Last year, in this column, I wrote suggesting that there wasn’t much a doctor does that a nurse couldn’t do just as well, training permitting.
I got a few bolshy letters suggesting that our “little angels” just weren’t up to the task. But my belief was reinforced when I met an independent nurse practitioner doing the most extraordinary things in the community.
For years, house officers bemoaned the fact that nurses refused to give paracetamol. Now nurses are running ‘hospital at home’ schemes and giving chemotherapy, IV antibiotics, ventilation and a whole host of complex treatments in the comfort of your own living room. Clearly, what’s held nurses back is the stifling hierarchy of the NHS and their own regulatory body rather than any lack of ability.
My independent nurse told how she taught a mother to put in cannulas, so she could administer gamma globulin to her three sons at home, rather than face the horror of carting them all off to hospital for the day. OK, so it’s not to every parent’s taste but it’s amazing how many of the tasks we previously cherished as ‘medical’ can be taught to the laity.
The discussion then moved onto this question: “If we were starting over again, would we invent doctors and nurses?” One experienced nurse talked about the frustration of wanting to retrain as a doctor, but having to go right back to the very bottom of the ladder, as if her 10 years on the wards counted for nothing.
The boundaries between professions are still absurdly strict and jealously guarded. For example, physios can’t hand out toilet seats (that’s the OT’s territory). For most of what the NHS does, we should use competence-based training, where we acquire skills ‘fit for purpose’, so we can do the job without having to join some elitist guild.
The dreaded European Working Time Directive, which means junior doctors won’t be allowed to work for more than 10 minutes without having a nap, will mean curtains for the NHS unless other staff are able to take on new tasks.
In the future, we’ll all be healthcare practitioners – one big happy family dividing up the profits equally. Or maybe not. Just as I’d convinced myself of the need for generic workers, a nurse asked me if there was anything a nurse did that a doctor couldn’t do.
“Top quality research,” I said, just to be amusingly ironic. Alas, she didn’t take the hint and produced the running order for an upcoming nursing conference. Three seminars being delivered include: ‘The tyranny of niceness’, ‘The role of gossip in the expression and management of emotion’ and ‘The transformation through humility in the experience of washing patients’ feet: An empirical study.’
And then the penny dropped. Doctors and nurses are fundamentally different species. You can give us the same tasks to do, but nurses will always tend to seek out emotions wherever they find them (even between a patient’s toes), whereas doctors will try their damnedest to leave the socks on and keep grief buried among the bunions.
It sounds like a rehash of the old ‘nurses care, doctors cure’ adage, but I’ve now spoken at enough doctor and nurse meetings to realise the difference. Nursing audiences are idealistic, enthusiastic and happy to be there. Doctors are generally cynical, grumpy and negative. In which case, we could all do with a bit of nurse in us.
I’m going to stop now before I’m lynched.