Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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NURSE ANAESTHETISTS
- Zachary Whitewood-Moores (26 October 1998)
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Re: NURSE ANAESTHETISTS
- Hugh Matthews (29 October 1998)
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Re: Re: NURSE ANAESTHETISTS
- Craig Lammas (17 April 2000)
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Nurse Anaesthetists-Need is there, but no support
- Nancy A Petersen (18 May 2001)
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Nurse anaesthetists: is the need there?
- Ian Nesbitt (19 May 2001)
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Zachary Whitewood-Moores, ITU Staff Nurse/MSc Student in Advanced Nursing Practice St.Bartholomew's Hospital/City University, London
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It is not too late for nurses to become anaesthetists in the UK. I believe the time is just approaching when nurses could undertake this role in a safe and effective manner. The grounding of intensive care experience and training (ENB100) would be essential, which provides the nurse with training in the care and supervision of a ventilated patient (usually very sick ones!). Training in specialist and advanced practice is vital to ensure the nurse anaesthetist is educated to medical levels of anatomy, physiology, pharmacology and skills based practice. This education has only recently become available to nurses in the form of Advanced Nursing Practice courses (almost all at the level of a MSc). It is likely that a nurse would in fact be better prepared than their medical counterpart as no task could be undertaken by a nurse without adequate training under supervision, dictated by the Scope of Professional Practice (UKCC, 1992). The ITU nurse cares for patients on a 24-hour basis, usually with little direct medical supervision. They are familiar with acting in a proactive manner with the titration of drugs within established limits, and giving advanced life support when necessary. There is little difference between this and caring for a routine surgical patient after following appropriate training in intubation, cannulation and the like within an established protocol. Most medical and nursing staff would recognise that junior doctors in fact receive much of their day-to-day coaching from senior nursing staff. It seems incongruous that these same nurses be denied the opportunity to advance their careers in this way. The argument that these nurses are needed in the critical care areas from which they come is flawed, in that many leave the profession through frustration with the boundaries of their practice or with the poor financial reward for the level of responsibility they undertake. It is better to develop these practitioners within the health service, building on their experience rather than see them leave healthcare entirely! Both doctors and nurses need to recognise the training and experience other professional groups acquire, indeed undertaking common training in certain subjects would be beneficial to both groups. The foundations in Anatomy, Physiology, and Pharmacology are just examples of the many subjects that could be studied together. With this Nursing obviously would need to be a graduate level profession, with a 4-year course of basic study (but that is another issue!). |
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Hugh Matthews, Medical student/former Operating Dept Practitioner University College London
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Editor, The proposal that nurses and/or operating department practitioners (ODPs) be allowed to give anaesthetics has been around since before I trained as an ODP some years ago. Z Whitewood-Moore's response to this issue, while interesting, is not in my opinion either desirable or economically viable. For a qualified and experienced nurse to undertake both an ITU/critical care course and then another course to bring their knowledge of relevant medical science up to that of a doctor would take several years, during which the nurse would have to live. In the current climate of funding for higher education, who is likely to pay the bill? Nursing and ODP training still attracts a substantial grant; medicine on the other hand no longer does and now fees have to be paid. At the end of all this, few nurses/ODPs would be prepared to work for a third of basic pay during overtime, and they would still be restricted in the work they could do unsupervised. If a non-doctor is frustrated by their limited role in anaesthetics, and has the motivation and academic capabilities to undertake advanced studies, I suggest that they consider medical training. Most medical schools will take mature students with relevant experience, and after five years one then has the option of pursuing any number of careers with full autonomy - a better reward for those years of study and debt. I have never regretted taking this course. Nursing has come in for criticism in the Press recently, and that profession needs people who are committed to nursing, not frustrated doctors. Yours, Hugh Matthews. |
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Craig Lammas, STAFF NURSE - MEDICAL ASSESSMENT UNIT HOPE HOSPITAL (MANCHESTER)
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AMERICA SAW NURSE ANAESTHETISTS AS EARLY AS 1877 WITH THE FIRST NURSE ANAESTHESIA SCHOOL BECOMING ESTABLISHED IN 1909. AT THAT TIME NO POST- GRADUATE ANAESTHESIA COURSES WERE AVAILABLE FOR OUR MEDICAL COLLEAGUES THUS THEY ALSO ATTENDED THESE NURSING SCHOOLS. THE TRAINING THEN CONSISTED OF A 6 MONTH PROGRAMME COVERING ANATOMY AND PHYSIOLOGY, PHARMACOLOGY AND ADMINISTRATION OF ANAESTHETIC AGENTS. THE AMERICAN ASSOCIATION OF NURSE ANAESTHETISTS(AANA) WAS FORMED IN 1931. TODAY THEY SUGGEST THEIR MEMBERS ADMINISTER MORE THAN 65% OF THE ANAESTHETICS ADMINISTERED ANNUALLY AND ARE IN 33% OF ALL CASES THE SOLE PROVIDER OF ANAESTHESIA. TODAY THEIR ENTRY CRITERIA IS :- DEGREE NURSE WITH AT LEAST ONE YEAR OF ACUTE CARE NURSING IE INTENSIVE CARE, CORONARY CARE AND EMERGENCY/TRAUMA CARE. ANAESTHESIA PROGRAMS LAST 24 - 36MONTHS (MASTERS DEGREE LEVEL) |
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Nancy A Petersen, Anaesthetic Training Coordinator Central Middlesex Hospital- London
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I am an American trained nurse anaesthetist who has been in the UK for 4 years, working in the private sector as well as the NHS. I have had several Trusts voicing a want to have nurse anaesthetists, but, in the end, not the guts to follow through with the politics. Also, I have found the nursing leadership to be quite weak, to say the least. In fact, the NATN, of which I am a member, have refused to discuss the issue with me at all. They have also not returned my emails or phone calls. The other big problem in the UK, is the level of training for nurses in general. The basic level of training is not at all up to the standard for any nurse to follow that up with the anaesthetic training I had to go through, as in biology, anatomy and physiology, organic chemistry and last but not least pharmacology. Also, my pass rate for all my courses, both in nursing school and anaesthetic training was at least 75%, at present, in the UK, it is 40%. Plus, I had to go through hundreds of negatively marked quizes and exams and then Boards at the end of my nurse and anaesthetic training. The UK, dropped their national exam for nurses 8 years ago. So, both from political and educational standpoints the UK is not even close to accepting nurse anaesthetists, ALTHOUGH, they are badly needed, both from a patient care and to help the nursing profession standpoint. Sincerely Nancy A Petersen BSN, CRNA |
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Ian Nesbitt, SpR anaesthesia newcastle
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Why are nurse anaesthetists badly needed from a patient point of view and to help the nursing profession? The UK does have few anaesthetists per capita compared to the rest of Europe, but it is rarely the lack of anaesthetic staff that keeps waiting lists so long or cancels operations. Employing nurse anaesthetists to compensate for a lack of medical anaesthetists will not solve the problem: Shortages of trained ICU nurses and physical bedspace both in ICU and on the wards are more common reasons to cancel procedures. Maybe we need more nurses, not nurse anaesthetists. |
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