Saturday, March 15, 2008

The Expanding Nurse

The baseline qualification for a Paediatric Oncology Nurse is course ENB 240: Care of Children with Cancer.

Which drugs do or don´t mix, drug safety issues, a specialist oncology nurse, more often than not, is more skilled than a doctor or a general nurse in finding that vein for an injection, to know that you don´t give an analgaesic to a febrile oncology patient, how to clean or draw blood from a Hickman Line and much much more.

On average 35.7 % of paediatric nurses working in units with child cancer patients are qualified at the ENB 240 level. I wish it was more.

Some of the nurses on the Borchardt Ward and Clinic at the Royal Manchester Children´s Hospital are trained or are being trained in the special skills of caring for children with cancer. I will assume the national average of 35.7 %. As most treatment for both in-patients and out-patients is on the day-shift, most of that 35.7 % is going to be on the day-shift. I wonder if the leading evening/night shift nurse is ENB 240 qualified.

Can´t we be told ? Can´t the hospital say we abide to such and such a standard which I can then look up ? Do I have to feel guilty at going to the PALS service ? How can I find out how many ENB 240 nurses exist on the Borchardt Ward ?

Drs Crippen and Rant have commented on and criticised many many times on the NHS use of Nurse Practitioners being allowed to make clinical decisions.

Fortunately, no nurse, ENB 240 qualified or not, on the Royal Manchester Childrenś Hospital cancer ward/clinic has ever made a clinical decision about our daughter. The paediatric cancer specialist nurse at the RMCH knows his/her limits and will call the doctor, even if it is the trainee night-time locum.

Drs Crippen and Rant - you should not be complaining at Nurse Practitioners, Nurse Specialists etc - we need more of them (35.7% is pathetic).

However, you are right to complain at the government´s policy to ¨expand¨ the nurse´s role into diagnosis and clinical work as a cheap alternative to using or training doctors

So give the specialist nurse practitioners a break, ok ?

Obviously, Nurse Practitioners, Specialist Nurses and all their variations are as much as part of the general population as GPs, consultants, patients, carers, nurses and are as susceptible to government/DoH/NHS spin as ¨John and Janet¨. Given ¨expanded¨ responsibility (clinical and diagnostic decision-making - a little bit of power ) it is, of course, in your job description against which you will be evaluated ...

The issue here is that the government is trying to hide its holes in clinical provision - in its budgetary concerns, its capital investments rather than day-to-day running costs, MTAS etc etc.

... rather than training nurses to be specialists within nursing and training doctors to be specialists within doctoring.

Perhaps the Royal College of Nursing should say something ... or perhaps they are as pathetic as the BMA.


Martyn said...

if you are talking aobut an inpatient unit the distinction between shifts is generally irrelevant as the majority of Nursing staff working in inpatient settings will be on some form of rotating shift pattern, the exceptions - the unit nurse manager and anyone with particualr 'family friendly' or occupational health reasons not to work a rotating shift pattern

Türkin said...

Good Job! :)