Let’s talk about a hot topic that has strong opinions in the medical/health blogosphere: nurse specialists.
The current array of advanced nursing roles – clinical nurse specialists, nurse practitioners, consultant nurses – are a frequent target of Dr Crippen aka NHS Blog Doctor. He accuses them of replacing doctors, of “dumbing down” healthcare, of taking nurses away from patient care, pretty much of being representative of just about everything that’s wrong with the NHS. His opinion matters, because he’s the most popular British medical blogger out there. His castigation of the “nurse quacktitioners” has been echoed by other blogging doctors, such as Shiny Happy Person and Dr Rant.
So, nurse specialists and nurse practitioners. They’re useless, they’re destroying the NHS and all doctors hate their guts. Right?
You don’t currently see all that many of these roles in psychiatry (though there seems to be an increasing amount of nurse therapists delivering CBT interventions) so I took advantage of a sojourn over to the world of “proper” medicine and nursing to find out more.
On the ward where I’m currently placed, we have a number of patients with a diagnosis of epilepsy. The local epilepsy unit was holding an open day, so I decided to ask if I could pop over to their open day and increase my epilepsy knowledge. The ward manager readily agreed, asking me to “grab any leaflets that they’re giving out, in case they’ll be any use for us on the ward.”
So, I head over to the epilepsy unit. I grab leaflets, I scrounge free tea and biscuits, I go “oooh” at the technological wonders of the EEG (what can I say? I’m a techno-geek, and you don’t get to see much fancy technology in psychiatry. An X-Box for the ward is about as hi-tech as we get). A consultant neurologist is giving a talk on the subject of “living with epilepsy”, so I decide to sit in on his talk.
During the talk, we see a video dramatisation of a consultation between a patient with epilepsy and the consultant neurologist. At one point in the video, the consultation tells the patient, “I can see you’ve got a lot of ongoing concerns, so I’m going to book you in for an appointment with the nurse specialist.” Aha! Nurse specialists! Useless amateurs, the lot of them! Though I can’t help noticing that in the video he doesn’t appear to be seething and gritting his teeth as he says it. Maybe he’s just not a very good actor.
During the question-and-answer session, I ask him, “I noticed that you referred the patient to a nurse specialist. Could you tell us more about how the workload is divided between the doctor and the nurse specialist? Who does what?”
“Well”, he replies, “The nurse specialists add value to our service by providing an extra level of continuity. They give advice and counsel the patients about their concerns to do with epilepsy. They answer phone and e-mail queries. Increasingly they prescribe – not in terms of starting people on new medications, but things like adjusting the doses up and down. When delegating tasks to a nurse specialist, I take account of their level of skills and experience. For example, we’re lucky in that we have a nurse specialist who’s worked here for 15 years. Obviously you just can’t buy 15 years of experience in epilepsy, and she’s very knowledgable on the subject. If she were to leave and be replaced by someone starting from scratch, then obviously that person wouldn’t have the same skills and I wouldn’t delegate the same tasks. The nurses don’t do things like diagnosing epilepsy or starting new treatments – I do that.”
Well, that actually sounds rather sensible, to be honest. It also provides a good repost to Dr Crippen’s argument that all the nurse specialists should be sent back to the wards to do bedside care, because that’s where their skills lie. I’m not trying to deny that good quality bedside nursing care is vital and is a skilled role, but if you have a nurse who has spent 15 years working and training in epilepsy, then it strikes me as nonsensical to suggest that she should get out of the epilepsy clinic and go pick up a bedpan.
After the talk, I’m scrounging more tea and biscuits, and I bump into the neurologist. He asks me if I’d had an appointment with a nurse specialist and that was why I was asking.
“No, I’m a student nurse,” I reply. “I was just curious as to what her role was.”
“Well,” he says, “We definitely need more nurse specialists, especially in primary care. Because continuity of care is currently lacking, and the nurse specialists provide that continuity.”
Then he wanders off to mingle some more, while I suddenly develop mental images of Dr Crippen, Dr Rant et al collectively developing an acute case of Exploding Spleen Syndrome at his words.
While we’re on the subject of nurse specialists, mind if I lay to bed a certain myth that I keep hearing repeated on medical blogs. Time and again, I come across people (usually doctors) commenting that “nurse specialists are cheapo doctors for the NHS. That’s why you don’t get them in the private sector.” Dr Crippen has repeated this myth.
Simply untrue. For the record, nurse specialists are not just found in the NHS. The private sector uses them too. This can be found out easily by simply picking up a copy of the Nursing Standard or Nursing Times and turning to the jobs section. If you can’t find a copy, just google the words “nurse specialist bupa” and see what you get.
The moral of the tale is this: blogs like Dr Crippen’s might be popular, but at the end of they day they’re still just one man’s opinion, and not necessarily an informed opinion at that.
Excellent piece Zarathustra.
However, after seeing John Sweeney’s work this week on Panorama I just hope Dr Crippen isn’t a scientologist or your NHS career may be over before it has begun! (I suggest you burn your hard drive and any incriminating documents you have about paganism)
I’m never sure whether I admire Crippen as a “Private Eye” type figure with his much needed criticism of the government’s mismanagement of the NHS… or whether he’s just another “Angry from Milton Keynes” who has nothing constructive to say and only sees the negative in everything.
However, he at least deserves a pat on the back for sustaining the long standing animosity between doctors and nurses and ensuring that divided we fa… oh… maybe I’ve got this wrong.
Zara, a very brave post considering Crippen seems to have a very large and faithful following.
However, I have to agree with you wholeheartedly. I’ve looked at his blog before but I don’t read it regularly (and therefore don’t link to it either) – personally I couldn’t see what all the fuss was about.
I saw a nurse practitioner just the other day. I often do, instead of troubling our over worked GP’s with something that is trivial but needs medical advice none the less. You’d think GP’s would be grateful of their support. Maybe he’s just past it and is worried he’ll be replaced soon?
I believe the term for Dr Crippen is “burntout”. I used to enjoy reading his blog and occassionally still do when he is talking about the day to day patients he sees, but it is mostly all political whinging these days.
Really good post there Zed. It’s nice to get a bit of balance in the blogosphere. I wonder if he will link to this in the BritMed Blogs. We may have a bunch of highly educated *coughpompous* medical doctorgods disagreeing! Or maybe not!
In all fairness to Dr Crippen, he does a good job highlighting a lot of medical and health issues…but oh dear sweet Cthulhu, he moans! He moans! What must it be like to live at his house? He must walk into the dining room, sit at the table, demand to know why his dinner was cooked by his wife instead of a cordon bleu chef, and then bang on for the next hour about New Labour.
Mr Man’s Wife, you mentioned your nurse practitioner at the GP. Since GP practices function as independent small businesses that’s another example to show that it’s a myth that nurse practitioners and nurse specialists are only found in the NHS. Presumably the doctors in the practice felt confident enough in the abilities of nurse practitioners to hire one. After all, it’s not as if Patricia Hewitt and the Royal College of Nursing stuck a gun to their heads.
I have to agree with the comments above. I think Dr Crippen is brilliant at highlighting issues but he is prone to massively generalising on issues. There is no doubt he is popular, and is of course entitled to his opinion. The success of his blog though means that the uninformed might take his view as the only view. It is for nursing bloggers like us to set the message straight on these matters.
I agree with azulinebloo on Crippen – the best posts are the ones where he talks about the patients he sees. Sometimes I read some of his other posts just to be masochistic – his unquestionably old fashioned attitude towards Nurses overall, and Midwives in particular, for me just perpetuates my sown stereotypical assumption of Dr’s as pompous bleeps.
i see you’ve earned yourself a sentence-by-sentence deconstruction of this post over on nhsblogdoc, zarathustra! congrats!
(i agree with you btw. personally i think his latest post just shows him up to be a pompous chauvinist who feels the need to try and undermine anyone who dares to disagree with him)
Blimey Zarathustra, You have risen up against the mighty Dr Crippen, well done! but over on NHS Blog doc, he has just done a sentace by sentance break down of your post, so it has certainly ruffled his feathers.
But I have noticed he hasnt been brave enough to ventre over here and say it for himself.
I do enjoy reading NHSBlogdoc, but I think may be crippen is living back in the dark ages and wont be happy untill all nurses are falling at doctors feet, making them cups of tea and washing bedpans.
Link to sentence by sentence deconstruction.
http://nhsblogdoc.blogspot.com.....rt-13.html
Oh bollocks, we`re going to have a blogwar whilst I`m rushed off my feet.
I can`t figure Crippen out ( and I`ve no idea how he manages to blog so prodigously ). I think he`s generally supportive of nurses, but there`s no doubt about it, his tone is calculated to irritate us. Even those of us who agree with much of what he says. His reaction to dissent is also rather worrying. Nurse Ratchet was destroyed for her ill advised comment when she was only finding her feet in the blogsphere.
Stand firm Z, the insufferably arrogant wing of medicdom will soon be lining up to have a pop at you. Fuck `em.
And note, she has been there for a mere 15 years but in that time has not learnt how to diagnose epilepsy.
She is not clever enough to do that. She has not been to medical school. She was probably not clever enough to do that either.
I don’t normally lower myself to using webspeak but…ROFLMAO!
Hi guys
First, however much of a following NHS BLOG DOCTOR may have, Mental Nurse is perfectly entitled to say whatever he likes; I do, so why shouldn’t he!
And the “following” NHS BLOG DOCTOR has, such as it is, is not composed of people who agree with everything I say. Far from it.
Yes, the NHS is dumbing down, and that does us all a disservice; it particularly does the patients a disservice. Note that I am critical of ALL dumbing down, and give GPsWIs a bad press too.
Why do we not just all do the jobs for which we trained?
Have a look at that ridiculous botty-wipe from Sue and Dave that I refer to in the article on NHS BLOG DOCTOR
Tell me honest, tell me true, is there a single one of you out there who can take it seriously? I tell you now, if any one of you DOES take it seriously, then he/she is doomed. And if a lot of you take it seriously, the NHS is doomed.
Crap like that is all over the NHS at the moment, and we need to stop it.
Finally, and it is worth repeating, freedom of speech and expression is the most important principle of all. If it was not, I would not have referred to Mental Nurse’s article in the BritMeds. I sure as hell don’t agree with it, but that does not mean it is necessarily wrong (though I think it is) and it most certainly does not mean that it is not worth reading.
John
By the way:
“I’m never sure whether I admire Crippen as a “Private Eye” type figure with his much needed criticism of the government’s mismanagement of the NHS… or whether he’s just another “Angry from Milton Keynes” who has nothing constructive to say and only sees the negative in everything.”
You can categorise me in any way you like, but kindly take the trouble to read some of the articles before you come out with tendentious crap about me “only seeing the negative in everything.”
Take a look at:
http://nhsblogdoc.blogspot.com.....agina.html
or
http://nhsblogdoc.blogspot.com.....rs_07.html
or
http://nhsblogdoc.blogspot.com.....or-it.html
and then, finally, the photo and caption in this article are dedicated to nurse-specialists the world over:
http://nhsblogdoc.blogspot.com.....odern.html
Hi Dr Crippen
Okay, I’ll reply to your request to look at the “Sue and Dave” website in this thread, since the original subject is currently being debated vigorously in the thread on your blog.
Reading through it, the page strikes me as being about some sort of rather wanky “team building” exercise. The kind of thing that conjures up images of middle-aged, middle-class office workers running around a forest playing paintball in order to try to gloss over the fact that they all loathe each other.
As someone who doesn’t really know much about the Hospital at Night programme and how it operates (its not something we see much of in psychiatric units) I found myself thinking that I’m still not much the wiser after reading that website.
I gather from the website that it involves Hospital Clinical Coordinators, and that these appear to be nurses who have or are working towards masters degrees, and that they seem to work alongside PRHOs. Other than that I’ve not much idea of how they operate, what their roles and responsibilities are, and so on. What I’d most like to know is the similarities and differences in roles between the HCCs and PRHOs.
So, in summary, yes it probably is “botty-wipe”, as you put it. But I’d want to do more than read that website before coming to any kind of opinion about Hospital At Night.
If I want to see someone about an embarrassing personal rash, I will go and see a doctor. If I wanted to discuss nurses and nursing, I would not.
Just my two pence worth.
Dr Crippen is obviously feeling threatened in the way he has thrown in pointless name calling in his retort.
It is the same old arguments.
This man doesn’t seem able to accept anothers point of view. Zed is perfectly capable and intelligent enough to “take on”, as it were, Dr C, although this was not the intention, he was merely sharing his thoughts and opinions.
This looks to me like Dr C is trying to push out another nurse blogger, this time the nurse is merely a student. Oh dear, next he will be comparing penis sizes along side educational credential.
I happen to know, Zed is better than that, thankfully.
In all fairness to Dr C, it wasn’t him that pushed out Nurse Ratchet. It was a gang of loudmouthed, braying hordes from DNUK who did that. Dr Crippen neither participated in nor condoned the Great Nurse Ratchet Lynching.
And if this debate comes down to comparing penis size, I’ll win this one comfortably. *slaps corroborating evidence onto the table*
My recollection is a little different. Crippen was initially gleeful in his taunting, nay bullying, of Nurse Ratchet. O.K, he did express some embarassment and he did dissociate himself when the pond-dwellers from DNUK piled in. However, I still feel he was instrumental in the wholly unnecessary evisceration of the poor woman and I haven`t forgiven him.
DNUK ?
Doctor`s Net UK. It`s a doctors internet playground. I don`t know what format it takes, you have to be a medic to register and gain access.
You’re obviously not clever enough to gain access OSB.
I wonder what they get up to in there? From the testosterone-laden old-boy chumminess of the DNUK lot, I’d imagine they spend their time going on about who “fagged” them in boarding school and carrying out the internet equivalent of flicking each other with wet towels.