In this country maybe. In the States you call the iv nurse. We do these psychomotor skills because
nobody else did or would. If you practised enough, you'd be the ace bottom-wiper, too. We need to
move on from this cupping of the hands round any particular single skill to protect it from other
people. I wouldn't trust myself with a pair of lift-out forceps any more although I was once taught to
use them. Wallace cannulas are now withdrawn because so many people were useless at inserting
them the serious complication rate got a bit worrying. (Can't have been doctors that did that,
surely? Anaesthetists even......?!)
Bottom line - we should not be the backstop for psychomotor skills we need not possess.
> Pop quiz:
>
> Who is called when a nurse with appropriate training in IV
> cannulation, with the relevant certificate and permission
> from their trust to perform cannulation, fails to cannulate?
>
> Answer: (Eventually) a member of the team of doctors
> responsible for the patient's care, no?
>
> Now I have noticed amongst members of the junior doctor grade
> more junior than myself, a number of people who end up
> calling more senior staff because they have been unable to
> cannulate, e.g. Anaesthetic SHO, which currently includes
> me. And this observation is not mine alone. We come along,
> and find several potential locations to cannulate, and
> granted we spend some considerable amount of time putting in
> cannulas, but I feel that I might have been able to cannulate
> these patients when I was a House Officer.
> Why?Because I did a significant number of cannulations as a
> house officer.
> Now, this task is being taken away and carried out by other
> HCPs of professionals allied to healthcare to such a degree
> that some juniors don't get a chance to 'practice' on people
> whom it is relatively simple to cannulate, so when it comes
> to the 'difficult' cannulation, they don't know where to
> begin.
> A skill is being lost, which I would think that a doctor
> should be able to carry out. Especially in an emergency in a
> shut down patient. This psychomotor skill is an important
> one.
>
> The point I'm trying to make is that by farming out all these
> types of tasks to other people, we are losing the skills, yet
> we are the people who are called when the task becomes more
> complicated than e.g. the ENP/HCA level 2 feels is more
> complicated/difficult to handle.
> Adam
>
>
Rowley Cottingham.
Consultant in Emergency Medicine.
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