Nurse Led Practice and Independent Nurse Practioners allowed to diagnose, prescribe and treat patients in NHS hospitals have mushroomed in UK since the Government decided to modernize NHS. I have worked in such surgery and am now publishing this to draw the attention of authorities and leaders of medical profession to help me with my ethical dilemma.As a doctor, I initially thought this was a good idea and was keen to participate but now find it is ethically uncomfortable to support this shift of care to nurses. Nurses are not medically trained and lack in-depth knowledge of anatomy, physiology, biochemistry, microbiology and pathology. Lacking this knowledge is likely to affect diagnosis, clinical management and treatment
A nurse is a health professional who is centered on protecting the families, communities, individuals to make sure that they maintain, attain and recover optimal functioning and health.
Since nurse have been allowed to practical procedures, prescribe and treat patients they are getting over confident and started behaving as if they know how to manage most illness. We as doctors know this is a very dangerous situation because our basic duty as a doctor is to identify a medical condition, which is safe to manage and refer the ones we cannot to hospital care. It takes years before we can master the art and feel confident. I found out the nurses are not trained as doctors, they have meticulously followed protocols and policies, but this is not safe practice. Most nurses learn from seeing what other doctors do and are keen to remind us about the protocol and policies but fail to understand that it is the doctor who has the responsibility for the care of patients.
I have seen simple problems like scabies, fungal infections and asthma with bacterial infection treated wrongly with steroid, asthma cough that was responding to bronchodilator treated with cough suppressants, mouth ulcers in immuno-suppressed patient treated with Bonjela and skin rash due to staphylococcus treated with penicillin.
It is important we realize disease presentations, drug therapy and management have been changing rapidly in the last ten years. Advent of antibiotic resistant bacterial infections is now threatening our profession. Allowing nurses to prescribe antibiotics is not safe because the data and protocol they follow are based on existence of antibiotic sensitive bacterial infections. Inadevet use of antibiotics is said to increase bacteria developing resistant strains.
As doctors, how could we have allowed this to happen in the NHS? If it is our duty to let GMC know when a doctor is unsafe, what are we supposed to do if the problem happens to be a nurse?
I am now officially questioning the role of NHS Independent Nurse Practitioners role, Nurse Prescribers and Specialist Nurses managing in-patients in our NHS.
“OUR DUTY”
If we, the doctors cannot defend our patients and our profession, what is this all about "Safe Doctors" and "The right to treat"? If health authorities think NICE Guidelines is the Bible for doctors and BNF dictates my treatment then why should we encourage and train our youngsters to become doctors? People can read these guidelines and the pharmacist can dispense medication to patients. This could save considerable amount of taxpayer’s money to NHS.
GMC impose strict criteria to prevent non-European doctor from working in UK. They are expected to pass examination organised by The Professional & Linguistic Board to prove they are "Safe Doctors" before being allowed to work as doctors in UK. How is that the nurses who do not understand the difference between Penicillin, Amoxicillin & Flucloxacillin and think doctors must strictly follow BNF to prescribe medication and feel using nasogastric tube to drain distended bladder as un-ethical are allowed to prescribe medication and offer treatment.
Nurses who cannot make out the difference between budesonide and inhaled steroid in the management of upper airway obstruction and the role of hydrocortisone and prednisolone in the management of combined immune deficiency to instigate a complaint against a doctor. These nurses have not been properly assessed and have not received any medical training yet they are treated as independent medical practitioners. This I find it ethically uncomfortable because, patients who have suffered from trivial problem or complaints, which could have been managed better, are made to suffer.
I feel the GMC, BMA and DH have ignoring "Medical Ethics" and so doing more harm to medical profession. Various publications, guidelines and rules have been drafted by PCT which are not in the interest of patients who seek help from doctors but only to protect the institution which thrives on a the so called "Noble Profession".
The very people who claim to manage and modernise have ripped the profession relationship, which is more important than the personal for a sick patient, apart. Our trusted patients who believe in us are made to suffer because the organization has nailed our (doctors) hands to the coffin.
I have seen simple problems like scabies, fungal infections and asthma with bacterial infection treated wrongly with steroid, asthma cough that was responding to bronchodilator treated with cough suppressants, mouth ulcers in immuno-suppressed patient treated with Bonjela and skin rash due to staphylococcus treated with penicillin.
It is important we realize disease presentations, drug therapy and management have been changing rapidly in the last ten years. Advent of antibiotic resistant bacterial infections is now threatening our profession. Allowing nurses to prescribe antibiotics is not safe because the data and protocol they follow are based on existence of antibiotic sensitive bacterial infections. Inadevet use of antibiotics is said to increase bacteria developing resistant strains.
As doctors, how could we have allowed this to happen in the NHS? If it is our duty to let GMC know when a doctor is unsafe, what are we supposed to do if the problem happens to be a nurse?
I am now officially questioning the role of NHS Independent Nurse Practitioners role, Nurse Prescribers and Specialist Nurses managing in-patients in our NHS.
“OUR DUTY”
If we, the doctors cannot defend our patients and our profession, what is this all about "Safe Doctors" and "The right to treat"? If health authorities think NICE Guidelines is the Bible for doctors and BNF dictates my treatment then why should we encourage and train our youngsters to become doctors? People can read these guidelines and the pharmacist can dispense medication to patients. This could save considerable amount of taxpayer’s money to NHS.GMC impose strict criteria to prevent non-European doctor from working in UK. They are expected to pass examination organised by The Professional & Linguistic Board to prove they are "Safe Doctors" before being allowed to work as doctors in UK. How is that the nurses who do not understand the difference between Penicillin, Amoxicillin & Flucloxacillin and think doctors must strictly follow BNF to prescribe medication and feel using nasogastric tube to drain distended bladder as un-ethical are allowed to prescribe medication and offer treatment.
Nurses who cannot make out the difference between budesonide and inhaled steroid in the management of upper airway obstruction and the role of hydrocortisone and prednisolone in the management of combined immune deficiency to instigate a complaint against a doctor. These nurses have not been properly assessed and have not received any medical training yet they are treated as independent medical practitioners. This I find it ethically uncomfortable because, patients who have suffered from trivial problem or complaints, which could have been managed better, are made to suffer.
I feel the GMC, BMA and DH have ignoring "Medical Ethics" and so doing more harm to medical profession. Various publications, guidelines and rules have been drafted by PCT which are not in the interest of patients who seek help from doctors but only to protect the institution which thrives on a the so called "Noble Profession".
The very people who claim to manage and modernise have ripped the profession relationship, which is more important than the personal for a sick patient, apart. Our trusted patients who believe in us are made to suffer because the organization has nailed our (doctors) hands to the coffin.
“MODERNISING HEALTH CARE”
In the name of modernising medicine, our Government and NHS have destroyed our profession made us loose control and encouraged bacteria, virus and fungal infection spreading in our community. CDC & Doctors in UK are criticising government in developing countries to impose strict guidelines on antibiotic prescription to help control antibiotic resistant bacterial spreading in our community but NHS feels nurses could be allowed to prescribe. Alexander Fleming did warn us to guard penicillin because he did find that bacteria were rapidly becoming resistant to treatment.
I have spent half my lifetime working as a doctor, always believed in the NHS and been proud to be part of this organisation. I feel healthcare must be free of cost to all and must be a service offered by people who are dedicated and thrive on gratitude. It is sad to see how medical profession has been highjacked by politicians and greedy businessperson and has been commercialised to generate profit.
Since our Government has taken-up the task of modernizing NHS, I think the problem of providing good free healthcare has escalated to catastrophic proportion. NHS has vigorously shifted the care of patients to nurses and ignored doctor’s advice. I only heard sad stories from friends and patients who have seeked help from NHS. Most find it hard to get an appointment to seek advice from doctors or consult specialist in the hospital. Due to the delay, some patients have been managed badly in hospitals. Our hospitals are riddled with infections that are killing thousands but the advisers (Specialist Infection Control Nurses) have not helped to reduce this threat.
I think the NHS has breeched basic human right by denying and preventing the rights of patients to access healthcare.
I have spent half my lifetime working as a doctor, always believed in the NHS and been proud to be part of this organisation. I feel healthcare must be free of cost to all and must be a service offered by people who are dedicated and thrive on gratitude. It is sad to see how medical profession has been highjacked by politicians and greedy businessperson and has been commercialised to generate profit.
Since our Government has taken-up the task of modernizing NHS, I think the problem of providing good free healthcare has escalated to catastrophic proportion. NHS has vigorously shifted the care of patients to nurses and ignored doctor’s advice. I only heard sad stories from friends and patients who have seeked help from NHS. Most find it hard to get an appointment to seek advice from doctors or consult specialist in the hospital. Due to the delay, some patients have been managed badly in hospitals. Our hospitals are riddled with infections that are killing thousands but the advisers (Specialist Infection Control Nurses) have not helped to reduce this threat.
I think the NHS has breeched basic human right by denying and preventing the rights of patients to access healthcare.
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