Extended Roles vs Expanded Roles

When I read your post, I don’t think that doctors would have a problem with extending your tasks. I, as a doctor, have no problem with extending tasks for nurses as long as they recognize that I have more general knowledge and it would be very pleasant if the would recognize me as the clinical lead. I believe that doctors have been trained to have a helicoptorview and that we need doctors in health care. You can’t split up all tasks, give them to specialists, and still believe you are delivering quality patient care. A lot of patients can be treated according to protocols, and a lot of protocols can be done by nurses, but what about people who won’t fit into a protocol. Who is detecting them, how are they treated? Or will we not treat them anymore because they are not important to reach the targets?

I think shades of grey is right. There are times when I know I need to see a GP or a specialist, and times when someone else can provide exactly the service I need. I’m not sure absolute rules can be given - all patients are individuals, and all situations are individual. I believe what is important is for all the professionals involved to recognise what service is needed and for the wishes of the individual seeking a service to be taken account of.

““Hence although I’m in favour of nurse specialist roles, they need to deployed alongside doctors as opposed to instead of.

Zarathustra, that’s precisely my view, also. Again, we find ourselves violently agreeing

“as long as they (nurses) recognize that I (Doctors) have more general knowledge and it would be very pleasant if the would recognize me as the clinical lead.”

No problem with that Doc.

Hi there,
first, to let you know, I’ve been reading this blog for a few months now and it’s great, very informative, and at times very funny.

Thought I’d add my 2p (or 2c for euro-land) here as a Service User (I prefer the term “patient” but never mind). As someone who, for unknown reasons, doesn’t have a “standard presentation”, it does worry me to think that I would be diagnosed by someone who hadn’t done all that training to “catch” the exceptions.

Basically, I’m bipolar, and although most of the time I am symptom-free and have a normal life, I have had 4 hospitalisations in the past 20 years, all for depression, with them being farther and farther between as time goes by (which is good).

Depressive episodes for me apparently look like mixed manic states to whatever SHO is trying to work out what the hell is wrong with me on admission (my not being at my most articulate or pleasant-tempered (groan) when dragged in by the ear to the hospital by nearest and dearest).

Every time, the initial diagnosis of the episode, and this time by a doctor, albeit a less experienced one, is incorrect, and the consultant has had to overturn it (as I have moved regularly due to work, it’s been a different PCT each time or a different region).

This saves me 2-3 weeks of feeling like poo each time while they work out, hmmm, she wasn’t manic after all. Not to mention those luuuuvrely anti-psychotics.

I’m not having a go at SHOs, just, they are still training, and there’s a reason they have a supervisor. The same would go for a nurse specialist - no problem with this as long as there are medics involved as well, as the same would go for them as for the SHO.

Once they’ve worked out what’s wrong with me and discussed meds (meds work a treat for me, I’m one of the lucky ones), to be honest, during a hospitalisation, I have little need to see a doctor at all, a nurse can spend the requisite 10 mins a week to review how the meds are doing, do the requisite blood tests etc. I’d have no problem with all of this being done by nurse specialists.

As long as the NHS bureaucracy doesn’t decide, hmmm, this way we don’t need to have consultants or registrars at all, let’s just get some nurse specialists and a few more SHOs and… I know of cases in the US in HMO-land where some people have access to a prescribing nurse only and not a psychiatrist at all, for financial reasons, and have to fight to see a medic at all with their insurance company if they think the nurse isn’t sufficiently experienced or knowledgeable, and “justify” why they think this is required. Which is what would worry me. It’s the last thing you want to be doing when you’re ill.

As you say, everyone working together, not replacing one another - as long as the bureaucrats don’t do the latter.

Well, the standard of debate seems to have improved immeasurably and that`s tribute to both nurses and nursing blogs which have consistently refused to join the medics in the gutter. Crippen`s pathetic jibes have just become tiresome and the Rant`s are nothing more than, a joke. No one will listen to your argument, however valid, if you express it in those terms. There`s another point that needs making too, Crippen`s developing a habit of rounding on new nursing blogs. Nurse Ratchet was just trying to find her feet in the blogsphere. She was crucified and has, sadly, not reappeared. I haven`t read Fat lazy male nurse but I hope he isn`t intimidated. As I`ve said on numerous occasions, I fundamentally agree with Crippen`s argument on this and many other issues but I won`t be lending him any active support. Medicine used to be a respected profession whose members were capable of demonstrating some humility. Now they don`t seem to be able to open their mouths without trumpeting their academic credentials and declaring what a loss they are to the City and the scientific community. When did self praise become the ultimate recommendation ?.

Coming form The Continent where I never spoke about my academic credentials, I feel that the atmosphere is different in the UK. I feel not respected as a doctor (by managment, no problem with my multidiscipinary team) and the only way to get some respect seems to be to show my whole portfolio with all my certificates including my 8 A-levels. At The Continent, you would never speak about your secondary school results when studying at university. You see, I have already started with boasting about my credentials. It is part of your society.

Credentials ain’t worth a toss.

I recall once enquiring about nursing in the USA. I was told (no idea if true or not) by the registering body Stateside that I needed my RN registration with proof of obstetrics and gynaecology.

“What the fnuk do I need Obsungynae for” I asked “I only want a job in psychiatry.”

Answer: “In case you get a mental patient who is pregnant”

To which: “Don’t you have midwives then?”

The times in which I have needed any ‘o+g’ skills in mental health is …hmm… nil. My scope is mental health. Why do I need to expand my role when someone else is already capable of doing it - and my mental patient has every right to access a proper trained midwife anyhow - not some midtitioiner nurse?

I wonder which bits of medicine training are actually pertinent to mental health nursing to advance the nursing clinical skills? Differnetial diagnosis would certainly help - and on the back of other threads - the specific ability to include/exclude organic disorder. Sure it’s what docs do already - but we’re running out of them apparently. Or at least - someone’s trying to save my tax-dollar by cutting health costs.

Other than the aforementioned, do our learned colleagues (cue the doc) uphold any other aspects of the medical training that supports their (purely) mental health skills?

[I reserve there is a huge benefit in having a generally trained medical practitioner involved who can track for all A&P issues - but this is usually due to shoddy or slack GP work and a pervasive indifference to those with mental health issues across most disciplines outside of mental health that seems to accept a sub-standard level of general care cos 'he's not the full shilling'].

I’ve replied to this but it became so lengthy and opinionated I felt it best to make it a post myself rather than derail this thread with my fanciful chatter!