I'm an experienced nurse. Why do doctors treat me as their PA?
I’d worked as an advanced nurse practitioner (ANP) for a few years when I had a routine meeting with one of the consultant supervisors. He arrived late, thrust a lunchbox into my hands and told me to heat his food in the microwave.
This wasn’t the first time I had been delegated such a task. I’d booked (and cancelled) dinner reservations, called travel agents and moved cars in hospital car parks. I’m a nurse, not a personal assistant. Frustrated, I questioned why this kept happening. Was it because it was traditional for doctors to be served by permissive and obliging nurses who stood to attention by the patient’s bed as they patrolled the ward? Was it because I worked with surgeons, known for their talent and decisiveness, but also for their arrogant and egocentric characters? Or was it simply that they didn’t understand my role?
Meet the nurse who will soon perform surgery on patients alone
Read more
I wanted to work in emergency medicine because I believed my advanced skills were transferable and that the younger, more modern senior doctor found in emergency departments would be more supportive of the ANP role. I was relatively young, ambitious and dependant-free, and had the time to dedicate to a change in career direction. However, it has proved to be an even more frustrating challenge.
ANPs, or advanced clinical practitioners in emergency medicine, are employed throughout the UK and even internationally. In the UK, they are supported by the Royal College of Emergency Medicine, which provides a structured programme (pdf) to be completed over a three-year period with senior consultant supervision. ANPs are experienced nurses who are educated to master’s degree level and can independently assess, diagnose, treat and discharge patients, prescribe medications, run clinics, do independent ward rounds and perform advanced clinical skills. They were introduced in response to the European Working Time Directive (2003), which limited the working hours of junior doctors, creating a shortfall in medical rotas. There were calls for the nursing role to expand to accommodate the increasing pressures on the NHS.
This attitude extends beyond other staff to patients, who refuse to be seen by us and ask for a 'proper doctor' instead
The introduction of the ANP has been credited in academic literature with improving the experiences of patients and staff, patient outcomes and the efficiency of NHS services. Advanced practice is not restricted to nurses, however. Physiotherapists, paramedics and pharmacists can also pursue advanced clinical roles. You would think their presence would be welcomed in the emergency department, with 50% of junior doctors in 2015 choosing to take a break from training at the end of their foundation years. In 2016, there was a 5.5% increase in attendances at major emergency departments compared with the previous year (pdf).
The reality is that we are left unsupported and misunderstood. I’ve been asked “What are you here for?”, “What can you actually do?”, “How much do you get paid?” and “Why didn’t you just go to medical school?”. This extends beyond other staff to patients, who refuse to be seen by us and ask for a “proper doctor” instead.
I have never wanted to be a doctor. I am proud of being a nurse; I have more than 10 years of experience and have worked in a variety of settings. I wanted to remain hands-on and continue providing patient care rather than pursue a career in nursing management with targets, staffing problems and complaints.
I have worked through the swine-flu epidemic and seen pregnant women die, I have nursed many patients at the end of life, delivered bad news, picked relatives up off the floor and recognised the signs of deterioration in many patients. Now, I get to do all of the above and more and remain true to my profession.
I shunned studying medicine to become a nurse. Here's why
Read more
We are there to support, educate and provide a constant and stable workforce in the midst of junior doctors rotating through placements. We get paid in line with our experience and in recognition of our increased clinical responsibility, but our salary has a limit. Doctors will become consultants and their pay will increase exponentially as their experience grows. Old-fashioned attitudes persist despite our attempts to educate people about our role, and more of us are contemplating leaving the nursing profession or moving to departments with a concrete reputation for good consultant support and/or an established advanced nursing team. Some of my colleagues are on long-term sick leave, desperately unhappy at work or having counselling. Years of study feel like a waste. I, too, wonder whether to return to first-level nursing or leave the profession altogether.
If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com
Do you work for the NHS? Please take our survey and tell us about your job. It should only take 10 minutes
Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views
If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs