That all nurses want to be specialist nurses or nurse practitioners and if they do who is leading them into this false dawn? This is the question that has been troubling me over recent days, when I am not fretting over the future of my own job that is!
Yesterday I met with the two people I am mentoring (management and leadership wise) through a Community Matron course and their tutor to go through the competencies they need to meet as part of the course and how they will be able to do this. Our PCT has been slow to introduce this new role into our area and we have been penalised in the latest round of brownie point awards for it. But we have wanted to make sure that we know what the role should be locally and that all of our nurses working in the community know how to care for all of our patients. All district nurses are specialists in community nursing, they have specific skills in wound management and palliative care and are often referred to as specialist generalist.
That is not to say that case managing patients with highly complex needs is not important, because it is, and that is also not to say that we don’t want to prevent these patients making unplanned and unnecessary visits to the local hospital.
Sad to say, but one of the underlying reasons for this is the state of our local acute NHS trust. This is an organisation that has suffered poor staffing levels, poor management and leadership and poor financial management for a number of years. In the past they have sourced the world for nurses to recruit to their ailing numbers because those who trained locally would not work there if they had a choice. I have no first hand knowledge of their nursing care because thankfully I do not live on its doorstop, but I have heard stories which would make my hair curl if it wasn’t already curly. They have nurses for practice development, experienced nurses whose job is to help those on the wards to develop their practice, they have implemented essence of care (ridiculed, but a way of getting those who know no better to learn how to do things). They have specialist nurses, people who advise on infection control, those who advise on wound care and many more no doubt. But they seem to be unable to improve things. Now they have serious debt, so where vacancies existed there are just smaller ward establishments so it is really hard to see how they can improve. For us working in the community all we can do is feed back their short comings and to try to stop patients who could be cared for at home going into the place and to do that we need to have staff with a wide range of skills.
We do not have lots of specialist nurses, we have Macmillan nurses (who provide cancer / palliative care) and we have some people concentrating on diabetes and also therapists who specialise in neuro rehabilitation. We are cautious because we want to make sure our staff recognise that our patients need more than specialist care. It is an uphill battle I can tell you.
Anyway, back to my meeting yesterday where we discussed how the two nurses can obtain the experience they need to meet their course competencies. Both have GPs as medical mentors, willing to share their knowledge to teach our nurses new skills. Both are prescribers but do this cautiously too, they want to work with their GP colleagues not go off as some kind of maverick, saving lives and getting up the backs of our medical colleagues. OK so I am painting a Utopian vision that is not the whole reality but sometimes good practice does happen, it just doesn’t seem to be reported in the blog world or anywhere else.
Please note that half this post went missing into the black hole of the WWW if it in anyway doesn’t make sense! Blogging is fun, but at times hugely irritating!!
Comments on: "Is it true?" (4)
Hi again Julie. Leaving aside JC’s dumbing down/nurses replacing doctors badly argument, I’m all for greater knowledge and experience being brought to the coal face. Not to mention better standards of care.
The (seemingly insurmountable) problem lies in applying this excellence to daily working conditions. You only have to look at Val’s posts today on JCs blog, it’s impossible to imagine that good standards of care can be achieved in those conditions.
I have heard the opinion that it’s all very well a specialist nurse coming to show us how things should be done properly, but how would they manage if they had a quarter of the time available for the patient. Further, that a specialist generalist (what a mouthful) actually has a harder job that a specialist, and perhaps the former shoukl be the one who has a higher banding. I have a lot of sympathy with those views (based onl on my own experences)
I realise that working to a higher standard isn’t always more time consuming, but I suspect that it is in the majority of instances.
It doesn’t improve morale either when you know how you should and could be performing, but are unable to because of outside forces.
Doom and gloom eh! And my wifes car is sitting on the drive and i can’t get it to start. And its raining! Still, Blackburn will beat Chelsea tonight.
Bad news on that then Neil!
Yes can’t disagree with your comments Neil and I am not really sure of the answer, I just know that I would rather pull out my own finger nails than work as a nurse in either of my local acute trusts right now.
A query I heard today Julie.
If a Nurse Specialist/Advanced Practitioner is involved in an incident at work whilst working (as per their job decription) in a role where traditionally you would have found a doctor, would the nurse be expected to have performed as a competent Nurse Specialist/ANP, or as a competent doctor (i.e. the doctor who is no longer there)?? Seemed a potentially risky grey area for the nurse, which may be affected by ones employers attitude to incidents, whether scape goating or genuinely investigating and trying to prevent reoccurence.
Hope the outing to Thorpe Park went ok. I agree about tiredness, you don’t know how tired you are til you stop.
Well a competent doctor if doing work usually done as by a doctor (though not sure a court would make a distinction as competent is competent). If following hospital protocols / policies then is covered by vicarious liability.
I am knackered thanks Neil. The queuing was too much. But I had fun with the kids, what an auntie I am!!