Sunday, September 03, 2006

"We used to have a doctor, but now the Nurse IS the doctor!"

Occupational health is a lovely area to work in.

At least it used to be in the old days when nurses did their work and doctors did theirs. Somewhere along the way, the managers realised that OH nurses could do much more of the doctor's role than they had previously realised.

I remember one of my first jobs in 1996 in Bromborough. I was sent to do a days work performing lung function tests on employees exposed to flour dust. When I arrived, a lovely old GP (He was 76 years old) met me and had a bit of a moan that I hadn't got there a bit earlier so that I could make him a cup of tea before the patients arrived.

As the day progressed I did the lung function tests and sent the employees through to the doctor with the results. I wasn't allowed to interpret the results (God forbid that a nurse could do this!)

Ok...I know this is very old fashioned and that most of the employees did not need to see the doc with their lung function results. Around 90% of them were normal and I could have dealt with these perfectly well. However, the employees went back to work pleased as punch that they had seen a doc and the managers were happy that their money had been well spent.

Fast forward 10 years and we have gone from one extreme to the other. I did a shift in the Midlands a few weeks ago. When I arrived I was given a list of people on sickness absence to contact. I called them at home and spent a long time on the phone with each of them. Many had complex illnesses, the details of which I struggled with. I had to use the Internet to look some of the details up whilst I was on the phone to the employees so as not to sound as though I didn't have a clue, and to be able to advise whether the new drugs they had been prescribed would render them unable to drive and affect their ability to do their job.

By the end of the day, the managers wanted a report from me, detailing how long these people were going to be off, if they were likely to come under the DDA etc:

I found this difficult because in my other jobs, this is the doctors’ role, not mine. As a nurse I was never taught these disease processes in such depth as to be able to now estimate likely times of recovery. I am good at my job - I have a degree in OH nursing and eleven years full time experience, but I have always worked with a doctor. I asked the company if they had a doctor and they looked blank and said that they used to have a doctor, but "The nurse is now the doctor"

I am lucky in that I have worked with an excellent OH consultant during the past ten years and when I was writing my reports to the managers, I visualised what he would have said in the same situation. I managed to complete the reports and did a reasonably good job. The off shoot of this is that the penny pinching managers have won! They saved hundreds of pounds by using me rather than a doc and I was stupid enough to do the work that they wanted to a good enough standard for what they needed. I should have looked at them like they had two heads and said "Actually mate, this is the docs job"

I know that many of my OH colleagues would criticize my views on this, but I am appalled that we are now doing the doctor's jobs. If for one minute I thought that we were being given these new roles because they thought we were an amazing group of nurses I would perhaps put a sock in it, but lets be honest here - IT'S ALL ABOUT MONEY!!

I cost £25 per hour. The doc costs £150 per hour. Easy maths. I agree that we can do much of the OH role but I also know where my competency ends and when to look to a doctor for advice.

My big worry is that when I have qualified as a doctor, I might well want to come back to occupational health. By then though, there is a good chance that all the docs will have been replaced by nurses.

2 comments:

porthos_100 said...

I will look forward to your posts. I am a 31 year old physiotherapist, I am starting my second year in medicine in UCL this year, my story has many parallels with yours. I fully agree that as my experience has increased and physios start to do the triage in ortho and rheum clinics, they are working as registrars and have to appear grateful to be doing the job for 30K less than a registrar!!!

anna gregory said...

Hello
Thanks very much for your comment! It's a shame more of us HCWs can't realise what is going on before it is too late. Once the managers have nurses and physios in expanded roles, there will be no going back.

GOOD LUCK with your course

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I knew I wanted to study medicine from 5 minutes into my nurse training in 1992. This didn't go down too well with my peers but it has taken me eleven years to get my life in a place where I could apply to medical school, so I have paid my nursing dues! I was lucky enough to get two offers. I have been married for seven years to an ex footballer who is now a PE teacher. We have no plans for babies but I would love more King Charles Spaniels. I start medicine on September 20th 2006 and am absolutely petrified.