Nursing and Medicine

1. Nursing and Medicine “As yet there has not been a sensible discussion with the nursing profession about what nurses and doctors respectively bring to a therapeutic relationship. A debate is needed about the difference between nurses and doctors.” Kings Fund 2008

2. Mark Radcliffe 2000 “Medicine remains in the ascendancy but so what? The capacity to cure has greater market value than dealing with distress. And so it should.”

3. John Humphrys 2008 “I couldn’t talk to her because by the time I arrived she was unconscious but they are so bloody brilliant in these hospices. It was a big room that she was in and it was 9 o’ clock at night. They hadn’t turned on the lights and there was this soft light coming in from the corridor. I was sitting at the window in the corner and the nurse who came in didn’t see me.”

4. Continued… “She bent over to her and stroked her forehead and talked to her and obviously my wife couldn’t hear her but she said something, and you know, it felt like….love. If I could have done, I would have gone over and hugged the nurse.”

5. Caring is… “Human caring is a powerful creative activity with impact!” David Reilly “it’s the care, compassion and communication which are remembered and which shape subsequent experience of health and health care. Such memories can last for decades.” Kenneth Calman 2001

6. The Placebo • Literally= “I will please” “A sham treatment plus a good bedside manner” Godlee 2008 “if a sham treatment plus a good doctor-patient interaction can be so powerful, doesn’t this become a useful treatment in its own right?”

7. The placebo … • Godlee qualifies this by saying: “for some conditions, the placebo effect may after all be one of the most powerful tools in your medical bag, but only if youknow how to use it”

8. Steven Wright “so much of the effectiveness of nursing is based not so much on what nurses do to patients, but on how they do it to them” • He adds that as nurses our aim is not merely that patients get better (the cure) but that they feel better (the care).

9. Monica Fletcher “as the vocation of nursing has evolved we seem to have lost fundamental values. Nursing now focuses less on patients and more on acquiring knowledge and skills to further its status.”

10. John Alcolado MRCP 2000 “The minority of nurses who wish to take full medical histories, examine patients and prescribe drugs should take a medical degree” “When is a nurse really a doctor in all but name”?

11. Dan Ariely 2008 “Professions started somewhere deep in the past in religion and then spread to medicine and the law. Individuals who had mastered esoteric knowledge, it was said, not only had a monopoly on the practice of thatknowledge, but an obligation to use that power wisely and honestly”.

12. Barbara Safriet JD 2007 “Overlap among professions is necessary. No one profession actually owns a skill or activity in and of itself. One activity does not define a profession, but it is the entire scope of activities within the practice that makes any particular profession unique.”

13. Safriet continued… “Simply because a skill or activity is within one profession’s skill set does not mean another profession cannot and should not include it in its own scope of practice.” “No one professional has enough skills or knowledge to perform all aspects of the profession’s scope of practice”

14. The imperatives of the ANP role 1. The ANP must be trained, competent and accredited with ongoing clinical supervision and educational/professional development 2. The ANP must add to the quality of patient care: effective and sensitive response to patient need

15. The imperatives of the ANP role 3. The ANP must provide evidence based practice • Safriet asks: how does the new skill or service fit within/enhance a current area of expertise, and “is there evidence that the procedure or skill is beneficial to public health?”

16. Salvage and Smith 2000 “For decades we understood the professions as a conventional nuclear family, with doctor-father, nurse-mother and patient-child” …”but the patient has grown up. A new 3-way partnership should displace the vanishing family”

17. BMJ fast responses 2006 • Dumbing down medicine • The death of good nursing care • Jumped up and uppity • Contempt for nursing care • We are trying to protect patients from a nursing profession that does not nurse, but does appear desperate to become doctors

18. The Editorial.. “if as she argues, the distinction between medicine (cure) and nursing (care) will become increasingly blurred, how much blurring will it take before the distinction becomes meaningless?” Fiona Godlee • Maybe it was a lot less messy when as is said in the 1880 editorial “the nurse must be a person who plays blind obedience to (doctors’) orders.”

19. Medicine and Nursing. Cure or care? “the distinction between medicine (diagnosis and cure) and nursing (care) has become increasingly blurred. Medicine and nursing from part of a continuum, and where you are on that continuum- whether you are a doctor or a nurse- changes depending on what the patient needs from you at any one time.”

20. Understanding Doctors (Kings Fund 2008) “what we end up with is a mish-mash of role substitutions of people who may be imperfectly prepared in terms of their foundation of education…and this is a potential problem and will ultimately erode not just medicine but the values associated with the other professional clusters as well”