This document is very different from some of the earlier drafts I saw. It is
also more realistic and does not suggest the abandonment of emergency
medicine as a speciality as previous drafts seemed to.
Andrew Hobart makes a good point, that the studies of Nurse Practitioners
suggest that they are no better than our most junior SHO's (not something I
think we should aspire to).
There are several nurses who hold extreme views that EM doctors should have
no role in the management of "minor" injuries (diagnosis in retrospect), and
that such departments should on principle have no EM doctor input. The
argument is that it restricts their practice and makes them subserviant.
Most NPs (that I have worked with) do not think like this and seem to want
to work as an integrated unit. This would seem to be a more realistic model.
Unfortunately, those with the most extreme views are often those that shout
the loudest and get noticed.
Simon
Simon Carley
SpR in Emergency Medicine
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Evidence based emergency medicine
http://www.bestbets.org
----- Original Message -----
From: "Andrew G Hobart" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, October 25, 2001 7:00 PM
Subject: Re: Reforming emergency care
> The first thing which caught my eye in this report was -
> "The minor injuries service will be nurse led."
>
> I think that this is either a big mistake or a poor choice of words.
>
> I accept the evidence that nurse practitioners can provide as good a
standard of
> care as SHOs and have therefore no problem with minor injury services
being
> nurse PROVIDED. However most of this evidence has come from units which
are
> Consultant LED. At present most of the research base, treatment
development, and
> teaching has been medically led.
> To move towards units which are nurse provided but jointly nurse and
doctor led
> would be innovative and might be the answer to our patients needs but to
go
> wholesale for a nurse led service before this model has been shown to work
is in
> my view a mistake.
>
> I tend to assume that words mean what words say but maybe the DoH thinks
that
> nurse led means nurse provided and I am worrying about nothing.
>
> Perhaps Matthew can shed some light?
>
> Andrew Hobart
> A&E Consultant
>
> Dr Matthew Cooke wrote:
>
> > You may be interested to read the Dept of Health report, Reforming
Emergency
> > Care, which is launched today and is now available via
> > www.doh.gov.uk/capacityplanning
> >
> > Matthew
>
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