Good Idea or bad?
nurse practitioners to be trained up ... - Atrial Fibrillati...
nurse practitioners to be trained up for two years to do minor surgical procedures What do you think?
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Ianc2
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47 Replies
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BobDVolunteer
Since some nurses already do sterling work in arrhythmia services* I see no reason why not. OK I wouldn't want a hip replacement done by a nurse but a small skin blemmish removed (such as BCC) why not?
*When I was on the BHF committee running the arrhythmia nurse trials many EPs said they would rather have one than an extra registrar. They were trained to MA level by the way.
No problem with me if minor surgery.
I think the nurse practitioners at my surgery are better than the GP's to be honest. They tend to give you far more information about what's wrong with you.. When I had a painful skin spot on my leg a few years ago. I was told clearly when I saw the nurse on the Thursday that if I hadn't had a response from the dermatology dept by the following Tuesday, to let her know. She showed me photos on her PC of what it could be and took a photo of mine to send to the department. I was given an appointment for the next week and had it removed the following one. It turned out to be a squamous carcinoma.
Not too sure about them doing surgical procedures, but then why not if they've been trained. How about GP's being trained to do minor surgery (like they used to) and the nurse practitioners taking over more general appointments.
Hmm wonder what others on here will think about it?
Jean
Interesting idea Jean.
I've had two appts for different things with nurse practitioner at our surgery and I too found her more helpful than the GP s !
in reply to jeanjeannie50
Hiya Jean,
If you follow my posts on this you'll see my views clearly spelt out 
Lol !
John
I work at a surgery and have to say our nurse practitioner is fantastic very knowledgeable I would have no issues at all
For it, 👍- we have prescribing Nurse Practitioners in our surgery & Arrythmia Nurses prescribing so I think it a great idea - as long as they receive equivalent remuneration as a doctor would for a similar activity.
Nurse Practitioners are the nurse equivalent of Consultants, often have Masters & Doctorates in addition to their Nursing degree so I can see no reason to not approve & am really pleased to see career progression for nurses & a chance to attain equal status.
I'd rather have a definition or a number of definitions of minor surgical procedures. Minor routine or minor emergency? Gut reaction is no thanks. Surely it's not a question of only to what level their qualifications are, but, of the degree of hands on experience and under what supervision.
CDreamer in reply to
Well 2 years training would include training, experience & supervision. Any Scrub nurse will have witnessed many surgical procedures- a doctor in training will often be expected to perform a procedure under supervision having witnessed it a few times. What would be the difference?
I’m not following your concern?
baba in reply to
Where/ how do you think doctors get their experience and training.?
Many will have had the guidance of experienced nurses as well as more senior doctors, when they were first out of medical school.
in reply to baba
It would have been more useful for me, to have you and CDreamer ( for that matter) to have answered my question on my first line rather than take the approach you have !! In my 75 years on this planet I have had the good fortune not to spend very much of it in GP's surgeries or hospitals. Whether that changes in however much time I have left on this planet is something I cannot predict. Certainly my time in a GP surgery has never EVER involved any form of surgical procedure and even these days it probably amounts to one or three visits a year and one of them involves only the administrative procedure of filling in a form for a DVLA medical to renew my bus drivers licence - which so far I pass every year. All my hospital experience has been of a diagnostic nature on about 3 occasions and on one occasion knee replacement surgery and since that is major surgery it doesn't fall within the realm of the original post.
So, in the context of my first line you'll see why I asked the question ........ what a pity you didn't direct your reply to my question ......... and now I'm still no wiser as to what constitutes a minor surgical procedure or procedures. Had you have written a more helpful and constructive reply I might have revised my original gut reaction of no!
Don't bother answering my first line question now.
CDreamer in reply to
Certainly a grumpy and none useful reply.
How could we possibly answer your ‘1st Line’ when we wouldn’t know?
I was genuinely asking why you would be concerned to have a nurse rather than a doctor perform minor surgical procedure - in a genuine life threatening emergency I would be glad of anyone who was knowledgeable doing it anywhere - roadside if need be - if it would save my life.
I am always interested in the polarity view of any subject as it enhances my thought process. I’m still none the wiser as to your concerns but no matter. I have had at least 5 small procedures done in GP clinic. Lucky you have not needed anything & keep well.
Long may it last.
Im a retired RN and actually prefer to see a nurse practitioner. Im in the US and find nurse practitioners Ive seen are more thorough, take more time with the patient and do more teaching. They have to be good and prove themselves. Ive seen too many docs with burnout, apathetic or just overly confident.
One problem is that-so far as I know- there hasn’t been any research to determine whether this is a) as safe and b) as effective as having a doctor perform a procedure. Secondly, how is a “minor procedure” defined? Perhaps, over time, the procedures could become more “major” given the pressures on the health service. At the least, this should be trialled locally to see how things work out, before it is introduced nationally.
Buffafly in reply to
If the nurse has the same training for the procedure as a doctor I can't see the problem? Some years ago I had a spot removed from my back because it was itching constantly and woke me up at night - that was done by a GP. Nowadays you have to go to a hospital in another town to have suspicious lesions removed - considerable expense and inconvenience and day out of two people's lives because you need someone with you in case you have a bad reaction to the local. If a nurse had dealt with my husband's BCC in the first place it probably would have been investigated sooner as they tend to be more cautious - our GP reassured my husband it was 'only a scab' - now he needs plastic surgery to repair the wound 😞
And admit being sexist but a female nurse might have suspected he was lying/ didn't have a clue about how long it had been there - not a 'couple of months' but nine 🙄
in reply to Buffafly
I would argue that whilst a nurse might have the same ‘mechanical’ skills as a doctor, he or she might not be as astute at identifying any complications or unusual/important features during a procedure. I also think that once this door is opened one might find that increasingly more and more procedures become defined as ‘minor’ when they are not such. I do t think that convenience is the overriding consideration here.
baba in reply to
"I would argue that whilst a nurse might have the same ‘mechanical’ skills as a doctor, he or she might not be as astute at identifying any complications or unusual/important features during a procedure."
I would love to know how you arrived at this conclusion.
in reply to baba
“I would argue that whilst a nurse might have the same ‘mechanical’ skills as a doctor, he or she might not be as astute at identifying any complications or unusual/important features during a procedure."
‘I would love to know how you arrived at this conclusion’
Well, a doctor has a formal training in the treatment of disease through medication, medical procedures and, quite often, surgery. A nurse practitioner has a formal training in caring for the sick and knows how to diagnose, treat and manage common ailments. The greater knowledge and expertise of a doctor might prove essential if, for example, a minor surgical procedure uncovered a more serious condition, or if the carrying out of the minor procedure resulted in a serious complication. Furthermore, I have suggested that there might be a slippery slope here: if there are insufficient doctors (as there are in the UK at the moment) there may be pressure for nurses to carry out more and more complex procedures and ones which are not necessarily minor. I think it’s a dangerous road to go down.
baba in reply to
You are assuming that the doctor has "greater knowledge and expertise".
in reply to baba
It is highly likely-indeed almost certain-that a doctor has greater expertise on account of the the type of training he/she receives. As noted above, doctors, unlike nurses, are trained in treating all kinds of medical conditions with medicines and in medical procedures. It’s unlikely that a nurse would have this sort of knowledge because this would not be part of a nurse’s training.
Buffafly in reply to
My GP uses Google when in doubt - I guess a nurse could manage that 😁 The nurse who supervises my asthma care consults a GP if in doubt. If a nurse was trained to perform a specific task she would surely be trained on complications etc and not be working without backup. It would be safer than in a private hospital where if things go pearshaped you have to be moved to the nearest NHS hospital!
Why not, provided that there is a stringent examination process to ensure adequate skill of hand. There are the capable and not so capable in all walks of life.
In this area it is CCU sisters that perform cardioversions and other specialist nurses do endoscopies and biopsies. In the Breast Cancer Centre they advise on concerns and complications, aspirate fluid and liaise.
My feeling is that the above procedures if performed incorrectly would be more life changing than removing moles etc.
The great thing about specialist nurses in hospital and community is that unlike GPs they have a specific area of expertise on which they can concentrate and develop their skills. This in some way makes them more knowledgeable in their specific area.
I do however feel that nurses should not lose sight of their skills in nursing care, I refuse to call it basic nursing and my concern is when these parts of the nurses role are moved to non nursing assistants. I think particularly important are, adequate nutrition and hydration and the observation of the patient as a whole person, picking up on early signs of things being wrong.
Not a problem for me. Nurses (and paramedics) do far more hands on work than GPs and Drs on a day to day basis anyway so their experience in some procedures and through observation is greater than the Drs. Like Bob maybe not a hip replacement but blemishes, cysts, stitches etc is fine by me. In an emergency then I would be grateful for anything when I think of the alternative and would take my chances. x
Hmmm, tricky one. Is it trying to get doctors on the cheap like the Government have done with HLTA's in education?
But then again as my EP said , his lead Rhythm Nurse knew as much about AF as he did.
My ex sister-in-law was a specialist respiratory nurse, had two degrees in nursing, became a high level research nurse until the funding ran out. Then left Nursing because of the pressures of working in that environment , working 16 hour shifts because someone hadn't turned up and they needed cover on the HDU, more paperwork than nursing etc etc .
What a waste of all that knowledge and investment 
GP's used to do simple surgery too, like vasectomy's and steroid injections in to joints, stitch up cuts, wart removal etc etc etc. But that seems to be below them now.
CDreamer in reply to
I do wish the NHS would value their nurses and do a lot more to retain them. It’s a very tough job both physically, mentally and emotionally. I do wonder if we are going to see a merging of the roles and titles and enumeration and a lessening of the traditional hierarchy. I rather hope so.
Buffafly in reply to
The trend seems to be to specialise - when I had a hip problem I was first referred to a 'musculoskeletal specialist' who referred me to a physiotherapist and when that didn't help referred me to a 'specialist physiotherapist' who gave me a steroid injection! None of those were doctors.
Good idea, with the right training nurse practitioners are perfectly capable of many surgical procedures.
Minor procedures. Sounds good. Then we need to distinguish between where the procedure is done. Is it in the surgery of the local GP? The problem comes when something goes wrong. Are there other skillful people on hand? Is the necessary equipment available?
Removing skin problems using liquid nitrogen, yes, I would trust anyone who was doing this job day in day out, since the manual dexterity needed improves with practice. How I would love it if I could get if someone, not necessarily a doctor, could do an electrical cardioversion since if I need it, the rate of success is higher if they are done promptly. But, cardioversions use sedation, which has risks, and there are other risks which means I would want to be within reach of a skilled backup team.
I am a retired nurse with over thirty years of working in operating theatres doing scrub, anaesthetics and recovery.
In the article published it mentioned minor surgery, which some nurses do already (removing lumps and bumps from the skin) along with some more specialist nurses trained to harvest veins for cardiac surgery. What the article did mention was hernia procedures. This is where I get worried. A hernia operation is not a simple operation though thousands are carried out each year. I have seen hernia operations go ‘tits up’ with a few being real emergency’s (life threatening). The level of hands on training the doctors get now is nothing compared to how it was 10-15 years ago, meaning they are less experienced. A registrar in the past would do an open hernia in about thirty minutes and make a good job of it. Today it’s more like an hour and a half, well you can make your own assumption as to how competent they are. (I am talking broadly here, there are some excellent doctors around).
I think this is just another way of getting cheap labour out of nurses. I have no doubt some nurses would be very good, but one has to ask why not become a doctor in the first place?
One hospital I worked at has several band 7 nurse practitioner jobs going, but with no interest being shown. So for me I disagree with it.
in reply to Jes59
This is exactly the concern: under budgetary pressure the NHS could classify more and more surgical procedures, like your hernia example, as “minor” when they are nothing of the sort.
Jess59 sums up my feeling. I did work for 16 years in a op theatre complex all be it non clinical way yet one sees, hears and observe a lot!
Great idea. All the nurses I have had the pleasure of meeting would be more than capable ( and most probably) willing to take these new responsibilities on. Let's hope they raise salaries to reflect this!
I have attended Moorfields Eye Hospital where I received injections into my eye for central retinal vein occlusion. These are carried out by specialist nurses and my feeling is that, as they do this routinely, they are actually more skilled than a doctor who only does it less often. The same seem to apply for blood tests. In my experience there is less discomfort when blood is drawn by a specialist.
Not sure
It depends on the real reasons behind the suggestion.
Best case is that it will improve health care, waiting times and job satisfaction for nurses and doctors and open opportunities for new nursing jobs to be made available.
Worst case is that it is a cheap way to get more for less, overstretch an already overstretched profession and not provide any additional nursing jobs to fill the gaps.
It sounds to me like a great idea, until I think of the likely implementation, penny pinching and corner-cutting which will accompany it. A well planned and properly funded approach is needed - will we get that?
Great idea as they already have already undergone pretty good training.....
I see no reason why, once trained nurses won't do a brilliant job. Thing is when these nurses are taken off the wards and trained to do these things who is going to replace them. The NHS is short of all grades and finds it hard to recruit and keep nurses so don't know whether this will help the position.
why not?
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