In fact I’d go as far as to ask the following questions:

What is a nurse?
Are all nurses the same?
Are nurses turning into mini doctors?
Should nurses know their place?
Are nurses less intelligent than doctors?

These all arise for me from a discussion which has been happening today over at Dr Crippen’s Blog, please take a look to get acquainted with the facts, as I am not sure I can go into it all now.

One of the major problems with nursing in my opinion is that nurses really don’t know what they are meant to be any more. Now if a nurse doesn’t know what she (or he) is then heaven help the poor feeble minded doctor, not to mention the patient. When I trained as a nurse (and yes it was an apprentice style training) at a large London teaching hospital nurses pretty much learned how to care. We were there to assess the patient, but only in the context really of the care we would deliver, and to ensure there was nothing we needed to call the doctor to do for us. In those days we gave intravenous drugs, but did little else which could be thought of as the domain of medicine. We followed the consultant on his round (and it usually was a he, unlike today), made notes and carried out orders. We didn’t challenge what was said. If the doctor struggled to communicate adequately with the patient, we went back and quietly picked up the pieces. After all we couldn’t expect the doctor to be able to do that bit it wasn’t his job.

In the 1980’s something radical happened. Each nurse became responsible for their own actions, and even more radical, they were allowed, if they thought they had the correct knowledge and skill to do a lot more of the things previously done by a doctor. This led to nurses defibrillating patients, cannulating, giving more scary IV drugs, and even beginning to take on minor surgical procedures.

As time went by, nurses took on more and more of the work that had previously been a doctors. Not all nurses, and certainly not all nurses agreed with this. A lot of nurses see their place with the patient, administering care (whatever care is), and a lot of doctors feel that nurses are doing things that they have neither the knowledge base nor skill to do safely. Now someone has had the audacity to let nurses prescribe and for some this is definitely the thin end of the web. Now I have my own reservations about letting too many nurses, with too little real knowledge loose with a prescription pad and the BNF, but then I have seen some very dodgy medical prescribing so let’s not get carried away.

What we need in nursing is a proper career structure. Where you learn how to nurse before you move onto the extended roles, where you learn how to communicate before you medicate. I would like the nurses at each level to be educated appropriately for the job they are going to do and I would like to see them paid properly when they reach the higher levels of practice. In my own opinion I was a reasonably good District Nurse and a pretty good Specialist nurse once I had been prepared for the role. I wasn’t a doctor and didn’t need or seek to act like one. But what I wanted most was to feel I could give the best care to my patients. I wanted to be part of the specialist team (consultant, nurses, therapists) where we all had a part to play in the care of our patients and I wanted to make sure that the patient knew when he/she needed specialist care from us and when they needed their own GP.

The lack of structure, the lack of recognition for the work I did and unfortunately only too often the attitudes like the ones expressed over on Dr Crippen’s site got to me in the end and here I am.

Not sure I have answered my own questions, but no doubt this is a topic I will return to in due course.
Nursing NHS