One of the objections raised in the arguments against advanced nursing roles (nurse specialists, nurse practitioners, consultant nurses) is the claim that these are NHS-only roles. The argument tends to go along the lines of “stick with the NHS and you’ll see a nurse specialist; go private and you’ll see a doctor.” Dr Crippen has made use of this argument.
Dr Crippen has again makes this point (or at least strongly implies it) since then, in his reactions to the new NICE guidelines on feverish children.
Atavistic: relating to or displaying the kind of behaviour that seems to be a product of impulses long since suppressed by society’s rules
Health Care Professional: I am sorry, there is no doctor available.
HCP: Have you Considered Private healthcare?
So, nurse specialists for the NHS, doctors for the private sector. It’s great rhetoric, but is it actually true? Let’s get the bourbon biscuits out and have a look at the claim.
As a bit of lazy research, I’ve picked up a copy of this week’s Nursing Standard and flicked to the jobs pages. So let’s see who’s recruiting nurse specialists and nurse practitioners.
Well…
Sweet Tree Home Care Services are looking for a “Client Liaison Nurse - Dementia and Mental Health Specialist”.
Trinity Hospice (a private hospice) want a Clinical Nurse Specialist in palliative care.
As indeed, do St Peter and St James, also a private hospice.
The Prostate Cancer Charity have vacancies for nurse specialists in, funnily enough, prostate cancer.
Chase and Inventive Solutions both want “nurse advisors” on enteral feeding and asthma, respectively. Argue among yourselves as to whether a nurse advisor constitutes a nurse specialist. They certainly seem to be asking for a similar level of experience and qualifications to a nurse specialist.
Also various GP practices (which function as independent small businesses) want nurse practitioners to come and work in their practice.
To read Dr Crippen’s blog, you’d get the impression that if you sign up to BUPA you’ll never see a nurse specialist or a nurse practitioner. As you can see from the above vacancies, that simply isn’t true.
There are arguments to be made for and against advanced nursing roles. My own feeling is that I’m not opposed to them so long as they are nursing roles, rather than cheap replacements for doctors. For that reason I’m more in faviour of nurse specialists and nurse consultants than I am of nurse practitioners since those two strike me as operating in a much more nursing (as opposed to doctor-substitute) capacity than nurse practitioners. Nevertheless, I’m happy to listen to the arguments against advanced nursing roles so long as they are evidenced-based and use facts, not rhetoric.
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23 Comments
Just a brief bit of explanation. I actually made this post a couple of weeks ago, but it was kept in draft mode until now. This is because around the time of the bourbon fight some anonymous troll decided to look up the domain name registration and use it to try to “out” our real identities. Hence we decided to stay nice and non-controversial until the registration of the domain name could be changed into the name of a helpful non-nurse.
As a result the list of job adverts doesn’t actually come from this week’s Nursing Standard, but one from a few weeks ago.
This week’s job adverts in the Nursing Standard include:
A “specialist nurse in palliative care” for St Catherine’s Hospice Limited, and also the same job title for Saint Francis Hospice, a registered charity.
A “specialist palliative care nurse (community)” for Marie Curie Cancer Care
A “renal training nurse specialist” for Baxter Healthcare
A “clinical haemofiltration specialist” for Edwards Lifesciences
A “clinical nurse specialist in cognitive behaviour therapy” for Care Principles
I was sure I had seen the post before! Also this isnt the first post this week asking Dr Crippen to explain himself, over on Random acts of reality they are not happy with the good doctor.
Hi Slurrey.
I take it you’re referring to this post?
Yup thats the one, but I notice Dr C hasn’t come out to defend himself yet, maybe he doesnt make house calls any more? leaves that to the district nurses?
There’s a couple of comments made by Reynolds which are worth repeating:
“The seeming belief that Dr. Crippen has is that the best nurse practitioner in the world is far worse than the most idiotic doctor. This is something that I do not agree with.”
and
“when he isn’t being a arrogant twit he is being absolutely right.”
I’d agree with both of those comments above.
Reynolds has said what I wished to far better than I could.
Judging any group by selecting only their mistakes and errors is never going to be right. The comments I hear Consultant Psychiatrists make about GP’s have turned my hair white !
I always felt reading Dr Crippen was like reading the Private Eye. Everything needs to be taken with a pinch of salt.
NPs infiltrating the private sector eh -whatever next ‘psychiatric nurse practioners’ ?
Well in certain respects psych liaison nurses provide the proto-type for many of the attributes associated with NPs working in general practice.
PLNs have stacks of experiencec [as a general rule].
They provide continuity of knowledge and care - an indispensible commodity for patients with mental health issues attending A&E.
They can navigate the MH system efficiently [lots of lovely local knowledge].
They develop intuitve expertise in assessent during acute episodes.
In case you hadn’t gathered I’m pro-PLN [years of first hand experience of watching them work you see], and I would defy anybody to prove they don’t substantially improve the experience of staff and patients alike in A&E.
The semantics of how to label activities that blur traditional nurse/doctor boundaries is undoubtably a source of tension but as Zarathustra points out - it’s something that even the private sector seem to be cottoning onto.
I know two consultant nurses. Both are highly respected by their clinical colleagues for their intelligence, clinical expertise and dynamism, and both have a track record of published research. They’re also both very respected for their teaching abilities by the student nurses.
One of them sits on the clinical ethics committee of our local NHS trust. He recently told me that the CEC refuses to refer to him as a “consultant nurse” in any of their literature. Whenever a list of committee members is produced, he’s always listed under some job title other than consultant nurse.
We have a response.
http://nhsblogdoc.blogspot.com.....07-25.html
Hmmm, if one can actually call that a response:
“Mental Nurse still does not understandthat private patients are referred to and seen by consultants and that NHS patients take pot luck. Look at the Lean Health video at the top.”
That’s it. No counter-evidence offered, other than suggesting we watch a news snippet on YouTube (the claims of which Dr Crippen hasn’t even attempted to refute in any kind of meaningful way). No real attempt to even address the point made. Weak.
He is a very busy Doctor. All his blog writing gives him very little time
Did you like the link Z ?
I did indeed like the link. Cthulhu ftagn!
Also, loved the playground insults about how I should look at the video of a “man with a beard and funny teeth”.
Or, as he might also be described, the Professor of Emergency Medicine at the University of Warwick.
Just been looking in the back of the BNF about nurse prescribing. I find that ‘Nurse Independent Prescribers are able to prescribe any licenced medicine for any medical condition, including some controlled drugs’ It goes on to list some of the controlled drugs, including diamorphine, fentanyl, morphine, buprenmorphine, etc, and gives the situations where they are indicated for NIP prescription, mainly in palliative care but sometimes in postoperative care or acute pain control. Must be a bit scary to be a doctor watching one’s role being eroded, although I must confess I’ve never seen a GP doings hands-on palliative care or known an A & E doctor go out in an ambulance to someone having an MI.
Yeah, I can see why doctors may see this as intruding on their role - just as RNs get upset at HCAs performing roles usually done by RNs.
Even so, the boundaries between nursing and medicine have been shifting long before Nude Labour came on the scene. Time was when if a patient needed his blood pressure checking, a junior doctor would be summoned to do it. Nowadays a HCA does it routinely by pressing a button. No doubt when nurses started picking up a sphygmomanometer the Dr Crippens of the time started muttering about “dumbing down” and nurses “not having the skills” for this task.
As for blood pressure checking, see also: venepuncture, cannulation, catheterisation, IV drug administration - all tasks that used to be done only by doctors and now done regularly by nurses.
I’d like to see the debate on advanced nursing roles being opened up a bit and becoming more refined. Rather than simply a blanket: “Nurse specialists and nurse practitioners: good or bad?” debate, I’d like to see people talk about the variety of roles and which ones are and aren’t appropriate to be performed by nurses. At the moment there’s no middle ground to the argument. Nobody seems to be saying, “I think nurse specialists do a good job at a-b-c, but I don’t think they should be doing d-e-f.”
Zarathustra - I worked with some brilliant HCAs when I was an RMN. Our then slightly macheavelian ward manager had the idea of advertising posts in the Guardian and it wasn’t too long before one or two psychology graduates joining us [pending a career break, of course] in addition to the eclectic mix of ecowarriors and the like.
But I’m not so sure the HCA/nurse - doctor/nurse comparison is so straightforward.
On average Quacks have 10yrs post-grad experience, on top of basic nursing registration, /- a BSc or BA.
Needless to say many of these nurses have ‘man managed’, and are professionally mandated to provide evidence of CPD, this usually entails, as a minimum, a specialty specific course [taken over 1 academic year at level 2/3 - in our case the ENB 199, or equivalent] plus a teaching/mentorship course [ENB 998 or similar].
On top of this, again using A&E as an example, most of the senior nurses have done ALS & ATLS /- APLS.
In our department the NPs must also complete additional training [A33 or equivalent] plus a further module, snappily entitled ‘Advanced Physical Assessment’.
While academic standards are obviously very important the crux of the NP role, as I see it, is to liberate nursing talent that only comes with many years of experience [although I'm not suggesting that experience alone is likely to be sufficient] - the PLNs are a case in point, relatively autonomous senior nurses who bring great benefits to patients attending A&E.
Personally, I’m not too keen on glass ceilings or artificial barriers [although I understand many nurses have acompletely different take on this issue] - as Woody Allen once said;
Not read this yet. Too early in the day for me:
Debate : Doctors for the rich, nurse specialists for the poor
At least we are normally excellent !
The way things are going elsewhere you may have to combine ‘the trials of Zarathustra’ with this thread : )
Oh dear. 51 comments already.
Oops, I did it again, as a great philosopher once wrote.
I think next time we change the tagline it should be to “normally excellent”.
I really have nothing to contribute on the subject of nurses specialists having very little contact with them. From discussion with other nurses though they seem to be well respected valuable members of the nursing community by and large.
But this comment I did take exception to:
It is as plain as the hair on my face what I am upset by. Beards. I do like men with beards. I also like women with beards. My mother, herself, is a very bearded woman ! So please can we just leave facial hair out of this discussion ?
Thank you.
I would just like to add that I support and agree with Z in almost everything he has posted on this subject. I am enjoying watching from the sidelines thoroughly.
Also, the “over-promoted nurse specialist in the video” doesn’t actually appear to be a nurse.
She is a Director of Learning or some such thing. Even if she has a nurse background that makes her pure management. Which is the language she speaks. Management not Nurse.
I liked the Professor in the first video. Even though he also spoke fluent manager.
The “bearded teletubby” in the second video seems to be (after a bit of googling) a sociologist. Which would explain why that video was a combination of sociology drivel and management drivel (though not nurse drivel).
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