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Agreed, have thought this myself for years Rowley, having "grown up" in the system you describe. Things were definitely more efficient in those days. Now nurses object to being seen or treated as "handmaidens", whereas in reality we were simply functioning as a highly efficient team. And I agree with Helen. Some ENPs can be painfully slow, at least when compared with an experienced middle grade or consultant. AF Rowley Cottingham <[log in to unmask]> wrote: 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./