Who is here to perform minor clinical procedures when nurses take on new roles?
I appreciate the idea of nurses taking on wider roles to enhance medicine.<1> I notice that other healthcare professionals, such as pharmacists and physician associates, are also trying to expand their scopes of practice.<2><3><4> Nevertheless, should we rather spend more effort to ensure all professions have the fundamental skills for their jobs?
As suggested in a BMA publication, doctors are more likely to perform a procedure than nurses.<5> In many NHS hospital wards, doctors cannot easily find other professionals to perform minor procedures, such as venepuncture, intravenous cannulation, and urinary catherization. This creates huge workload for on-call doctors, and distract them away from their intellectual input to patient care. My nursing colleagues in Canada are often shocked to hear doctors are required to perform these procedures in the UK.
My British medical colleagues have offered to teach other professionals on these procedures, but tend to receive lukewarm responses. Some of these professionals suddenly said they knew everything about the procedures and did not need us to teach them. Some learnt the procedures, but somehow forgot what they learnt as soon as the next group of junior doctors rotated to the placement.
As an analogy, it would be embarrassing if pharmacists said they could not do dispensary work, but would only take on wider roles in consultation. When I worked as a pharmacist in the past, my supervisor reminded me to take responsibility on drug-related issues in both the wards and dispensary. He added, “If another profession can do all your jobs, then you're just replaceable."
I am worried who would provide the essential services, such as minor procedures, to patients when everyone else wants to take on a bigger leadership role. Would “I don’t know how to do it” become a trump card to deny a task?
References:
1. Crisp N. Nursing—the wave of the future. BMJ. 2018;361:k2355.
2. Yeung EYH. Explaining the role of pharmacists in multidisciplinary care. Br J Gen Pract. 2017;67(663):447-448.
3. Yeung EYH. Pharmacists are not physician assistants. Br J Gen Pract. 2017;67(665):548-548.
4. Jackson B, Marshall M, Schofield S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract. 2017;67(664):e785-e791.
5. Are doctors more willing to 'have a go' than nurses? London, UK: British Medical Association; 2015 Mar 25; cited [2018 Jun 3]. Available from: https://www.bma.org.uk/connecting-doctors/b/the-secret-doctor/posts/are-....
Competing interests:
I have been paid for working as a pharmacist and medical doctor, but not writing this letter.
Rapid Response:
Who is here to perform minor clinical procedures when nurses take on new roles?
I appreciate the idea of nurses taking on wider roles to enhance medicine.<1> I notice that other healthcare professionals, such as pharmacists and physician associates, are also trying to expand their scopes of practice.<2><3><4> Nevertheless, should we rather spend more effort to ensure all professions have the fundamental skills for their jobs?
As suggested in a BMA publication, doctors are more likely to perform a procedure than nurses.<5> In many NHS hospital wards, doctors cannot easily find other professionals to perform minor procedures, such as venepuncture, intravenous cannulation, and urinary catherization. This creates huge workload for on-call doctors, and distract them away from their intellectual input to patient care. My nursing colleagues in Canada are often shocked to hear doctors are required to perform these procedures in the UK.
My British medical colleagues have offered to teach other professionals on these procedures, but tend to receive lukewarm responses. Some of these professionals suddenly said they knew everything about the procedures and did not need us to teach them. Some learnt the procedures, but somehow forgot what they learnt as soon as the next group of junior doctors rotated to the placement.
As an analogy, it would be embarrassing if pharmacists said they could not do dispensary work, but would only take on wider roles in consultation. When I worked as a pharmacist in the past, my supervisor reminded me to take responsibility on drug-related issues in both the wards and dispensary. He added, “If another profession can do all your jobs, then you're just replaceable."
I am worried who would provide the essential services, such as minor procedures, to patients when everyone else wants to take on a bigger leadership role. Would “I don’t know how to do it” become a trump card to deny a task?
References:
1. Crisp N. Nursing—the wave of the future. BMJ. 2018;361:k2355.
2. Yeung EYH. Explaining the role of pharmacists in multidisciplinary care. Br J Gen Pract. 2017;67(663):447-448.
3. Yeung EYH. Pharmacists are not physician assistants. Br J Gen Pract. 2017;67(665):548-548.
4. Jackson B, Marshall M, Schofield S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract. 2017;67(664):e785-e791.
5. Are doctors more willing to 'have a go' than nurses? London, UK: British Medical Association; 2015 Mar 25; cited [2018 Jun 3]. Available from: https://www.bma.org.uk/connecting-doctors/b/the-secret-doctor/posts/are-....
Competing interests: I have been paid for working as a pharmacist and medical doctor, but not writing this letter.