UK health secretary wants to liberate nurses' talents
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7241.1025 (Published 15 April 2000) Cite this as: BMJ 2000;320:1025
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Two thirds of the way through a Government term of office, and the
rhetoric has already begun. Using words such as "liberate" to imply an
ongoing war between Doctors and Nurses, the Health Minister is trying to
suggest division and antagonism between professionals within the NHS.
While Doctors and nurses work tirelessly to help patients, often in mutual
appreciation, the government seeks cheap political gain with empty
speeches aimed at driving wedges between us. The skills, training, roles
and talents of nurses should not be confused with the real issues
surrounding the failure of the current Government to increase Doctor and
Nurse numbers, reduce waiting times and relieve bed shortages.
Competing interests: No competing interests
If the aim of this government and the Royal Colege of Nursing is that
nurses will soon undertake such a wide range of tasks as performing minor
surgery, running their own outpatient clinics, endoscopy, etc. Who will be
left on the ward to nurse patients?
Competing interests: No competing interests
In the Sunday Times this week (April 9th) Melanie Phillips voiced the
despair of many doctors with her perceptive article about "modernisation"
of the Health Service. Nurses exercising their new skills as prescribers
will inevitably spend less time caring for patients in the traditional,
and sorely missed fashion. Furthermore, the introduction of another source
of medications will add to confusion in patient care. Rather than saving
money, this will lead to increased NHS litigation costs from problems
caused by unforeseen drug interactions.
Let's not forget that what patients want is a highly qualified
specialist doctor supported by experienced, dedicated, caring nursing
staff who will attend to their needs. Money spent on "super nurses" whose
first interests are e-mailing, the Internet, and acting as doctors is
money diverted from essential patient care.
Yours faithfully,
Dr Richard Osborne
Consultant Cancer Physician
Dorset Cancer Centre,
Poole Hospital,
Longfleet Road,
Poole, Dorset. DT11 0NP
Competing interests: No competing interests
Effective teamwork between doctors and nurses does not need to
involve one group taking over the work of the other. The individual
members of the most effective teams have distinct roles and do not compete
to do the same, more desirable tasks. Not everyone working on an
aeroplane is involved in flying it, or even in helping to fly it. The bus
conductor and the driver co-ordinate their activities, but do not fight
over who tings the bell and who holds the steering wheel.
Why, then, is it that the only way anyone is able to perceive doctors
and nurses working more closely together is by nurses taking on the
traditional role of a doctor?
Anyone who has been in hospital knows that good nursing care and
individual attention are priceless and promote healing in its widest
sense. The thrust of much of the debate in this special BMJ, and
certainly the implication of what Mr Milburn is saying, is that
"traditional" nursing cannot in itself be a rewarding career. No wonder
recruitment is so difficult. I find ex-nurses in all sorts of
environments, and they mostly seem to be caring people who have left
reluctantly because they feel their basic nursing is undervalued, by
managers, by some doctors, but also by the nursing profession itself.
I am not an anti-nurse doctor. There is definitely a significant
role for specialist nurses in some clinical settings, and I would support
a fast track for able nurses into and through Medical School. Mr Milburn
has implied that nurses should not be seen as working for doctors. This
is an extension of the revolt from being seen as the doctor's hand maiden
that we are all familiar with.
However, our junior doctors are mostly working very long and very
hard. We are approaching a situation in some departments where a doctor
cannot ask a nurse to do anything. Some of the new style nurses are more
interested in listening to the patient's chest than sitting her up and
making sure she has something to vomit into. Sometimes blood gets taken,
sometimes not, and frequently nursing observations don't get done through
lack of staff or time. This is not doctors and nurses working as a team,
it is doctors and nurses unnecessarily and unproductively duplicating the
same work. We are told that this represents improved team working whilst
we see junior doctors, all of whom are temporary team members wherever
they work, treated as unwelcome intruders into someone else's territory.
I know of many junior doctors working on units where they are not even
provided with a stool to sit on, whilst other "team members" working far
fewer hours enjoy whole offices, sitting rooms and a free supply of
chocolates.
There are three things I hope will come out of this debate. Firstly,
as it is no longer the role of the nurse to work for the doctors, we need
to create another group of healthcare workers whose role this is. Maybe
this is a niche for (paid) medical students. Secondly we should value the
different roles of individuals in our healthcare teams, not compete for
the same role. Thirdly we all need to learn the true meaning of teamwork.
Competing interests: No competing interests
It is all well and good to say that these roles should be undertaken
by the nursing staff, but who is going to do the current jobs that nurses
are required to do? Do we simply employ more care assistants, as they are
cheaper than qualified staff and return to the two tier system in nursing
that the conversion of enrolled nurses was supposed to remove.
We all know that the Junior doctors are stretched, and that
reallocating some of these roles will undoubtedly ease their work load.
But what about the ward nurses where there can often only be 1 or 2
trained nurses caring for up to 40 patients at a time, will there be more
money made available to increase these shortfalls before dumping others
workloads on an already overburdened service?
Competing interests: No competing interests
I read the "things"that were listed as those that nurses need to do
after aquiring the needed "skills" . Those are in fact the skills that are
acquired at the Medical School. Therefore if this is a genuine call ( and
not only a political declaration ) it is realy a recommendation for
nurses to become medical doctors . This possibility is available anyhow
and I really cannot understand the reason for this call unless there is an
urgent need to use cheaper alternatives to doctors. Such a situation
exists in many underprivileged countries but I find it hard to believe the
UK is in such a situation
Competing interests: No competing interests
It's about time!
It's about time that nursing is recognized for the important role it
serves in the community. Nurses have repeatedly shown to improve hospital
and outpatient care throughout the world. They have much more training in
many of the skills necessary to take care of the entire patient including
communications, sociology, psychology, and physiology. It is only logical
that nurses are given the freedom to do many of the things they do now
indirectly, without the need to continually go to the physician for
"permission". Hats off to the UK!
Erich Widemark, RN, MSN, FNP
Phoenix, Arizona, USA
Competing interests: No competing interests