What’s so funny about peace, love and understanding?

Oh dear.

He’s angry. Very angry.

Now that I’ve stirred up the hornet’s nest again over at Dr Crippen’s, I think it’s now time to inject a little bit of peace and harmony. A bit of the dove and the olive branch. A bit of ebony and ivory, are side by side in the MDT meeting, oh Lord, why can’t we?

After all, we have a new Prime Minister, and his first act in office has been to boot out Patricia the Hutt, so it’s a time of good cheer.

So, on with the olive branches.

Take a look at some of the comments made in that particular thread. For example, there’s me:

For the record, I’d just like to state that I do not believe that nurse specialists are “just as good as doctors”. I think there’s a reason why doctors spend so long at medical school, and I don’t think nurses can or should attempt to compete with that level of expertise.

My own opinion of advanced nursing roles is I have no problem with them, provided that they are nursing roles, designed to complement a doctor rather than replace them. Basically, I’m in favour of nurse specialists as extra-skilled nurses, but not as under-skilled doctors.

Just to give an example, consider a clinical nurse specialist in, say, wound care, acting as a point of contact with regard to wound management. Wound care is an area that nurses deal with routinely - district nurses in particular tend to have a lot of expertise in wound care. One could argue that such a role is much more identifiably a nursing (rather than substitute-doctor) role than, say, a nurse practitioner diagnosing and treating minor illnesses.

Then there’s these words, by Garth Marenghi, who has been stridently in the “anti-nurse specialist/practitioner” camp.

I think there is definitely a role for nurse specialists when they are extended nursing roles.

However when these roles stray too far towards doctoring and not nursing roles then it spells big trouble.

A doctor’s role is not that easy to explicity define, and this slippery grey slope has been exploited by the dumbing down process.

Behind the rhetoric, these two positions really aren’t that far apart. Both have no objections to extended nursing roles, but neither wants to see nurses working outside their competency.

There is a middle ground to this argument that can and should be explored. If The A + E Charge Nurse’s repeated citings of research papers are to be believed, there are a lot of things that nurse specialists/practitioners can do well and safely. If that’s the case, they should be allowed to do those things.

But at the same time, it’s in nobody’s interests for nurses to operate outside of their competency, and we should resist political pressure for nurse practitioners to replace doctors where a doctor is what is needed.

Let’s not forget that the dividing line between medicine and nursing has always been fuzzy and shifting. Time was when a junior doctor would be summoned every time a patient needed his blood pressure checking. Now a HCA does that by pressing a button. Just as blood pressure monitoring has become part of the nursing role, so too have cannulation, catheterisation and IV drug administration. I doubt that anybody would want to have those tasks become solely the remit of doctors again. Otherwise, how would junior doctors find the time to do anything else?

So let’s explore the middle ground. Where possible our guiding beacon should be research data, properly collected and published in peer-reviewed journals. Allowing nurses to take on the extended roles that they can do well, but not in a cavalier, politically-driven fashion that could put patients at risk and discredit the nursing profession.

Isn’t that a better approach than simply screaming “quacktitioner”?