> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Vic
> Sent: 12 August 2006 17:48
> To: [log in to unmask]
> Subject: Re: I think we have this all wrong
>
>
> I've tried to stay out of this debate but finally want to add
> my two pennyworth.
>
> In the old days nurses nursed. They didn't prescribe (they
> told us to do the writing and take the responsibility for
> their decisions), they made patients comfortable by
> fulfilling their care needs in every respect. It never was a
> menial job, and all the doctors on the ward knew that the
> patients were more grateful to the nurses who made them
> comfortable than to the doctors who put them in pain because
> it was the nurses who always got the chocolates or jellied
> fruits. As a hospital doctor I only once got a thank you
> present, a bottle of whisky for saving a child's life.
Or more to the point the perception rightly or wrongly is that doctors
are rich and nurses poor...
It is very easy to sat 'the nurses' but it forgets that until
relatively recently , it wasn't qualified , Regsitered Nurses providing
care on wards, assisted by support workers it was un(der) supervised
students and/or used and abused as required because of their status 2nd
level nurses...
> Now I have no issue with nurses taking clinical decisions
> that doctors used to, though I feel that this is one of the
> ways that the Government is trying to weaken the power that
> doctors have. When they finally decide they will kick us down
> the salary scale, a strike will find the nurses happily doing
> our jobs.
Or if Crippen (he of the blog) is to be believed, this has already
happened...
The question is will none medicla staff ever replace Consultants and
other senior doctros - probably not but we will see an increasing move
away from service provision by the trainign grade medical staff ...
The comparision between the a few months I nthe speciality SHO and the
several years if not decade + of experience of the senior Nursing
staff... Vic alludes to this but sees the regualrisation of thepractice
he describes as a threat rather than explicit acknowledgement of the
practice...
> Of course the Nurse & Paramedic practitioners will
> soon cotton on to this, and after some bloody pay disputes
> things will end up just as they are now, except that the
> experience base of the practitioners will have been dumbed
> down and worse of all, no-one will know how to actually care
> for (i.e. nurse)a patient.
While we continue with the systems we have there should be little fear
of thesituaion getting worse - it could get better however if all the
Nurse academics were made to maintain a clinical caseload, much I nthe
way the vast majority of medicla academics do ....
The greatest risk in the above scenario is direct entry ( whether
graduate or undergraduate) 'physician assistant' roles - we have no
imperitive to employ the combat medics returning from Viet nam so do
we need to create what is turely a 'mini doctor' rahter than adding
roles to established Professional groups ?
>
> I already see Consultants who have never learnt how to really
> examine a patient properly, they rely on investigations, and
> on several occasions I have seen a student nurse refuse to
> help clean a grossly incontinent patient.
All health professionals need to take back ownership of the clinicla
education of students - just because people aren't employed by the
hosapitals anymore doesn't mean hospital staff don't have the
responsibility - however the absence of governmental will to provide and
protect time for mentorship...
>Some Ward managers
> seem not to see the filth on the walls of their wards or the
> fact that patients can go unfed, un-toiletted and even unobserved.
Which is indicative of a culture where those roles are not seen as
desirable by the clinically focused senior nurse( who is now in a
clinical specialist, Nurse practitioner or ECP post) leaving those who
see a a ward managers job as a way to management roles - and
consequently advocate for management by brown nosing rather than for
their staff and patients ...
Equally it is a reflection of a situation where understaffing to a
dangerous degree is an accepted part of Nursing and therapist
practice...
>
> I could go on ad nauseam about the deterioration in care that
> has occurred in hospitals, but all the managers do is to
> reply that they need more paper trails and managers.
Which is obvious as admitting otherwise would mean damaging their job
security ...
>
> We do not need more managers, we do not need more paperwork,
> we do not need modern matrons.
We do as it has taken back some pride in nursing rather than nursing
disappearing into ( and becoming assimilated of)management above the
senior sister role ...
> We don't need nurse
> practitioners. We do desperately need nurses who know how to
> make a patient feel better, and doctors who understand that
> medicine is both a science and an art (both long in the learning).
And how exactly do you propose to provide that AND keep people in
Nursing who do care aobut clinically focused things - when tesco will
pay more for the nurse looking for their first management post ...
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