 wrote:

They, however, do not have a medical degree. That is what you need to safely diagnose and treat patients.

Would I trust an inexperienced junior (probably overworked) doctor over a qualified nurse practioner with at least 5 years experience in the area they are prescribing for? To draw (a not very good I admit) analogy - Is a HGV license necessary to be able to drive a car on the road?

tallaght01 wrote:

It isto save money, nothing else.

Yes of course it is. Thats also why we have nursing assistants doing the jobs that nurses used to do years ago. As long as the standard of service provided is to the same high level then the customer (i.e. the taxpayer and patient) wins.

tallaght01 wrote:

You can believe me or not. It's all the same to me. They're only anecdotes,

A doctor relying on hearsay and rumours to back up a point

tallaght01 wrote:

Any nurse can call themselves a nurse quacktitioner or a nurse consultant.

Highly unprofessional and disrespectful of your colleagues (yes they do work alongside and not subservient to you). I can only imagine what you are like to work with.

tallaght01 wrote:

However, a good nurse is worth her weight in gold

Perhaps a slip but could be given your other comments be interperted as sexist and/or condescending. You seem to have a very old-school attitude to the role of nurses within the healthcare system.

tallaght01 wrote:

You are not trained like a doctor though. A doctor can examine any part of the body better than you can. They can diagnose better than you. They understand disease better than you. They understand the method of action of drugs better than you.

Yes and a consultant is probably better able to diagnose/understand/treat disease better than a junior doctor. Come to think about it I probably have a better understanding in the diagnosis/mechanism of colorectal tumours than you do, I'd also have a reasonably good understanding on how chemotherapy drugs work at a cellular level - would this make me or any other scientist any better at prescribing drugs? - NO

The reason I believe that nurses should be allowed to prescribe is that they have far greater contact with their patients. It is the nurse who will observe the efficacy of a drug on the patient not the doctor and given the theoretical knowledge to complement their practical experience I can't see why they shouldn't be allowed to prescribe

faceman

Jimoslimos wrote:

Seems to be a bit of snobbery wafting around here.

Would I trust an inexperienced junior (probably overworked) doctor over a qualified nurse practioner with at least 5 years experience in the area they are prescribing for? To draw (a not very good I admit) analogy - Is a HGV license necessary to be able to drive a car on the road?

Your and the other arguments put forward is like comparing apples with oranges. If you want to go down the road of analogies then you need to look at high skill high risk scenarios: Cabin crew on an airplane see how airline pilots fly a plane and im sure an experienced cabin crew member could in limited circumstances for a limited duration of time under supervision, take control of an airplane and fly without issue inflight. Afterall they see how pilots fly everyday. But is this good practice and safe? What if something goes wrong? Would you be a passenger on that plane?

wrote:

Yes of course it is. Thats also why we have nursing assistants doing the jobs that nurses used to do years ago. As long as the standard of service provided is to the same high level then the customer (i.e. the taxpayer and patient) wins.

Again there is a bit of a difference between filing paperwork and diagnosing/prescribing medicene. Apples and oranges.

wrote:

A doctor relying on hearsay and rumours to back up a point

I dont believe tallaght01 said that his points were hearsay

wrote:

Perhaps a slip but could be given your other comments be interperted as sexist and/or condescending. You seem to have a very old-school attitude to the role of nurses within the healthcare system.

Since when is the consideration for the well being and safety of patients become an old-school attitude?

wrote:

Yes and a consultant is probably better able to diagnose/understand/treat disease better than a junior doctor. Come to think about it I probably have a better understanding in the diagnosis/mechanism of colorectal tumours than you do, I'd also have a reasonably good understanding on how chemotherapy drugs work at a cellular level - would this make me or any other scientist any better at prescribing drugs? - NO

Is this not the point being made by doctors?

wrote:

The reason I believe that nurses should be allowed to prescribe is that they have far greater contact with their patients. It is the nurse who will observe the efficacy of a drug on the patient not the doctor and given the theoretical knowledge to complement their practical experience I can't see why they shouldn't be allowed to prescribe

Thats not accurate. Are you suggesting that the doctor prescribes a drug and moves on?

OUr healthcare system is in dire straits. Ive seen good and bad doctors and nurses. However me cant cut off our noses to spite our faces. I have no allegiance to anyone in the healthcare system. Im merely a patient from time to time. But i personally would only accept prescribed medication from a doctor.

Jimoslimos

faceman wrote:

Your and the other arguments put forward is like comparing apples with oranges. If you want to go down the road of analogies then you need to look at high skill high risk scenarios: Cabin crew on an airplane see how airline pilots fly a plane and im sure an experienced cabin crew member could in limited circumstances for a limited duration of time under supervision, take control of an airplane and fly without issue inflight.

I did say that my analogy wasn't great but its better than this one - you are comparing a low skill low risk occupation (what's the worst that could happen - a member of cabin crew spills hot coffee on me) with a high skill high risk one.

faceman wrote:

I dont believe tallaght01 said that his points were hearsay

...

tallaght01 wrote:

I can't prove that any of the above stories are true. You can believe me or not. It's all the same to me. They're only anecdotes, and even if they didn't happen to me,

Seems like hearsay to me

faceman wrote:

Is this not the point being made by doctors?

My point was that just because someone has spent more time learning the theory behind something doesn't mean that they are any more capable.

faceman wrote:

Thats not accurate. Are you suggesting that the doctor prescribes a drug and moves on?

Not quite, I'm sure a doctor will take as much time to examine, diagnose and prescribe for the patient as possible but in many cases a nurse will still have most contact with them

faceman wrote:

But i personally would only accept prescribed medication from a doctor.

I'd accept medication from anybody suitably qualified to prescribe it. Also in the cases where a blood test is required to diagnose for certain diseases it negates the use of having a medical degree. Physical examination of symptoms can only tell you so much.

wheresthebeef

the reality of the situation is that most often its the nurse who rings the doctor, and requests the doctor to prescribe a particular drug. the nurse already knows in most instances what the patient needs, but simply cannot give the written order to do so.

tallaght01. you have admitted that your experience of nurse practitioners is anecdotal and have stated that you do not believe its important whether or not the anecdotes described are accurate, but that the important thing is that the users of this board get the message that nurse practitioners are incompetent to perform their function. you further make claims about nurse practitioners and the regulation of their practice, saying there is no regulation of these professionals. this information is entirely incorrect and minimum standards are enforced and regulated by a number of professional bodies both here and in the UK. furthermore, you use emotive and insulting terminology when referring to your colleagues. if these were a legal case, i would not find you to be a credible witness. your comments on this forum have consisted of hearsay, anecdotes (which you have admitted may be not be true), and facts stated by you which in my previous post showed to be incorrect. you do not have enough information about nurse practitioners to make a comment, and even if you did you are still not credible. as a doctor i would expect you to be more precise in how you present an argument. anecdotal evidence is not worth the nothing its printed on.

tallaght01

and where do i start?......

The rage is palapable, but won't put me off the good fight :P

There's a lot of inaccuracies in the above posts. I'll try to reply to them without boring the neutral observer.

Firstly, I'll deal with the personal nonsense. The accusations of snobbery. The assumption that I'm crap to work with. The assumption that I think nurses are subservient. The accusations of unprofessionalism.

I work in ITU. There's 2 nurses to each patient. There's usually 2 doctors kicking about. I'm surrounded by nurses. Many of them are my friends. I have most of their phone numbers, because I socialise with them on the rare occasions that I get time off. I think they should be paid enough to own a nice house locally, buy a nice car, go on a nice holiday every year and have a reasonable standard of living. They should have a lifestyle comparable to other middle class professionals. Thet fact that they don't is scandalous. I constantly tell them this. I constantly praise them, because they are, by and large, excellent at their jobs. I respect them enormously, and they respect me. When one of our nurses was suspended because of making a mistake with medicine administration, I and our SHO organised the petition to senior management to have her reinstated. I don't believe anybody in the hospital is subservient to me. I'm not arrogant, and I'm not a snob. Just because I differ in opinion doens't make me any of the above.


I'm not unprofessional. I haven't had a lunch break in about 8 months. I work on average 3 hours per day overtime for free. Today is my day off, yet I spent 3 hours in the hospital. My research, which I do unpaid, involves inequity in healthcare ie the most marginalised and the poorest sectors of society receiving the worst healthcare. I do everything in my (very limited )power to fight this. I have worked for free in Africa because I feel so strongly about it. Nurse practitioners are the classic example of this. The great and good, and the rich will see doctors. The poor with no private health will see the nurse practitioner. Mary Harney will not see the "chest pain nurse practitioner" when she presents to A+E with a heart attack.

This is where I'm coming from. However, in the UK every single time a doctor criticises the role of the nurse practitioner, he is told he is "arrogant", and is characterised as some kind of mysoginistic Sir Lancelot-Spratt type character from the 50s. Yet I'm the one told that MY ideas belong int he 50s?

The sexist comment is, of course, nonsense. I work in paediatrics/neonatology. Therefore, the vast majority of my colleagues are female.

Let's look at some of the points made, in isolation.....

1) Wheresthebeef says "obviously one does not require a medical degree anymore. the experts have spoken". I don't regard Mary Harney as an expert in clinical medicine. I guess we'll have to disagree here.

2) My anecdotes about the misdiagnosis. I thought my point was reasoanbly clear, but I'll explain in more detail because the nurses on here have misunderstood. The incidents happened. I can not prove they happened. I was there, but I didn't take pictures. I didn't use them "To back up" my point. I used them to illustate my point. Big difference. The point I made was that even if we were to discard them as evidence (to continue the courtroom analogy ), they illustrate the potential for disaster when people who are only qualified within a very narrow remit try and treat the whole patient.

3) Jimoslimo states that he would trust the nurse practitioner over the inexperienced junior in a clinical situation. That's your perogative. You can exercise that right if you're ever brought into hospital. If I'm ill, however, I would expect that the receiving SHO (junior doctor) can examine ALL of my body parts adequately if required. whatever part of me he chooses to examine, I expect he will have examined the same bit in more than a thousand people, say. I would expect him to be able to formulate a potentially very broad differential diagnosis, order the appropriate tests, interpret the test results, and initiate treatment based on the test results. I would expect him to be better able to do this than the nurse practitioner. I would expect this becasue that is what he is trained to do. I would not expect him to be able to nurse me. I would not expect him to be able to provide physiotherapy for my soft tissue injury. He is not trained to do these tasks.

4) The issue of regulation: I will always admit if I am wrong. I was wrong to say there was no list of nurse practitioners in Ireland. There is. There is no list in the UK, although one is being mooted. Despite wheresthebeefs fixation with the issue, I don't think it's the salient point here. Don't get me wrong, I'm glad there's a register. But the point of regulation should be to impose minimum standards....here's an example of the published minimum standards........"Have substantive hours at supervised advanced practice level "...and "Have the competence to exercise higher levels of judgement, discretion and decision making in the clinical area above that expected of the nurse/midwife working at primary practice level or the clinical nurse/midwife specialist;
Demonstrate competencies relevant to context of practice". Now, I don't know how many hours count as "substantive". Can someone tell me? I also see a lot of chat about "competencies". What are these competencies?

I recently had my "6 monthly appraisal" with my boss. At this stage in my career I'm expected to be competent at doing various things. This appraisal is to assess whether I've achieved these competencies. They include neonatal chest drains, peripheral arterial lines, umbilical lines, venous cut-down, intra-osseous access, intubation etc etc etc. I have a log book of the times I've done these procedures. If I'm not competent in certain procedures, then I have to retrain. I have to show hard evidence that I am capable of what I say I am capable of. I do not have the luxury of ticking a box that says "are you competent to exercise higher level of judgement, discretion and decision making in the clinical area above that expected of an SHO?. Tick yes or no". And quite rightly too. The public deserve better.

There's lot being thrown at me, and I'm not sure if there's outstanding points for me to answer, except for the following...and I think this is the crux of the issue....Just take a while to read it...




"You're right. A doctor does know more about the body as a whole, a doctor knows more about the diseases of the body, and more about pharmacology. The Advanced Nurse Practitioner is someone who works within a highly specialised area. ANP's dont need to know how to examine the whole body, or know every pathology in existence. They are highly specialised experts in their own specific areas".




I appreciate that this thread is long winded, and boring to the neutral. However, I implore anybody who is still here to read the above. This is the REAL issue. This is why nurse practitioners provide poorer care than doctors do. It's a perfect example. Let's just look at it. Wheresthebeef is acknowlegding that nurse practitioners are trained within a very narrow remit.However, we must always realise that the systems of the body do not work in isolation. In my final exam at medical school, one of the cases I got was of a guy with a blood clot in his leg. He turned up with a pale leg. Now the nurse practitioner may know lots about examining your calf for blood clots if thats her area of expertise. That's fine. I examined his leg. Then I examined the blood supply from his abdomen right down to his leg. Then i listened to the arteries suplying his kidneys. Then i examined his heart. Then I looked at his ECG. The blood clot in his leg came from his heart, because his heart rhythm was irregular. Then i wanted to know why his heart rate was irregular. I examined him in his entirety and found evidence of thyroid disease. That was casuing his heart problem. I know that thyroid disease is associated with diabetes, so I asked about that. Turned out he was diabetic. So, in the space of a few minutes I've looked at the guy's leg, I've examined the blood vessels in his abdomen. I've examined his heart. I've interpreted his ECG. I've examined the arteries in his neck. I've examined him for signs of thyroid disease. His pancreas has also come into play with his diabetes.

His disease affected his WHOLE BODY. That's what disease does. He's not a complex patient, but he only came in with a pale leg. It's the kind of thing you will see and manage every day, even as an intern. This is my point. To be able to treat people, you need to be able to understand the whole body. You need to understand how systems integrate with each other. You cannot just be a "heart failure nurse practitioner" unless you can examine lungs and abdomens and vascular systems aswell as hearts competently.

Jimoslimos mentions knowing lots about chemotherapy drugs and colorectal cancer diagnosis and treatment. "probably" more than me. Before I did paeds, I did surgery. I worked in a tertiary referral centre for colorectal surgery. In terms of chemo drugs, I also have a BSc in Biomedical sciences. My final year thesis was on chemotherapeutic agents. I've also significant experience in kids haem/oncology. I'm reasonably happy with my knowledge of these agents. We can probably both say "methotrexate is a dihydrofolate reductase inhibitor used to treat some cancers". However, to bring you back to your example of colorectal cancer....when the patient first presents becasue he is pale and breathless, I know the causes of pallor and of breathlessness. I know they are wide ranging. the problem could be in his lungs, his heart, his abdomen. It may be colorectal cancer. But it may be many other things too. I can examine the patient head to toe for a cause. I can order the appropriate test to find out why he's pale or breathless or whatever. I can interpret the results. Therefore, I can start treatment. You can't. It's what I learned at medical school and while doing membership exams. You went to nursing school and learned to nurse. I have no doubt ur an excellent nurse.



So, in summary...(I'm going into work now in a few minutes, and am on call until monday moring, so wont be able to post again for a while!)......lets have a look at the arguments on both sides, from start to finish....


Against nurse practitioners:

a) They don't understand the basic human sciences aswell as doctors

b) They don't understand disease process as well as doctors

c) Therefore they can't take a history as well as a doctor

d) They aren't as competent as doctors at examining patients

e) They can't interpret test results as well as doctors

f) They don't understand drug treatments as well as doctors

g) They are unregulated

h) They are a cost cutting measure, to be used only on those with no health insurance


Pro Nurse practitioner:

a) They are, in fact regulated, I think you will find.

Have a nice weekend, folks.
Kind regards.

wheresthebeef

I'm surrounded by nurses. Many of them are my friends. I have most of their phone numbers, because I socialise with them on the rare occasions that I get time off. I think they should be paid enough to own a nice house locally, buy a nice car, go on a nice holiday every year and have a reasonable standard of living. They should have a lifestyle comparable to other middle class professionals. Thet fact that they don't is scandalous. I constantly tell them this. I constantly praise them, because they are, by and large, excellent at their jobs.

I don't know what to say to this. You haven't phrased this one very well. I could respond with something like "Your so good to lower yourself to their level. How nice of you to reach out to the common people."

1) Wheresthebeef says "obviously one does not require a medical degree anymore. the experts have spoken". I don't regard Mary Harney as an expert in clinical medicine. I guess we'll have to disagree here.

Mary Harney is just a PR face for the DoHC. Her advisors are the experts in healthcare policy. Prof Brendan Drumm of the Health Service Executive, is surely an expert in clinical medicine. I believe he is a paediatrician. Feel free to give him a ring, as a fellow paeds doctor and give him your views on nurse practitioners. I'm sure he'll be only delighted to here that your more expert on the matter than he is.

I'm not unprofessional. I haven't had a lunch break in about 8 months. I work on average 3 hours per day overtime for free. Today is my day off, yet I spent 3 hours in the hospital. My research, which I do unpaid, involves inequity in healthcare ie the most marginalised and the poorest sectors of society receiving the worst healthcare. I do everything in my (very limited )power to fight this. I have worked for free in Africa because I feel so strongly about it.

Boo hoo! Your rubber medal is in the post. Along with your massive pay check, and the knowledge that your a martyr.

2) My anecdotes about the misdiagnosis. I thought my point was reasoanbly clear, but I'll explain in more detail because the nurses on here have misunderstood. The incidents happened. I can not prove they happened. I was there, but I didn't take pictures. I didn't use them "To back up" my point. I used them to illustate my point. Big difference. The point I made was that even if we were to discard them as evidence (to continue the courtroom analogy ), they illustrate the potential for disaster when people who are only qualified within a very narrow remit try and treat the whole patient.

i still have trouble believing the ridiculousness of your anecdote regarding abdominal pain etc... Its absolutely farcical and couldn't be representative of the ANP population.

I would expect him to be able to formulate a potentially very broad differential diagnosis, order the appropriate tests, interpret the test results, and initiate treatment based on the test results. I would expect him to be better able to do this than the nurse practitioner. I would expect this becasue that is what he is trained to do.

This is also what the ANP is trained to do, having had a degree, and a masters education and at minimum 7 years clinical experience and satisfying the other requirements as set down by the NCNM.

4) The issue of regulation: I will always admit if I am wrong. I was wrong to say there was no list of nurse practitioners in Ireland. There is. There is no list in the UK, although one is being mooted. Despite wheresthebeefs fixation with the issue, I don't think it's the salient point here. Don't get me wrong, I'm glad there's a register. But the point of regulation should be to impose minimum standards....here's an example of the published minimum standards........"Have substantive hours at supervised advanced practice level "...and "Have the competence to exercise higher levels of judgement, discretion and decision making in the clinical area above that expected of the nurse/midwife working at primary practice level or the clinical nurse/midwife specialist;
Demonstrate competencies relevant to context of practice". Now, I don't know how many hours count as "substantive". Can someone tell me? I also see a lot of chat about "competencies". What are these competencies?

I recently had my "6 monthly appraisal" with my boss. At this stage in my career I'm expected to be competent at doing various things. This appraisal is to assess whether I've achieved these competencies. They include neonatal chest drains, peripheral arterial lines, umbilical lines, venous cut-down, intra-osseous access, intubation etc etc etc. I have a log book of the times I've done these procedures. If I'm not competent in certain procedures, then I have to retrain. I have to show hard evidence that I am capable of what I say I am capable of. I do not have the luxury of ticking a box that says "are you competent to exercise higher level of judgement, discretion and decision making in the clinical area above that expected of an SHO?. Tick yes or no". And quite rightly too. The public deserve better.

Its not just a list of names. It is an accreditation process which imposes a minimum standard, a clinical theory and practice requirement. The document you viewed is a document relating to the ANP in general. As each ANP's job is different, and responsive to service needs, each ANP will have different competencies required for their area of practice. I do not have access to the individual documents for ANP accreditation in specific areas but can assure you that nursing education programmes use a similar type of log book approach to psychomotor learning. We are given a list of key tasks which need to be performed at independant competent level. The skill should be completed without verbal or physical assistance, in an efficient period of time, and to the safety of the patient. As well as this, a list of values and competencies are listed which also must be signed off to complete a section of training, and to document that the nurse is competent. These skills must be observed by an already qualified person, and that person then signs the documents to say the student is competent in that skill. The usual is to watch one, assist with one, and then do one. At the end of the training period, the logs are all put together into a portfolio along with other things and the students/nurses competency is reviewed, full competence must be obtained to register in the appropriate manner. Ongoing training, and skills workshops are part of every nurses working routine and an allocated amount of study days are given each year. ANP's and CNS's get more study days than staff nurses owing to their increased autonomy.

I appreciate that this thread is long winded, and boring to the neutral. However, I implore anybody who is still here to read the above. This is the REAL issue. This is why nurse practitioners provide poorer care than doctors do. It's a perfect example..................
..................You cannot just be a "heart failure nurse practitioner" unless you can examine lungs and abdomens and vascular systems aswell as hearts competently.

This is not the reality of the situation. If an Advanced Nurse Practitioner, for example, is an Accident and Emergency ANP then they would obviously have to have the clinical acumen to assess the whole body to a fair extent. If someone is a Diabetes CNS, they would have knowledge about more than just Islets of Langerhans. You said yourself earlier that nurses had the holism approach going on. Nurses are more than aware of the interconnecting nature of the bodies systems. I am sure an ANP of a specific area would have to know the relevance of their area to other persons area's and refer appropriately. Also, as i have said, the sense of knowing when to call in the doctor is a valuable skill for an ANP. Afterall, your a paediatric doctor, if a child presented to you with a complication of diabetes, would you perhaps think it valuable to get the insight of an endocrinologist. Just because your a doctor doesn't mean you know everything. Thats why there are many types of doctors who are specialised to many area's. Similarly, no-one is saying that ANP's can do all of the jobs of a doctor and will know everything about every patient that presents to them.

Against nurse practitioners:

a) They don't understand the basic human sciences aswell as doctors

b) They don't understand disease process as well as doctors

c) Therefore they can't take a history as well as a doctor

d) They aren't as competent as doctors at examining patients

e) They can't interpret test results as well as doctors

f) They don't understand drug treatments as well as doctors

g) They are unregulated

h) They are a cost cutting measure, to be used only on those with no health insurance

These points are largely subjective. You do not know the level of competency of each and every nurse practitioner or of each and every doctor. You do not know what nurses do and don't understand, or what they can or cannot comprehend. You have no notion of how much pathophysiology i am taught, or pharmacology. You have no notion of what knowledge nurses may possess that goes beyond the minimum that they require. You are making generalisations. You believe you have summarised the points from the argument, you have only summarised what you believe to be true and attempted to present them as fact. You offer no genuine sense of any benefit that nurse practitioners could bring to the health system.
Enjoy your weekend on call, i'm sure you'll be paid handsomely for it.

faceman

wheresthebeef wrote:

I don't know what to say to this. You haven't phrased this one very well. I could respond with something like "Your so good to lower yourself to their level. How nice of you to reach out to the common people."

Boo hoo! Your rubber medal is in the post. Along with your massive pay check, and the knowledge that your a martyr.

This is not the reality of the situation. If an Advanced Nurse Practitioner, for example, is an Accident and Emergency ANP then they would obviously have to have the clinical acumen to assess the whole body to a fair extent. If someone is a Diabetes CNS, they would have knowledge about more than just Islets of Langerhans. You said yourself earlier that nurses had the holism approach going on. Nurses are more than aware of the interconnecting nature of the bodies systems. I am sure an ANP of a specific area would have to know the relevance of their area to other persons area's and refer appropriately. Also, as i have said, the sense of knowing when to call in the doctor is a valuable skill for an ANP. Afterall, your a paediatric doctor, if a child presented to you with a complication of diabetes, would you perhaps think it valuable to get the insight of an endocrinologist. Just because your a doctor doesn't mean you know everything. Thats why there are many types of doctors who are specialised to many area's. Similarly, no-one is saying that ANP's can do all of the jobs of a doctor and will know everything about every patient that presents to them.


These points are largely subjective. You do not know the level of competency of each and every nurse practitioner or of each and every doctor. You do not know what nurses do and don't understand, or what they can or cannot comprehend. You have no notion of how much pathophysiology i am taught, or pharmacology. You have no notion of what knowledge nurses may possess that goes beyond the minimum that they require. You are making generalisations.

Enjoy your weekend on call, i'm sure you'll be paid handsomely for it.

Its become pretty clear from your last post that you hold some grudge/resentment/chip on your shoulders against doctors. And for this reason alone its clear you will never listen to any doctor who debates this issue so this thread is becoming more and more pointless.

At the end of the day nurses at any level are not trained like doctors, nor does their training come close. And while i dont know if you are a real nurse/trainee nurse or whether tallaght01 is indeed a doctor for real, his points present a far more realistic picture of how I, a member of public (i.e. a patient from time to time ), have already perceived the issue and experienced.

Sorry but none of the arugments presented here have changed my mind nor would change my family's mind, we simply wouldnt allow a nurse practitioner prescribe us medicine over a doctor.

littlebug

I'm not a nurse or a doctor but have worked with and around them for the past 15 years so I've been following this thread with interest.
Wheresthebeef your contribution to this debate has been sensible, well thought out and intelligent for the most part and you come across as someone who has an admirable dedication to your chosen profession. However, I have to say that your comments regarding Tallaght01's salary and your poohpoohing of his voluntary work and research into health inequalities show where the real basis of your argument lies (i.e the grudge etc that faceman mentions) and for me has completely invalidated your otherwise interesting points!

Jimoslimos

/Deep breath/......

Right where do I begin?

tallaght01 wrote:

I think they should be paid enough to own a nice house locally, buy a nice car, go on a nice holiday every year and have a reasonable standard of living. They should have a lifestyle comparable to other middle class professionals.

I'm sorry if I'm misinterperting this but still seems condescending. You appear to be saying "yes nurses should be on a good wage...but not as much as me cos I work in a far superior occupation" Sorry but that is how I as an outsider sees it.

tallaght01 wrote:

I'm not unprofessional. I haven't had a lunch break in about 8 months. I work on average 3 hours per day overtime for free. Today is my day off, yet I spent 3 hours in the hospital. My research, which I do unpaid, involves inequity in healthcare ie the most marginalised and the poorest sectors of society receiving the worst healthcare. I do everything in my (very limited )power to fight this. I have worked for free in Africa because I feel so strongly about it.

Do you think that long unpaid hours and missed lunch breaks are unique to you. In the UK especially this is the norm for many professions not just your own. However I won't be cynical and admit I do have great respect for ANYONE who attempts to make a difference for those less fortunate than themselves for no financial gain.

tallaght01 wrote:

But the point of regulation should be to impose minimum standards

I always believed the point of regulation was to impose a "standard" full stop. This would be the same standard that doctors would also be required to meet.

tallaght01 wrote:

I do not have the luxury of ticking a box that says "are you competent to exercise higher level of judgement, discretion and decision making in the clinical area above that expected of an SHO?. Tick yes or no".

Do you seriously believe an ANP would have this luxury? I'd reckon that their competency to carry out a particular task would be assesed by a panel of their peers.

tallaght01 wrote:

Jimoslimo states that he would trust the nurse practitioner over the inexperienced junior in a clinical situation. That's your perogative. You can exercise that right if you're ever brought into hospital. If I'm ill, however, I would expect that the receiving SHO (junior doctor) can examine ALL of my body parts adequately if required.

Do you believe that a junior doctor with 6-7 years training is any better than a nurse with 4 years training (degree) + masters degree + 7 years experience (5 within their speciality). Also remember that not very nurse is going on to become an ANP (only a select few) whereas pretty much all medical students become doctors - it could be argued that this selective process result in a far better quality nurse practioner than junior doctor.

tallaght01 wrote:

However, we must always realise that the systems of the body do not work in isolation. In my final exam at medical school, one of the cases I got was of a guy with a blood clot in his leg. He turned up with a pale leg. Now the nurse practitioner may know lots about examining your calf for blood clots if thats her area of expertise. That's fine. I examined his leg. Then I examined the blood supply from his abdomen right down to his leg. Then i listened to the arteries suplying his kidneys. Then i examined his heart. Then I looked at his ECG. The blood clot in his leg came from his heart, because his heart rhythm was irregular. Then i wanted to know why his heart rate was irregular. I examined him in his entirety and found evidence of thyroid disease. That was casuing his heart problem. I know that thyroid disease is associated with diabetes, so I asked about that. Turned out he was diabetic.

Nobody is arguing the point that many conditions are multifactorial. The example you give is of a blood clot - (with no medical experience I would say) a treatable condition in itself but any doctor OR nurse would recognize that there may be an underlying cause. I'm not expecting nurses to start dishing out warfarin based on a single condition.

tallaght01 wrote:

But it may be many other things too. I can examine the patient head to toe for a cause. I can order the appropriate test to find out why he's pale or breathless or whatever. I can interpret the results. Therefore, I can start treatment. You can't. It's what I learned at medical school and while doing membership exams. You went to nursing school and learned to nurse. I have no doubt ur an excellent nurse.

Hmmm....where did I say I was a nurse? I'm not but I take your point, I wouldn't be able to treat patients adequately because I haven't been trained to. A clinical chemist would probably be able to interpet (given the background) the result of a blood test better than most doctors but would I trust them to prescribe - NO. IMO an ANP will have the adequate basic knowledge to be capable of making a correct prescription based on the information (through physical examination/blood tests) supplied to them

wheresthebeef

littlebug wrote:

I'm not a nurse or a doctor but have worked with and around them for the past 15 years so I've been following this thread with interest.
Wheresthebeef your contribution to this debate has been sensible, well thought out and intelligent for the most part and you come across as someone who has an admirable dedication to your chosen profession. However, I have to say that your comments regarding Tallaght01's salary and your poohpoohing of his voluntary work and research into health inequalities show where the real basis of your argument lies (i.e the grudge etc that faceman mentions) and for me has completely invalidated your otherwise interesting points!

yes i was very cynical with tallaght01. he's trying to make the argument emotive by trying to elicit some kind of sympathy for himself. no-where in my argument did i have to resort to painting nurses out as martyrs and saints. we all work hard, we all work beyond the minimum thats required of us, working extra hours and such, its part of the job. patients don't always feel well everday between 1pm and 2pm to facilitate lunch breaks. Tallaght01's job is probably more demanding than that of a nurse, time wise, however he is adequately compensated for the inconvenience.

Traumadoc

Back to the nurse prescribing - I think it would be a good thing. Ive seen it work overseas especially when analgesia is needed. As doctors we can often be preoccupied in establishing and treating the underlying cause.

Say for example a patient presents with a painful arm, a doctor will often get going establishing the diagnosis, order an xray,etc.. Nurses seem to be more concerned with aleviating the symptoms and would be more concerned with providing analgesia.

Ive worked where nurses have morphine protocols- they can prescribe and administer morphine. It works very well.

chuci

dr tallagh i find that some of your comments are quite derogatory quacktitioners is not aprofessional way to comment on your fellow multi-disciplinanary team you you use terms like that towards physios or o.t.s etc.perhaps people who you would consider "up there" with yourself? you do come across as a bit of a snob in your above comments and it does appear that you look down on us nurses as below you.

im glad that you have reduced yourself to the common people by acknowledging that we o get paid peanuts for the ammount of work we do but the way you put it sounded like the most derogatory peice of dribble i have ever heard. i have a car imagine that?? and i can drive it too.

i do believe doctors are skilled and this is due to their training. but to further your understanding in certain specialities why cant nurses? you saud above that you have great respect for the icu nurses they all had to under go a training course i assume to make sure they are competent to look after the patient and their families. i dont see why nurses who are already are highly specialised in their areas who have a wide understanding of diseases and their affect on the body why they should not be able to under go a course which will help them progress further and get them more money so maybe they can buy a house next to the hospital or have a nice holiday.

i hope theat you dont think its as easy as a tick the box for degree nurses these days? we are looked upon with such cynacisim people are just waiting for you to put a foot wrong. for eg i had to un block a patients catather because there was an emergency on the ward. my patient was in serious pain because of this clog. i knew how to do this procedure correctly as i had worked on a urology ward previously but as soon as i mentioned what i had done this theer was a slight ripple among the staff that i thought i wasa better than them. there was no well done for un blocking it and thats its patent,that the patient is comfortable. now i admitt that i may have acted outside my scope as a student nurse but i had my patients best interests and i knew the procedure. dont get me wrong if i had no clue i obviously would not have carried it out.

sorry that was a it of a ramble i have a huge interest in diabetes and metabolic diseases. if i trained hard enough and got my new title its some peoples views that hold us back from evolving more in our practice.

wheresthebee well done on your representation of us students as a fellow student (4th year) nurse bravo.

i have great admiration for those who do carry out voluntary work fair play tallagh.

i do agree that we could all sit down and argue this for days on end and never come closer to a decision but like it or not it is happening.

Dr Galen

well i've been following this one with great interest.........

did someone say "scrap"!!!!

some of you won't like this, but i really don't want to prescribe. I know i know, its a big step for nurses la la la

in all seriousness, all we'll probably ever be prescribing is paracetamol and laxatives. now that would be great and handy when i can't get hold of an intern. but wouldn't it make more sense for there just to be more interns......(JHO's for those in the UK i thinks)

i'm all for expanding nurse practice, beefy you know this as well as anyone, and fair play to anyone that wants the prescribing rights. but stop and think about some of the other issues, things like malpractice insurance to begin with. fecks sake i can barely pay my car insurance never mind that as well.

I didn't get into nursing to be a doctor, and i've said this before. I actually could have gone into medicine, but i chose not to. but more and more it seems that nurses are having to take on more and more junior doctor roles. I know EU law restricting working time has a lot to do with this, but look at the shambolic situation in Ireland for getting people into medical education. if we had more doctors, i wouldn't have to worry about patient x needing pain relief. I could ring the team and one of the 6 interns would be free to come up and sort it, (ideal world situation there btw). i could go on with other nursey type stuff.

for the record though, tallaght01, i think you are underestimating the education the Irish nurses are now getting. we get an awful a ount of Anatomy and pharma stuff thrown at us now. Sure I have interns on the ward asking me stuff about drugs, and to my OWN surprise sometimes, i'm able to answer

tallaght01, please mate, chill out a bit. I've had discussions with you before and been on your sie of things too. You seemed to me then as a decent sort. and not one of the protectionist stuck up docs that exist. some of your posts here haven't come across the best, so maybe count to 10 before you click submit.

and as for beefy................:p

Dr Galen

god i think i should follow my own advice and count to 10 as well,
my spelling is atrocious

faceman

Tallaght01 is getting too much of hardtime on this thread unjustly. It seems to me that tallaght01 got into medicene for reasons other than salary. I could be wrong but i doubt it. I find it hard to believe someone with a "condescending" attitude could be so rude to actually do voluntary work to help those in need. Maybe tallaght01 only volunteers to help middle and upper class tho.

Nurse_baz, its interesting to hear someone who actually works as a nurse (as opposed to studying it as some of the posters here are) expressing caution about any move resulting in nurses prescribing medicene.

However you did comment that tallaght01 underestimates irish nurse's training. I dont know what differences there are but surely you can admit that the training taken both theory and practical is training one to be as excellent a nurse as possible and not a part time doctor?

Still, i dont think the cardiologist in my local hospital can help me with my tinnitus. So i'll stick to my ENT for that. So likewise i'll let the nurses nurse, and the doctors, erm, doctor.

wheresthebeef

NurseBaz, your post is in contravention to our organistions policies. the (wo)men in black will be down upon you!!! they know where you live.

Still, i dont think the cardiologist in my local hospital can help me with my tinnitus. So i'll stick to my ENT for that.

The Adelaide and Meath Hospital in Tallaght has a lovely ENT Clinical Nurse Specialist. Maybe you could see her, she's ever so good.

Wisheress

wheresthebeef wrote:

Boo hoo! Your rubber medal is in the post. Along with your massive pay check, and the knowledge that your a martyr.

Enjoy your weekend on call, i'm sure you'll be paid handsomely for it.

Ah, I love to see someone completely negate their point and lose everyone's respect.

WTB, have a bit of appreciation for someone who is doing a good job. The above embittered and disrespectful statement says a lot about your character and personal begrudgery, and nothing about your profession.

(Shout to my favourite nurses in Beaumont A+E!!!)


Perhaps you need to see someone to work out your personal issues...I can suggest a good doctor.

DrIndy

I think this is an excellent thread and has drawn out a lot of points for further debate.

There are fundamental differences in training between nurses and doctors and many of the anecdotal stories that Tallaght01 has mentioned cite the example of where nurse prescribing is downright dangerous for patient welfare.

We are trained to look much more at the global picture regarding diagnosis and this is quite different from nursing training, and we automatically look into the problem whereas nursing is concerned with the symptoms. This is not a bad thing - I have a habit of delving into the diagnosis such as a DVT and treating it as appropriate as possible - but its a nurse who will remind you that they need pain relief and more reassurance regarding their condition. Many patients are intimidated when a doctor comes in and they don't ask the questions they should and they are distraught at their diagnosis - others take it in their stride. This is where nurses have such a phenomenal impact and deliver superb care for their patients. Notice as well that it is always the nurses who receive much more chocolates and cards than doctors ever do! They are much more fortunate in being able to spend more time with people than we can.

Back to prescribing, I still hold the strong viewpoint that nurse prescribing as is done in the UK is a disaster and introducing it here would be very dangerous. If a nurse should prescribe, it should be off a very strict formulary and only that formulary in which they are specifically trained. This will require changes in legislation. A CNS or ANP in A&E should not be able prescribe STD medications etc.

Regarding pain medications, Tallaght01 is correct regarding abdominal pain - pain is a very important warning sign that there is something seriously wrong and is the body's signal that something is happening - you have to examine someone who develops worsening (or not rapidly abating) pain as it means something nasty is brewing. That diagnostic step can only be made by a doctor who has those layerings of knowledge and long periods of training.

Remember when you compare doctors training - a GP who has one of the shortest training schemes still have 6 years Med School + 1 year intern +2 years general traing +5 years GP training = 14 years!

In the current plans for nursing - the time they require is significantly less and it is focussed training into certain fields which causes you to miss out on general training - they why? response and the "What is underlying this?" response when things are just not right in someone.

Hence open prescriction is a very bad idea. Also remember that nurses should take on malpractise insurance if they want to have similar rights to doctors and be liable for mistakes that they make and then suffer the same awful stresses when they are sued.

This concept has not gotten across to pharmacists who also want to prescribe here - they will need to be able to diagnose and a five minute chat across the counter does NOT equate to an appropriate clinical diagnosis with appropriate prescription as needed.

What would happen if nurse prescribing is introduced? If it is a free for all then rack and ruin will prevail. If nurses are permitted to restrictively give painkillers, laxatives and fluids on ward level - without appropriate training in physiology and pharmacology as well as disease - it will result in morbidity and mortality. If CNS or ANP go beyond a restricted formulary - this will also occur.

These are serious issues - but need to be looked at with a cool eye and sober mind.

Likewise, there are broader issues regarding other procedures that have been traditionally the treatise of doctors. Cannulation, blood taking, catheters, NG tubes, Central line removal, ABG's. All simple procedures that anyone with the correct training and understanding of risks can do and nurses expanding their scope of practise to better themselves will reduce the workload of doctors as well as ensure that their patients always receive their medications on time.

But blurring the line between doctors and nurses is not without its problems. We have very clear roles both in the health care sector and in the public's perception. Doctors diagnose and treat and nurses deliver care of their patients other paramedical disciplines work with us synergistically. One cannot survive without the other and it is not a case that doctors are superior to nurses.

purple'n'gold

nurses complete a 4 year honours degree.

There is absolutely no need for nurses to have an honours degree. Excellent highly competent and dedicated nurses still working in the system never aspired to a degree. This was just a scheme dreamed up to give nurses a sense of their own importance and hopefully keep them quiet. It is potentially dangerous and unnecessary to give nurses this authority. Doctors are trained and qualified to prescribe drugs, there is no need for nurses to do it.

Dr Galen

purplengold wrote:

nurses complete a 4 year honours degree.

There is absolutely no need for nurses to have an honours degree. Excellent highly competent and dedicated nurses still working in the system never aspired to a degree. This was just a scheme dreamed up to give nurses a sense of their own importance and hopefully keep them quiet. It is potentially dangerous and unnecessary to give nurses this authority. Doctors are trained and qualified to prescribe drugs, there is no need for nurses to do it.

indeed.......

so who wants to take this one? any of the doc's have an opinion on this......i'll answer in a bit, i'm too busy counting to ten

chuci

purplengold wrote:

nurses complete a 4 year honours degree.

There is absolutely no need for nurses to have an honours degree. Excellent highly competent and dedicated nurses still working in the system never aspired to a degree. This was just a scheme dreamed up to give nurses a sense of their own importance and hopefully keep them quiet. It is potentially dangerous and unnecessary to give nurses this authority. Doctors are trained and qualified to prescribe drugs, there is no need for nurses to do it.

ill have to count down from 50 for this one...........sense of our own importance you say well excuse me im going to be quite happy with myself when i leave coll with my degree and also my ba. i have no doubt that some nurses wish not to have a degree and thats their own choice but it nor does it mean that degree nurses are incompetent and you would have to be dedicated to stick out the bloddy course. you act sound like one of those nurses who never wished to aspire to degree. i would like more options when i leave coll than to just be "a nurse". you sound like a very arrogant person

Dr Galen

There is absolutely no need for nurses to have an honours degree.

could you back up your ideas in this one? using evocative and emotive ramblings like the bit beloew really doesn't give your ideas much credance. If its your opinion, thats cool, your entitled to it, but what exactly makes you have this opinon other than some hearsay and little experience of the real situation?

Excellent highly competent and dedicated nurses still working in the system never aspired to a degree.

and your experience of this? how far back are we going? because many of my collegaues educated under the old diploma or cert system studied for their degress within a few years of qualification.

This was just a scheme dreamed up to give nurses a sense of their own importance and hopefully keep them quiet.

by who? would you not agree that the international experience of making nursing an all graduate degree profession, along with the improved patient outcomes that follow this was really the driving factor. Added to this, the fact that nurses would then be better educated from the beginning and more able to take on expanded practice roles, in turn lessening the load on medical staff?

how much do you actually know about the curriculum for nursing degrees in this country or indeed any others that operate a degree system? much of the extra work involved comes in the way of learning about resarch and the research process. the aim is to increase the level and amount of research carried out in the world of nursing, and also to make sure that every nurse is more or less able to peer review any research that comes to them. thereby allowing them to make informed nursing decisions about how best to care and treat their patients.

It is potentially dangerous and unnecessary to give nurses this authority. Doctors are trained and qualified to prescribe drugs, there is no need for nurses to do it

again i'd like to know hat basis you have for forming these opinions. I might not agree with some of the other posters who hold the same opinons as yourself, but at least they show a rationale for their thinking.

and to give you a situation, where having nurse prescribing, within a set scope of practice can work...........

its 2pm on a Sunday afternoon. 2 junior doctors are covering the entire hospital. and you haven't poo'd in 4 days. your starting to feel pretty sick and bunged up. there's not a lot of reason for it. maybe you haven't been drinking enough fluids. maybe some of the pain medication your on is helping cause it. and maybe your just another one of the hundreds of people who get constipated in hospital. now a bit of laxative would do the trick but i can't do that cos i can't prescribe........

tallaght01

I never prescribe laxatives in the hospital situation without talking to and examining the patient and trying to make sure they've not got bowel obstruction or "subacute bowel obtruction" (do they use that term any more?...was used a lot when I used to do adult surgery, but was going out of fashion). But I do accept that they get prescribed willy nilly sometimes. Also, laxatives or enema? Actually, come to think of it, I'm happy to allow anyone else to take on the role of doing the rectal examination on patients :P

Thankfully not had to to a rectal on a patient in well over a year I think. Are rectals the worst type of physical examination to do? Anyone got a worse one? or is that a new thread in itself? :P

faceman

nurse_baz wrote:

how much do you actually know about the curriculum for nursing degrees in this country or indeed any others that operate a degree system?

Thank you nurse_baz, ive waited nearly 50 posts for someone in nursin to say this. (for the record I disagree with purple'n'gold's comments too.)

However you have asked a valid question. How many nurses know exactly what training a doctor goes through that gives them the necessary qualification and skillset needed to prescribe medicene?

Dr Galen

I never prescribe laxatives in the hospital situation without talking to and examining the patient and trying to make sure they've not got bowel obstruction or "subacute bowel obtruction" (do they use that term any more?...was used a lot when I used to do adult surgery, but was going out of fashion).

well yes and i'd expect nothing less from a doctor or nurse. but you know as well as I do that prescribing of laxatives and things like paracetamol for a headache are fairly simple operations. not putting down the role or educatin of a doctor tho. even prescribing fluids for a pre op patient could be handled by a nurse