Rowley wrote: "Now, of all those steps, the only ones that need a medical
qualification
in any shape or form are clerking and examining. I am an expensive
resource to be using so for such low-skill tasks as calling a patient
in. I wonder if rather than pouring money into training more people to
do our job, we should not be hiring a large number of (cheap) lightly
trained greeters, preparers and leavers and some secretarial system that
we can dictate to. So could ENPs. Would that not be much more efficient,
and will it not cut costs dramatically? I could easily see 20 patients
an hour and teach an F2 in minors in such a system."
This is just how it works in the US (well, the states I've worked in as I
know each state is like a different country in terms of its own ways!). It
works incredibly efficiently and the sense of team work is enormous; it's
humbling to see and experience. One thing that puzzles and upsets me a lot
is seeing working models (in all areas, not just medicine) that are more
effective than our current ones, which people seem to know about, yet
nothing ever gets done to change in the direction of a clearly proven model.
It's as if we look at these great models; a way of doing things better/more
efficiently/improved, shrug our shoulders and carry on regardless!
If you have the power to implement this sort of change in logistics - it
works!... very well!
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 12 August 2006 10:11
To: [log in to unmask]
Subject: I think we have this all wrong
I have been thinking. Never a good thing, I know. But I am becoming
increasingly convinced (and this thread on ENPs has reminded me) that we
are going down the wrong path. We are making more and more people see
patients directly. That means that there is greater autonomy (that's
good) but less team work (Not at all good). When I did my first A&E job,
I would go and see someone as a team with a nurse. I'd do the doctor bit
and he or she would do the nursing bit; traditionally cleaning wounds
and dressings etc while I wrote the notes. We could then move on to the
next patient.
What we have now is a fragmented set of individuals. As the nurses are
empowered, we are actually disempowered.
What happens today?
Who finds the next patient's notes?
Me.
Who calls them in from the waiting room?
Me.
Who prepares the cubicle for them once he realises that nobody has
cleared up from the last patient?
Me.
Who clerks the patient?
Me.
Who undresses the patient?
Me.
Who examines the patient?
Me.
Who cleans and closes the wound?
Sometimes someone else, but usually - me.
Who writes the notes?
Me.
Who gives standard discharge advice and forms?
Me.
Who enters the computer data?
I like to as it is my record but usually someone else.
Now, of all those steps, the only ones that need a medical qualification
in any shape or form are clerking and examining. I am an expensive
resource to be using so for such low-skill tasks as calling a patient
in. I wonder if rather than pouring money into training more people to
do our job, we should not be hiring a large number of (cheap) lightly
trained greeters, preparers and leavers and some secretarial system that
we can dictate to. So could ENPs. Would that not be much more efficient,
and will it not cut costs dramatically? I could easily see 20 patients
an hour and teach an F2 in minors in such a system.
/Rowley./
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