Nurse Practitioners.

Discussion in 'PRHO and Foundation Years (FY1 and FY2)' started by Michael, Oct 15, 2008.

  1. Michael

    Michael New Member

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    The worlds gone mad. I don't agree with NPs at the best of time, everytime I go round the wards there seems to be bugger all 'nurses' and everyone is a practitioner of some sort nowaday. This has led to patient neglect, half the time the obs don't get done, the normal nurses are overstretched and these NPs who seem to regard themselves as Drs seem to float about not really doing anything.

    I guess this hit boiling point when I was covering some shifts as a locum, one of the NPs came up to me telling me a few things, firstly that she had won over 100k on the lottery. I asked her if she was going to take some time off work, she then said that there was no point as that was 2 years wages for her. 50k a year!! I was a bit stunned and asked her what her basic was: £20 p/h with time 1/3rd at nights and time 2/3rds on a Sunday. She asked me what I was on so I said £10 basic and £5 for 50% banding.

    So lemme get this straight, NPs who overall don't really do that much, are way less qual than a F1, can't prescribe anything decent, have no real responsibility (as the F1 always has to review any pts they see), can't interpret blood gases or suggest O2 changes etc etc. Get paid yearly nearly double an FY1 and more than an F2 for someone way less clinically qualified. I thought the point of NPs was freeing up F1s etc to get on with the job and a cheaper alternative but I can't possibly see how they can be true when they are a way more expensive option.
     
  2. Varied A

    Varied A New Member

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    What is the NP there to do? If you've got a urology NP, for example, they're not there to do your jobs, interpret gasses, adjust oxygen and so on, they're there to deal with urology issues (e.g. catheter problems). If you've got a cardiac rehab NP, they're there to look at patient education, lifestyle adjustment, home support and so on, similarly with diabetes nurse specialists. You would expect an outreach nurse to probably do some of the things you talk about, but ultimately they're there to support nursing staff and keep the patient alive while the doctors look at the underlying picture, to work alongside you and not to relieve you completely. You may not see them doing all the things you do, but most have skills and knowledge in their specific area way above your own.

    Also think about their other roles - they may do some hands on clinical work, but there's often much more to it. HAN nurses for example will often take some of the load for you in terms of routine cannulations, catheters and so on, but their main role is to co-ordinate the hospital, support the ward nursing staff, arrange admissions/transfers. In the grand scheme of things, doing your jobs doesn't rate particularly highly. They also probably have wider service management/development roles, teaching commitments etc.

    For that, I think a band 7 salary (which is about what you are describing - 30kish basic + unsocial hours/location supplements), is pretty reasonable. They're not less qualified than you, infact they're probably moreso, but in different things. Just because one doesn't have a medical degree doesn't mean that they can't be as good as or better than a doctor at doing the particular thing that they do.
     
  3. James

    James New Member

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    The key difference between the noctors (NP's, PA's etc) is the breath and depth of knowledge the doctor has. Yes, it is likely that the specialist nurse in urology knows more about prostate problems than the F1 on the ward. But if the patient with the prostate problem develops sepsis or heamatemsis - it is the F1 doctor who has the experience and knowledge to diagnose and treat the patient appropriately. Noctors are a tool, used in the correct manner, within there area of expertise they are better and more cost-efficient than a junior doctor. But only the doctor has the ability and knowledge to look at the 'whole picture' and manage complex patients who don't fit into the boxes.
     
  4. Gizmo says -

    Gizmo says - New Member

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    i'm pretty sure i cant fink of any doctor who can look at the ole picture, or any indvidual in fact. thats why there are several roles that mek up ateam of staff, to complement each other.

    although some NPs can be exasperating as doctors at times, i fink this fread is simply a classic case of a doctor (who may ave ad a bad experience of course wif a nasty NP or two) seeing imself as above the NP and the NP below imself, and not being able to cope since their 'job ranking' programming that they acquired in early life really doesnt work on the wards.
     
  5. nicnac-87

    nicnac-87 New Member

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    you know what, it's doctors like you who don't get very far in life, because you think your sooo much better than everyone else!!
    You need to learn to not only grow up but start working along with other health professionals and not against them!!!
    In the end, that nurse probs knows a hell of a lot more than you do right now, your only a FY1, the bottom of the ladder, shes a nurse practitioner, one of the highest nurse ranks. She has very likely been back to uni and got a masters degree or even a PHD... have you??
    I have worked with nurse specialists who practically do the consultant's jobs for them!!!
    If you have such a big problem with it, go train as a nurse, as you seem to think their job is so much easier than yours!!
     
  6. Gizmo says -

    Gizmo says - New Member

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    well i am not a doctor, macca.

    but i tek it onboard, sorri, sorri. :(
     
  7. thom5455

    thom5455 New Member

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    I share many of Michaels concerns about NPs and some of problems in the NHS at the moment.

    NPs are useful if their skills and services are used appropriately i.e. to complement, not to replace as part of a cost cutting excercise. I have grave concerns about them being used as diagnosticians, as this is something that requires breadth and depth of knowledge of medical training. It would be so easy to miss something without a good level of knowledge in general medicine and the main specialties - something only a medical degree and postgraduate training can provide.


    PS: Nicnac-87, are you aware its possible to make a point without resorting to personal attacks and over punctuating?
     
  8. Michael

    Michael New Member

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    There not there to do my job because they are not trained to do so, or else they would be a doctor, they don't interpret gases because put simply they can't. Gases require not just deciding whether it hypoxic, retention, acidotic, alkalotic but also reasoning out the pathology of disease and its physiological effects on the body, I asked a HAPNP about the cause of a patients hypoxia her sum knowledge was nil aside from saying whether the patient was on too much or little O2 or retaining too much or too little CO2. So there was me being paid hourly HALF of what she was but yet I could interpret the gas, order further ix, implement approp mx whereas she could not. If your going to perform a test, then you should know how to interpret it, fully.


    Keep the patient alive, insinuates that they can give the appropriate treatment to achieve this. Since they can't prescribe or initiate treatment beyond the very basics, I fail to see how this woud occur. If a patient suffers a NSTEMI do they give GTN, Asprin, Clopidogrel, Diamorphine etc. No they stick them on 100%, bung on an ECG, give the GTN (IF prescribed) and bleep the doctor.

    I'm not asking them to do my jobs, cannulas / bloods are done by the med assistants, catheters they bleep us for them or get the nurses in the ward to do that. Doing 'my' jobs' it appears does not rank highly at all. Plus at most NP cover what 2 floors whereas the HO/SHO on have to cover all 5. I also note how easily the NPs have there breaks, some even have a kip at night but yet myself and the SHO can go the entire shift without a break.

    Band 8a - 40k + incentives. Absolute crap to the more qualified comment, if that was the case they would be able to do my job, but they can't. As for not having a medical degree and being better than a doctor, don't make me laugh, if that was a serious comment then the arrogance of the NP to compare him/herself knowledge base to that or greater than that of a doctor is deeply worrying.
    Funny that I do more hours than the NP, more unsociable hours as well but yet where is my reasonable pay promotion to 40k + incentives?
     
  9. ben_

    ben_ New Member

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    Worrying about the hourly rate is ridiculous and obfuscates the issue. You are in your FIRST YEAR of your job. A nurse practitioner is at or near the top of their profession. A fairer comparison would be with an ST or consultant - and I think we all know who would come out on top.
     
  10. Dr Noodle

    Dr Noodle New Member

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    I was wondering that too. I mean how are their wages any of your business and why on earth would you care??

    Can't comment on their usefulness obviously though our CT nurse where I work in Dublin is invaluable.
     
  11. Michael

    Michael New Member

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    Because the premise of the NP is supposedly a cheaper option than a doctor. We have 3 on at night that's 3 band 8a, 3 x 50k a year. For that price you could employ 5 all prescribing, all interpreting, all managing HO's not 3 if we encounter a problem we bleep the HO NPs. The very reason for having them in the first place has been completely destroyed, cheaper no, more qualified, certainly not.

    Ben that reply is utter toss, comparing a NP to a ST or Consultant, lol. Yes i'm sure a 3 year diploma, mostly done on clinical placements with little or no actual medical theory, followed by a lifetime of washing patients, dispensing drugs, staring at and leaving on time, bitching about the lazy doctors, then topped up with a Masters in something vaguley medically related, that even us lowely FIRST year doctors can obtain as part of intercalating that is those of us not already with a masters or PHD, makes you == to a SpR or consultant with a 5 year medical degree, numerous research publications and writing and reviewing research constantly, numerous skill course, thousands of hours of operating time, doing on average double your contracted hours, hundreds of conferences, college exams and now revalidation, equates to the same thing. Oh wait no it doesn't.
     
  12. Dee41

    Dee41 New Member

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    I am astounded at your ignorance of other team members. Heaven help you if any of the nurses you work with are reading your posts. I personally hope they wring you out and hang you out to dry. You obviously have a very poor regard for the nursing profession. I honestly thought people like you died out with the dinosaur!!!
     
  13. Michael

    Michael New Member

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    Wring me out to dry? going a bit OTT. As for nurses given my sister, sister in law, brother in law, mother, mother-in law are all nurses at present and having worked as a NA for 7 years I think I have quite a balanced view of nursing. My wife was even a nurse and worked as a district nurse before doing medicine, what have I said that is so offensive? the diploma is 3 years isn't it or 4 if you do the BSc, it comprises mostly clinical placements? don't they do washes or dispense drugs? I don't have a poor regard for nurses at all, I just disagree with the introduction of NPs as the cheaper option than a F1, which of course had your read my reply instead of spitting your dummy and bashing out a reply about me being hung out to dry you would have read. As I already said my issue was around NPs, I'm fully supportive of nurses who as I already said and note daily are undersupported, understaffed, overstretched and do an amazing job, I think the problem exists is that the too posh to wash culture of the NP is getting worse.

    However I'm sure that when your eventually qualified in 2014 and banding has been removed and your on the basic 22k a year then you will be more than happy with the massive difference in pay and responsibility between our two professions. The problem you might have missed is that whilst banding is being hammered into the ground with no reason behind it other than EWTD (which you will breach every shift), that this decision to cut our banding has been taken in conjunction with the hospital director (a former nurse) and the management (former nurses) who themselves have a nice 9-5 and earn over £150 000 a year and actively protect NPs pay increases who incidentally don't have to take an enforced reduction in banding, in fact one was proposed and they had the option to reject it, whereas as the F1 you will find no rejection option exists. Of course dinosaurs like myself that disagree with such paycuts, when our colleagues are having year on year pay increases, should be extinct.
     
    #13 Michael, Oct 16, 2008
    Last edited: Oct 16, 2008
  14. Doc Skin

    Doc Skin New Member

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    I think nurses are an essential part of the team and I don't think that salary is too high, as long as they have the work exp, skills and commitment, then why shouldn't they be financially rewarded?

    To be promoted to a band 6 nurse you need to have lots of work exp and the degree, think it's really difficult to get that post with the diploma.

    They may not have the same knowledge as a FY1 but they have years more experience working with patients in a clinical environment and that can count for a lot. Spending 5 years behind medical textbooks means you gain the knowledge but you are still a junior as a FY1, a NP is at the top. Don't nurses start on a salary of around 18k? Well it is only fair that their wage progresses with their increased experience and responsibility.
     
  15. Doc Skin

    Doc Skin New Member

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    also it's not NP's fault that banding has been cut for FY1/FY2, so why have a go at them for it? It's not their fault that they have been employed instead of FY1 to save costs. Why not complain about the real culprits?
     
  16. Gizmo says -

    Gizmo says - New Member

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    shes going soft on you, actually.


    you worked as an NA full time, you mean? or during brief stints of your medical degree?

    please clarify.



    so lets get this clear too - is your gripe that NP emplyment is procuring a larger part of the budget than docs, or is it NOW that qualified experienced nurse practitioners wif years of washing under their belt are 'too posh to wash'?
     
  17. ben_

    ben_ New Member

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    Michael, I'm afraid that you have comprehensively misunderstood what I said. How embarrassing for you. As my earlier post suggested, a 'fairer comparison' in terms of pay - the original poster's gripe - would be with a doctor 'at or near the top of their profession' - i.e. an ST or consultant.

    This takes quite a bit of effort to misread as 'NPs have equivalent qualifications to an ST or consultant' but congratulations because you managed to do it.
     
  18. Gizmo says -

    Gizmo says - New Member

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    it doesnt if you've been monkey trained into believing that university pre-clinical 'years spent in the library' qualifications are what makes you best able to treat a patient....which is so short sighted its probably the cause of many deffs in our NHS.

    i am sure we all concede that NPs can be as exasperating doctors ofcourse.
     
  19. Muffin2

    Muffin2 New Member

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    Giz you do know that apart form oxford and cambridge most courses don't have their students in library's for the pre-clinical years. think i've spent a total of three hours in the library in three years. things have changes in the past, oh say 17 years ;-)

    sticking to the thread through. tbh i'd be pissed off at a nurse earning more than me. especially since one told me yesterday that my heamoglobin level of 12 was too low
     
    #19 Muffin2, Oct 16, 2008
    Last edited: Oct 16, 2008
  20. Gizmo says -

    Gizmo says - New Member

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    well rather obviously, Muff, the figure of speech 'in the library' means 'in your books, which i am sure as well as you know that you 'ave spent MORE than 3 'ours studying in.
    although i'm not suggesting that its largely unnecessary, if thats the next red 'erring you decide to chase.


    whilst all med skools ave more pre-clin experiences in their course, none of them years 'ave the clinical experience amount that comes even close to the very real experiences you gain after this...if they were on a number line then the pre-clinical years clin exp would be Marxist 'yper negative and the experiences a nurse or doctor learns on the ward are ultra-positive Tory.
     

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