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A long-standing error in medicine is the practice of the use of the most inexperienced member of the doctor team in the most vulnerable and important situations when patients need expert decisions and management. At present the junior trainee sleeping in at the hospital has less experience and knowledge than the nursing team and is vulnerable with poor support when it is clear to the nurses that a more senior doctor is appropriate.
Should we not be enhancing the role of the senior nurses on the ward, to be in charge over night and make the decision to call the doctor team in the event of a deteriorating patient. This doctor called would be at specialist training level with reasonable experience to sort the problem or make the decision to call for senior help. The more junior of the team could come in with the specialist trainee and learn the ropes of such an emergency with appropriate support and be able to assist as required.
This change would require an enhanced role for the nursing team in that they would be in charge of the ward inviting medical or surgical help as required without the need for the most inexperienced member of the doctor team to be sleeping in at the Hospital. At present this young trainee has to spend valuable time assessing the patient with less knowledge and experience of the nursing team and so prolong the time before a doctor with the appropriate training is eventually called.
An important change would be the responsibility taken by the nurses on the ward once sufficient training was in place so that they would be considered more senior and more of an integral contributor to the team. This change would also give proper protection and training to the most inexperienced member of the doctor team and ensure a more rapid and appropriate decision and treatment for the patient deteriorating overnight.
Competing interests:
No competing interests
11 December 2018
James S Brown
Oral and Maxillofacial Surgeon / Honorary Professor
Aintree University Hospital / Liverpool University
Re: Ending the Doctor-Nurse game by enhancing the role of the Ward Nurse
A long-standing error in medicine is the practice of the use of the most inexperienced member of the doctor team in the most vulnerable and important situations when patients need expert decisions and management. At present the junior trainee sleeping in at the hospital has less experience and knowledge than the nursing team and is vulnerable with poor support when it is clear to the nurses that a more senior doctor is appropriate.
Should we not be enhancing the role of the senior nurses on the ward, to be in charge over night and make the decision to call the doctor team in the event of a deteriorating patient. This doctor called would be at specialist training level with reasonable experience to sort the problem or make the decision to call for senior help. The more junior of the team could come in with the specialist trainee and learn the ropes of such an emergency with appropriate support and be able to assist as required.
This change would require an enhanced role for the nursing team in that they would be in charge of the ward inviting medical or surgical help as required without the need for the most inexperienced member of the doctor team to be sleeping in at the Hospital. At present this young trainee has to spend valuable time assessing the patient with less knowledge and experience of the nursing team and so prolong the time before a doctor with the appropriate training is eventually called.
An important change would be the responsibility taken by the nurses on the ward once sufficient training was in place so that they would be considered more senior and more of an integral contributor to the team. This change would also give proper protection and training to the most inexperienced member of the doctor team and ensure a more rapid and appropriate decision and treatment for the patient deteriorating overnight.
Competing interests: No competing interests