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Are nurses the new doctors? | Are nurses the new doctors? |
(about 7 hours later) | |
Medicine has changed dramatically over the years with new drugs and treatments revolutionising the way patients are cared for. | Medicine has changed dramatically over the years with new drugs and treatments revolutionising the way patients are cared for. |
With that has come an overhaul in the way staff work. In particular, the demarcation between doctors and nurses. | With that has come an overhaul in the way staff work. In particular, the demarcation between doctors and nurses. |
What was once the preserve of doctors - prescribing drugs, ordering x-rays, referring patients and diagnosing - is now also done by many senior nurses who have had extra training. | What was once the preserve of doctors - prescribing drugs, ordering x-rays, referring patients and diagnosing - is now also done by many senior nurses who have had extra training. |
They go by a variety of titles from nurse consultants and clinical nurse specialists to nurse practitioners. | They go by a variety of titles from nurse consultants and clinical nurse specialists to nurse practitioners. |
Some specialise in a particular condition - diabetes or heart disease for example - while others coordinate care in A&Es and or community settings. | Some specialise in a particular condition - diabetes or heart disease for example - while others coordinate care in A&Es and or community settings. |
Go to a walk-in clinic or minor injury unit and the chances are you'll be seen by a nurse. | Go to a walk-in clinic or minor injury unit and the chances are you'll be seen by a nurse. |
Some GPs also use nurse practitioners to ease their workload by carrying out consultations. | Some GPs also use nurse practitioners to ease their workload by carrying out consultations. |
The 'super' nurse | The 'super' nurse |
Matt Hodson is a nurse consultant who specialises in respiratory disease. | Matt Hodson is a nurse consultant who specialises in respiratory disease. |
He has a masters and doctorate and leads a team of specialists who provide care in the community and in hospitals in east London. | He has a masters and doctorate and leads a team of specialists who provide care in the community and in hospitals in east London. |
Unless a patient has an emergency, they need never see a doctor - something the public still does not fully appreciate. | Unless a patient has an emergency, they need never see a doctor - something the public still does not fully appreciate. |
"Before we started, patients either saw their GP or went to hospital," he said. | "Before we started, patients either saw their GP or went to hospital," he said. |
"But now we are able to look after their needs - we can refer, prescribe, give clinical advice. | "But now we are able to look after their needs - we can refer, prescribe, give clinical advice. |
"If problems flare up we can provide oxygen or a nebuliser. These are the sort of things traditionally done in a hospital but there is a lot nurses can do," added Mr Hodson. | |
And the evidence suggests it works. | And the evidence suggests it works. |
Research by the British Heart Foundation on heart failure specialist nurses has shown that they can reduce hospital admissions and consultant appointments, giving a saving of over £1,800 per patient. | Research by the British Heart Foundation on heart failure specialist nurses has shown that they can reduce hospital admissions and consultant appointments, giving a saving of over £1,800 per patient. |
The charity Parkinson's UK has found that a specialist nurse saves over £200,000 a year in avoidable bed days, consultant appointments and unplanned admissions. | The charity Parkinson's UK has found that a specialist nurse saves over £200,000 a year in avoidable bed days, consultant appointments and unplanned admissions. |
Over the years I have heard nurses describing themselves as "mini-doctors" or "substitute doctors" doing the jobs medics once did. | Over the years I have heard nurses describing themselves as "mini-doctors" or "substitute doctors" doing the jobs medics once did. |
In fact, on wards you will often find experienced nurses asserting their authority over junior doctors. | In fact, on wards you will often find experienced nurses asserting their authority over junior doctors. |
Nurses vs doctors | Nurses vs doctors |
All this begs the question: what more could senior nurses do? | All this begs the question: what more could senior nurses do? |
After all, the NHS is facing particular problems recruiting GPs and A&E doctors in particular, while the ageing population is putting more and more demands on services. | After all, the NHS is facing particular problems recruiting GPs and A&E doctors in particular, while the ageing population is putting more and more demands on services. |
It was a point floated by the Royal College of Nursing this week. | It was a point floated by the Royal College of Nursing this week. |
Peter Carter, the union's general secretary, said senior nurses were a "huge part of the solution" in the push to create seven-day services as they could "make decisions, supervise teams and educate and mentor". | Peter Carter, the union's general secretary, said senior nurses were a "huge part of the solution" in the push to create seven-day services as they could "make decisions, supervise teams and educate and mentor". |
Currently there are about 64,000 nurses employed in England in senior roles - although it will include those in managerial position as well as nurse consultants and the like. | Currently there are about 64,000 nurses employed in England in senior roles - although it will include those in managerial position as well as nurse consultants and the like. |
That is only marginally fewer than the 72,000 hospital consultants and GPs that are on the pay roll. | That is only marginally fewer than the 72,000 hospital consultants and GPs that are on the pay roll. |
What do doctors think? | What do doctors think? |
The medical profession has always been reluctant to relinquish its roles and responsibilities. | The medical profession has always been reluctant to relinquish its roles and responsibilities. |
Paul Flynn, chair of the British Medical Association consultants committee, and a consultant obstetrician and gynaecologist, believes there is a "limit" to how far you can go with this. | Paul Flynn, chair of the British Medical Association consultants committee, and a consultant obstetrician and gynaecologist, believes there is a "limit" to how far you can go with this. |
He says evidence shows those senior nurses working in general practice, for example, order more tests and take longer to do consultations. | He says evidence shows those senior nurses working in general practice, for example, order more tests and take longer to do consultations. |
"It's not always more efficient, what we need is properly resourced staff across the NHS," he said. | "It's not always more efficient, what we need is properly resourced staff across the NHS," he said. |
"In hospitals nurse specialists can take on some of the jobs. For example I will make the diagnosis and then the nurse will take charge of discussing treatment options and managing that side. | "In hospitals nurse specialists can take on some of the jobs. For example I will make the diagnosis and then the nurse will take charge of discussing treatment options and managing that side. |
"It means I can get on and see the next patient. But you can't simply replace one with another," he explained. | "It means I can get on and see the next patient. But you can't simply replace one with another," he explained. |
It is, of course, a fair point. | It is, of course, a fair point. |
But with the nature of health care changing as medicine advances, and a growing amount of time devoted to helping people manage their conditions, there is arguably a growing role for the expert nurse as a way of making resources stretch further. | But with the nature of health care changing as medicine advances, and a growing amount of time devoted to helping people manage their conditions, there is arguably a growing role for the expert nurse as a way of making resources stretch further. |