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Rapid Responses: Rapid Responses published:
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Everywhere has a 'Lucy'
- Simon Geddes (28 July 2006)
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One small correction
- Andrew Clegg (29 July 2006)
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Why don't left-wing nurses empty bedpans?
- Vaughan P Smith (29 July 2006)
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Nurse...the screens!
- Andy Wood (29 July 2006)
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It's not a black & white issue
- Paul M Flynn (30 July 2006)
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Front line staff have to support each other
- Rajkumar Rajendram (30 July 2006)
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Be serious, please...
- Kevin GH Bailey (31 July 2006)
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nurses may not be able to rise to the challenge of clinical problem solving
- oscar,m jolobe (31 July 2006)
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In It Together
- Des Spence (31 July 2006)
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The rights of angels…
- James Penston (31 July 2006)
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No Angels
- Nicola C Gordon (4 August 2006)
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An unnecessary turf war.
- FJ (Joe) Morrissey (4 August 2006)
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Nursing and Medicine: a dream team!
- ghislaine c young (4 August 2006)
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nothing new- but there should be
- Jeff Fernandez (6 August 2006)
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I Love Lucy .....
- Phillip J. Colquitt (6 August 2006)
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What do nurses do?
- Hugh Mann (23 February 2007)
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Simon Geddes, Advanced Practice Nurse Aramac Qld Australia. 4726
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I thoroughly agree with the points Ms Salvage makes in her article 'Nurses get a tongue lashing'. Every location must have to suffer a 'Lucy Chapman' or a 'Dr X'. Whilst Dr X manages to generalise about nurses from an entire nation, most sensible people are able to differentiate between individuals and to identify the Lucy Chapmans from the truly dedicated Medical Practitioners. Whilst Lucy compares the nurse with a flight attendant, she takes care not to highlight the fact that she is a very inexperienced 'pilot' with an uncertain airline. A point worth considering, surely. Whilst Lucy clearly regards assisting patients with their personal hygiene requirements as a mundane activity, it is through these interractions that much valuable information can be gleaned by the astute health professional, thus ensuring the provision of holistic care to the client. I'll conede the nursing profession has its own unfortunate personalities, but to criticise a whole profession because of this is a little like bagging the entire airline industry because of one 'pilot's' poor landing. The best approach, surely, would be for all members of the health team to work together to achieve the best possible outcome for the patient. Or is that just some 'angelic' ideal? Competing interests: None declared |
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Andrew Clegg, SHO Medicine Leeds
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Congratulations to the author for an article that is, on the whole, a rational and level headed response to a number of inflammatory, sensationalist pieces published in the British tabloid press. It is a shame that a single pseudonymous individual has managed to present some genuine and sincere concerns held by myself and my colleagues in such an idiotic (and at times racist) manner, and in doing so undermine and trivialise our standpoint on this issue. This has managed to metamorphose us into professionals who are 'Embattled and unsure of (our) role in the new order, (lashing out) at a soft target'. I assure you that this is not what we are and not what we are intending to do. I do not wish to provoke another round of playground fighting so will simply ask my nursing colleagues to try to look at the issue from our point of view and attempt to understand, not necessarily to agree with, our professional point of view. I feel I must point out one portion of the otherwise excellent article that is simply factually incorrect. I undertook five years of general and clinical pharmacology training whilst at medical school and studied for an intercalated degree in pharmacology. Unless I am entirely ignorant of the current ANP training course I find the statement 'that nurses earn the right to prescribe through special training of greater depth and length than medical students' studies of pharmacology' slightly derogatory. A touch unfortunate as it is the only real piece of provocative material in the article. Regards Competing interests: None declared |
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Vaughan P Smith, GP on sick-leave Taunton TA2 7SZ
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Jane Salvage is right – up to a point. It’s wrong and pointless to slag off an entire profession, and wicked to single out, for extra slagging, those of a particular ethnic origin. But … having spent quite a bit of time in hospital recently, I’ve been left, reluctantly, with a poor impression of some of the nurses who treated me. Ms Salvage’s article would have been more impressive if she’d acknowledged that there might sometimes be problems with nurses and nursing, rather than pleading infallibility. In other words, if you’re criticised, it’s always worth asking yourself if any of the criticisms might be justified. What finally spoiled the article was the reference to Conservative Central Office. Was that a joke? If so, nul points. If not, at the risk of being tedious, can I say that I’m fed up with the underlying assumption, found so often in the BMJ and elsewhere, that Conservative = wicked. Like thousands of other doctors and nurses – maybe the majority – I’m politically Conservative, and a humanitarian who wants the best for his patients. So, Ms Salvage, you insult my party, I’ll insult your profession. Why don’t left-wing nurses empty bedpans? Competing interests: None declared |
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Andy Wood, SHO Ophthalmology Glasgow
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It would appear that every place I have worked has had a “Lucy”, very probably because the faults she outlines are common in the NHS. No one would suggest they are universal, that they apply to all, but in my limited experience nurse “practitioners” (Can one have a Nurse who isn’t a Practitioner?) of “holistic medicine” tend to sit drinking tea, eating chocolates and being on a “break”. For those not in the know a break is a semi-mythical period of time in which no emergency is too great, or too urgent to allow the unwarranted impedance of said event. I cannot be the only one who admires the nursing staff who are an example to all, indeed they are usually in the majority. I cannot be the only one who shudders with dread when I hear the use of such terms as “holistic care” and “health team”. Usually these are combined with pointless terms such as “robust”, “pathway” or the appalling “bundle”. It is hardly language which will enlighten or advance any working relationship. Rather redundant verbosity which all too often purposefully deceptive in nature and a convenient substitute for professional care. I doubt very much if any nursing staff have “….earn(d) the right to prescribe through special training of greater depth and length than medical students' studies of pharmacology”. I believe the current plan extends to a mere 38 days. One would hope that both professions concentrate on their respective fields and get back to providing care, not hiding behind double talk and grandiloquent pronouncements of ability as a substitute. As an aside the labelling of Doctors with the title of Lancelot Spratt reflects badly, in the original Richard Gordon books Spratt was a much gentler figure than portrayed on film, indeed a sad figure who diagnosed his own stomach cancer and left St Swithan’s to die peacefully and alone at home. Despite this I doubt he would have had much time for “pretend Doctors”. Competing interests: None declared |
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Paul M Flynn, Consultant O&G Singleton Hospital, Swansea, SA4 3QJ
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Both the professions of medicine and nursing have a broad range of individuals in them ranging from absolute saints to the pathologically lazy. Happily most of both professions is still nearer the canonisation end of the spectrum and neither profession is enriched by slagging off the other over a few poor examples. I think Jane Salvage has displayed admirable restraint in her article and wish that the 2 pseudonymous doctors had done the same. Competing interests: None declared |
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Rajkumar Rajendram, specialist registrar general medicine & intensive care Departments of General Medicine & Intensive Care, John Radcliffe Hospital, Oxford, OX3 9DU
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Dear Editor, I would like to thank Ms Salvage for her response to those seeking to divide doctors and nurses at a time when both professions are under attack. I have sincere respect for my nursing colleagues which I developed as a medical student forced to participate in a few nursing shifts. I am extremely grateful to the charge nurse who took me under his wing. He explained that prescriptions are worthless until received by the patient and proceeded to demonstrate how to set up intravenous fluids, reconstitute powdered drugs and administer nebulisers. Sadly these skills are rarely in the repertoire of many junior doctors who can then only complain when their prescriptions have not been given to their patients. Caring for patients is a team sport. When I feel that patients require fluids or antibiotics, I am able to (and often do) administer them myself. When I get bogged down nursing staff often go out of their way to help me through. Over the years the boundaries between the roles and responsibilities of healthcare professionals has blurred. Whilst many doctors argue that the rise of nurse specialists has deprived them of training opportunities, I have found that senior nurses are often more willing to teach than senior doctors. Recently I was shown how to insert Hickman Lines by a vascular access nurse specialist. Doctors and nurses all have the same agenda and so we should try to put our patients and our health service before petty squabbles over who is responsible for what. Reference: 1. Salvage J. Nurses get a tongue lashing. BMJ 2006;333:265 Competing interests: None declared |
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Kevin GH Bailey, SHO in Ophthalmology Birmingham and Midlands Eye Centre, City Hospital, Dudley RD, Birmingham B18 7DY
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EDITOR-Jane Salvage’s article ‘Nurses get a tongue lashing’ (BMJ 29 July 2006) is patronising and fails to concede that Lucy Chapman has any point to make. Perhaps she should consider that what Lucy Chapman wants is not ‘a listening ear’ but a reversal of the current trend of doctor bashing from allied health professionals. I read with interest and astonishment Ms Salvage’s claim that ‘nurses earn the right to prescribe through special training of greater depth and length than medical students’. Is this really true? In order to secure a place at medical school, a candidate must get a good grade in A Level chemistry, in order that they have some understanding of the complexities of biochemistry. This scientific grounding underpins the undergraduate teaching of pharmacology in medical schools, which is augmented by the study of physiology and pathology. In my undergraduate career, pharmacology was taught and assessed continuously throughout the 5 year course and in final examinations. Is it possible that nurses who prescribe know more about the effects of prescribed medications than newly qualified medical graduates? I find the notion quite unbelievable. This issue is particularly relevant in light of the recently published views of the British Pharmacological Society who feel that junior doctors need more training in pharmacology and clinical pharmacology. If a junior doctor, with all the skills and knowledge that a medical degree brings, needs more training before being considered fit to prescribe, how can extending nurse prescribing powers possibly be justified. Surely it would be better for patient care if each profession concentrated on doing what they are trained to do, properly. Competing interests: None declared |
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oscar,m jolobe, retired geriatrician 1 The Lodge,842 Wilmslow Road, Didsbury,Manchester, M20 2RN
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Expert nurse clinicians are a creation of the medical profession, so we should not complain when we see them entrenched in clinical practice, espcially in view of the fact that their contribution has been instrumental in the attainment of the targets set by the European Working Time Directive. However, although many expert nurse clinicians are highly competent at protocol driven decision making, they do not have the necessary skills or experience to negotiate the bewildering maze of clinical problem solving options required to arrive at a clinical diagnosis, especially when this involves flitting back and forth between the principles of Occam's Razor and those of Saint's Triad(1). Therefore, we should be selective about which of our clinics they should run assisted, and, especially where diagnosis and clinical problem solving is concerned, we should beware of allowing them to cascade their experience to others. Likewise we should beware of giving them latitude to give clinical opinions on cases referred by one consultant to another References (1) Hilliard AA., Weinberger SE., Tierney LM., et al Occam's Razor versus Saint's Triad New England Journal of Medicine 2004:350:599-603 Competing interests: None declared |
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Des Spence, GP Glasgow G20 9DR
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I was bright at school and goodness I might even have been included on the ludicrous "talented and gifted" register if at school today - I found it easy to be good at those measurable aspects of intelligence. I am ,however, stupid. For it took me a long time to realize that it is those things that defy measurement that truly set people apart. Dear Nurses ignore the uni-dimensional ranting of the spotty faced medical intelligentsia. Remember that it is we doctors who have medicalised society and unleashed the mindless modern medical interventionism that marauds through our hospitals. The most difficult and powerful intervention of all - the power of doing nothing at all - long forgot. The NHS and Health care is defined by duty, commitment , humour, humility, listening, support – our humanity. These attributes abound as much in nursing as they do in medicine. Doctors who criticise the nursing profession are to be pitied rather than scorned for they are suffering from the academic delusional state that merely having 3 As at A level gives greater insight into this human condition – it does not - as they will discover in time and at some cost. Competing interests: None declared |
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James Penston, Consultant Physician/Gastroenterologist Scunthorpe General Hospital, Scunthorpe, North Lincolnshire DN15 7BH
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Sir, Had Jane Salvage [1] confined herself to defending her profession against the charges of incompetence and laziness, she would have found most doctors keen to distance themselves from such cheap and unwarranted accusations. But she couldn’t resist taking those few steps up into the pulpit and, in so doing, alienated many potential supporters. Preaching the gospel – according to which nurses have the right to just about any role that takes their fancy – Ms Salvage caused resentment among many in the medical profession. She used the example of nurse prescribing, exaggerating the educational content of the “special training” whilst failing to understand that there is much more to prescribing medication than a course in pharmacology dedicated to a handful of drugs. The decision to treat a patient is made in a clinical context and requires a detailed knowledge and understanding of medicine. It is likely that Ms Salvage and many who promote the expansion of roles for nurses know that the practice of medicine is far from easy. But the gospel demands denial: remember, nurses have the right to diagnose and treat without bothering with medical school. And so we have to listen incessantly to the lie that being a doctor is really not so difficult after all. References [1] Salvage J. Nurses get a tongue lashing. BMJ 2006;333;265. Competing interests: None declared |
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Nicola C Gordon, SHO, Medicine Royal Victoria Hospital, Belfast. BT12 6AB
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I read Dr Chapman's article with a hollow laugh of recognition. When I took it to work to show my colleagues they all responded in the same way: every single one of us could sympathise with Dr Chapman and we all had had similar experiences of treating very sick patients with very little nursing help. The overall patronising tone of the article should not detract from the frustration that undoubtedly lies behind it. Perhaps Dr Chapman chose to write to the press as she felt she would not be listened to if she raised her concerns with her seniors. I felt her article reflected much that is wrong with the NHS but it is unfair to attribute all the problems to nursing incompetence. Medical school is not adequate preparation for being a junior doctor and early days on the wards are frequently a terrifying combination of huge responsibility and little experience. Add in nurses who are demoralised due to poor pay and understaffing and who have been sent an agency auxillary instead of a staff nurse and the result is the situation Dr Chapman describes at the start of her article. Conditions for both doctors and nurses need to be improved to overcome the low morale that is rife in the NHS. Better pay and a more pleasant working environment for nursing staff would be a start. And for doctors a more practical approach to medical training so that the first day on the ward is not the first time a newly qualified doctor sees a sick patient. If the basics are looked after perhaps the team work and improved quality of care will follow. Competing interests: None declared |
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FJ (Joe) Morrissey, Senior Lecturer, School of Nursing SciencesJames Cook University, Townsville, Qld4811, Australia
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I am fascinated by the correspondence raised by Jane Salvage's article. Many of the responses are thoughtful, and reflect the deep sense of team work by nurses and doctors. However, some correspondents have fallen for the provocations of the original "journalists", who must be rubbing their hands in glee at the prospect of doctor bashing by some nurses and the inevitable patronising of nurses by some doctors. The reality I'm sure we all recognise is that in Britain and here in Australia nurses and doctors find themselves worn out trying to provide any kind of decent service in the current managerial climate. The result is a flight from the profession, with even more stress on those remaining. Although I'm now in Australia, I trained in Newcastle upon Tyne, and still keep in touch with UK colleagues. I am saddened to have read recently how low Stoke Mandeville's reputation has sunk as a result of misguided use of targets. If we (and I mean all of us involved, directly or indirectly in health services) want to make a difference, we need to avoid rising to the bait of opportunistic journalists. Rather, we should unite against the common enemy - management consultants and policy advisers who see health care only in business terms and wouldn't recognise a patient if one jumped out and bit them. Competing interests: None declared |
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ghislaine c young, nurse practitioner bd183ee
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Thanks to Jane Salvage for writing a thoughtful and measured article. She is absolutely correct, the time is ripe to set aside any thoughts of comeptition or animosity between our two professions and to engage in a positive and rational debate about how we can work in active cooperation. Each profession has members in it that would be better employed elsewhere! On the whole though, nurses and doctors do a great job in often adverse and stressed conditions. For patients to benefit the two professions need to value and learn from each other. Medicine and nursing are two sides of the same coin, and the sooner we realise that together we can achieve more for our patients than can be done singly, the better. One way to set aside our differences might be for joint learning. So why not have nursing and medical students sharing some of their core modules together? The future is bright for our two professions- but only if we admit that there is more in common between doctors and nurses than divides us. Competing interests: None declared |
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Jeff Fernandez, Alcohol and nursing research lead Islington PCT EC1V 7QL
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I read the article with some form of indifference. I agreed that some doctors are in some areas, very threatened by the idea of nurse prescribing, but nurses at high grades are very experienced and skilled. This extension of responsibilities will indeed make a doctor's life easier. That is the fact, which is oddly forgotten. Also, in many cases as a nurse myself, SHO's ( Senior House Officers) have looked to the experienced nurse in suggesting what to prescribe, what dose and when to review. This has never changed, it begs the question that a good doctor relies on his nursing staff. This is never admitted by the medical profession and needs to be. Like some of the responses, we all need to grow up a little and the world is changing and more demanding of healthcare. Boundaries will become more 'blurred' but patient care will be improved with more prescribers of good experience. Nurses will provide that. Doctors can respond to more complicated presentations as a result. Doctors need to develop their understanding that they as a profession, are not immune to a changing world. Move on please; and that applies to all of us. Competing interests: None declared |
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Phillip J. Colquitt, RN/Technician-Brisbane based Independent comment
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.....was a terrific TV show. Since junior doctors get paid less than I do(RN level 1), I propose what may well be a cost neutral randomised controlled trial in which all care is delivered by junior doctors, and nurses are eliminated from the ward. A neighbouring ward could act as a control. I’m not sure of the validity of Lucy as project coordinator. Competing interests: None declared |
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Hugh Mann, Physician Eagle Rock, MO 65641
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Nurses act as intermediaries between doctors and patients. Nurses assist doctors in patient care by administering medicine, educating patients, monitoring patient progress, and reporting problems. But nurses are much more than just a doctor's assistant. Nurses have a great deal of clinical experience, and sometimes nurses have more clinical experience than the doctor. A wise doctor knows that it is a good idea to ask for the nurse's opinion and recommendation. I learned this as a medical student, intern, and resident. In fact, some of the best teachers I ever had were nurses. And some of the best doctors I've ever met were nurses before they became doctors. I have a great deal of respect for the knowledge and experience that nurses acquire. It's too bad that so many nurses are underpaid and underappreciated. Competing interests: None declared |
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