What do you think nurses do?

[Felix01]

I've just been reading some of the threads over the past few weeks and I wanted to ask MNers, What do you think nurses do in their jobs on day-day basis ? Responsibilities etc how many patients they look after?

I work as a care supervisor in a dementia unit and we write everything down. There are forms for anything that happens, accident forms, falls charts, incident forms, ABC charts, hour checks and many more. Every time we go to a resident it gets written down in their folder.

I wouldn't want to be a nurse, too much pressure.

A lot of the nurses “sitting at desks” on our ward actually clocked off a couple of hours ago, and are finishing off their paperwork in their own time because they didn’t have time during the shift.

(I realise you know that, I’m explaining this for the benefit of non-HCPs)

This was all several years ago, so before the "crisis".

The disappointing thing about this thread is how many people are falling over themselves to pit doctors and nurses against each other. There’s a lot of “chasing doctors” and “keeping doctors in check” and “telling doctors what to do”.

Why can’t we celebrate one (vital, hard-working) staff group without shitting on another (equally as vital and hard-working) group?

There is no black and white answer is there ?
first of all.depends wether you are a general nurse ,mental.health nurse ,children's nurse etc as they are very different files
and then it depends what area you work in within a specific discipline ,when I was a mental health nurse,I worked mainly in acute mental health wards,and for a period in dementia ,very different jobs although equally as stressful.

@OnOldOlympus
I think one of the problems is that nursing has traditionally been seen as inferior to medicine but now we have a situation where nurses, in their specialities, know just as much as the medics do-they have the same master's degrees and the same prescribing powers. Yet nursing is still seen as the realm of "bed baths" so it's frustrating.
The other issue is that, in some areas, doctor cover can be very difficult to get. In my last job the psych worked two days a week and had all but "checked out" and we couldn't get doctor cover for love nor money. When we could get cover it was semi useless locums that really did need to be instructed. The solution from the RCP/management was to make more and more jobs nursing tasks (diagnosing, prescribing, even ECT is becoming nurse-lead)-yet the consultant still got all the credit when the service worked well. It just doesn't feel fair.

I’m a specialist nurse. I have a large caseload of cancer patients. I manage their care for the most part independently of medical staff. I have my own clinics where I see double the number of patients the consultant sees. I consent them to treatment, prescribe second courses of chemo onwards, order radiology imaging, assess and manage side effects, counsel patients and decide when treatment isn’t working. In addition I triage unwell patients via a helpline and spend a lot of time directing shared care services and organising treatments and interventions. I make referrals to other services. I am also the clinical lead and wield a final say on strategy and operation. I manage a large team of nurses and do rotas, recruitment processes, appraisals, performance management and endless support. For this I get paid a similar wage to a junior doctor but unlike them, my pay is topped out. The only way I would be able to progress any further would be to move into senior management and have zero clinical input with patients. The only job that has monetary value in the NHS is senior management. It’s very sad.

Before that I worked in a succession of specialist nurse and ward manager roles. In my hospital we nurses working in cancer care do bone marrow tests, place central lines, deliver all of the chemotherapy, blood transfusions, site cannulas, take bloods, put up endless drips, place catheters, assess blood results, organise supportive care, oxygen therapy, manage sepsis and deteriorating patients, liaise with ITU, coordinate complex discharges, manage HCA and domestic teams. This is on top of the ‘traditional’ nurse roles that the public think we do.

People might be surprised to learn that they might only see a doctor at their first outpatient visit, or when on a ward they might see a doctor for a few minutes or less each day. There aren’t enough doctors and, other than surgery and tumour biopsies, treatments are almost totally delivered by nurses.

The scope of the role has changed enormously from when I qualified more than three decades ago. The pay and recognition hasn’t kept pace by a long shot. Hence experienced staff get cheesed off and leave. We have an endless turnover of junior staff who we have no time to support. Students quickly recognise it’s a mugs game and leave before they become too invested or take their skill set overseas. I don’t know a single A level student at my daughter’s school who plans to study nursing. They are canny and see better opportunities for a good life working elsewhere.

Well well well. It looks like I REALLY don't know what and how much work a nurse does. I was kinda speaking from experience from the few times I've been in hospital.

I honestly thought nurses look after 5 patients or so at a time. But I see people saying up to 20?!!!?? How is that even possible???

I also didn't know nurses told doctors what to do.

Thanks for educating!

I’m a district nurse, my day looks something like this:

night before check my list of patients, I have 8 bilateral legs, an initial assessment, syringe driver and a routine catheter change plus diabetics. try to work out a route which will avoid traffic etc
Morning of shift, check all the notes to see if they’ve called out over night, any palliatives have RIP’d etc
start off for my first of my diabetics, can have anywhere between 1-10 depending on who else is on, sickness etc. including probably 5/6 of them who could easily do themselves or have family members who live with them but refuse to do it as the NHS can do it instead
fight through traffic, get to my first patient, have a phone call to say a palliative has come on for pain, he loves the other side of our zone so back through the traffic
Attend the patient, he is EOL, family are very emotional, patient has nothing in place, call the local hospice staff who are too busy to come out so DN’s to sort. Emotional support given to family and patient, pain medication administered, hour spent reassuring patient/family, ordering equipment, stock checking meds etc. hard virus and have to compose myself for 5 minutes afterwards.
Back across the other side of the zone to continue with rest of 8 diabetics which now I’m a hour behind so 3 have rang in to see where I am.
Finish diabetics and go to initial assessment. Due to staffing no time for the paperwork so that’s pushed back for another day, dress the wound, check skin etc and go
Head to next patient, call out comes for the same man from earlier in pain again, back to him, he is in final hours. Emotional support given, pain relief (controlled meds that are signed by 2 in the hospital) drawn up alone around distraught family
leave And head to next visit, phone call a catheter has come on. Only 2 trained on today, other nurse stuck with patient who was on the floor on arrival so waiting ambulance so can I go, patient is in pain. I have the syringe driver so cannot get there for another hour, patient will have to wait. Get there, patient has enlarged prostate and and is losing very large clots, patient has dementia and daughter furious he has been left in pain, apologise but advise no one available, 30 minutes spent on the phone trying to get patient into urology ambulatory to bypass a&e

carry on with visits, patients complaining I am ‘late’ and they’ve been waiting to go out. We only see housebound patients but no clinic appointments available so DN’s to dress until there is (there never is, patient will stay on caseload till healed)
Spend time with lovely patients who are so pleased to see us. We are the only people they will speak to all week, wish I could stay and chat for an extra 5 minutes but have got to get on.
More call outs come on, palliative, catheters, dressing come off etc.
Finally complete am visits at 3, rush back to base to Chuck a sandwich down my throat then use my unpaid lunch break to get a head start on paper work, ring GP to request antibiotics for an infected leg I saw earlier, order dressings, complete notes, OT referral, podiatry referral, respond to social services re a safeguarding, 4 incident reports, try and complete mileage. Halfway through a referral and a call out comes on verification of death for the poor man from this morning. Out to verify him, distraught family, heartbreaking situation and have a little cry in the car. Rush to drop paperwork off at gp.

It’s now 4.30, supposed to finish at 5 but have 3 diabetics. Head to the first one, they are having a hypo. Make them a drink and something to eat, head to the other 2 patients. Get them done for 5 but then have to head back to the hypo patient, they’re still low so have to pass on to out of hours. They’re short staffed as well so they’re not happy but no choice.

finish work half hour later, get home for 6. Still have referrals and incident reports to do, get them done for 7.30. Check on the patient I sent to hospital earlier that day then close my laptop for the day ready to do it all again tomorrow!

That's mature of you to acknowledge, lots of folk wouldn't be grown up enough to return to the thread to say that

What a lovely thread

Sorry I forgot to mention that.

Every time my DD or I have had a vaccination, the details of the vaccination e.g. batch number etc has to be recorded against our records. In the flu (and polio clinics) there is one person updating records while the other person administers the vaccination.

When I was pregnant the idiocy of paperwork was fully revealed. Any of the healthcare practitioners who saw me had to record things in triplicate as none of the systems talked to each other and I needed to have paper notes.

I agree with @OnOldOlympus

I think this entire conversation is extraordinarily pointless and harmful for all NHS workers. There’s no reason why this discourse should be doctors versus nurses. Both professionals have completely different roles and responsibilities. Both are essential for the effective running of hospital and community services.

I don’t think the nurses on here should feel like they have to diminish the role of doctors in order to make themselves appear valuable. Everyone knows you’re valuable. My brother is a doctor, and I’ve just spoken to him about this. So, I speak from his point of view. Nurses do not ‘tell doctors what to do’ this is such a toxic thing to say and perpetuates the often unpleasant environment in the NHS. Both work hard. Both have some level of professional autonomy. When on call, my brother covers up to 200 medical patients, reviewing them, making acute diagnoses and subsequently managing them, whilst being bleeped by 10 other wards at the same time and holding a crash bleep.

I do think a lot of nurses including specialist and other senior nurses underestimate the role of a doctor, particularly those on call. I think if some nurses were put in that same work environment, they would change their tune. Specialist nurses are brilliant at their specific job but they are not generalists like most doctors are, and depth and breadth of practice is incomparable, because ultimately, that patient still has an overseeing consultant who takes overall responsibility, and when troubleshooting is necessary, specialist nurses still go back to consultants/registrars, especially when they feel out of their depth.

Ultimately, the responsibility is not the same. So, for a specialist nurse to sit here and say ‘I tell doctors what to do’ ‘I do the same job at them’ is unfair and completely misleading. You have different roles and it’s okay to accept that. If you don’t want a different role, you can always go into post-graduate medicine and you’ll realise how much medical school covers that you may not already know. Please think of the Dunning-Kruger effect.

Again, I repeat, both roles are important and now isn’t the time to argue with one another. You both deserve to be adequately remunerated. The Tory government probably want to divide and conquer and would be happy to read this conversation so see it happening. You both have clearly defined roles and responsibilities, you are both valuable. But ultimately, you are different.

@Back2Back2t

I really think it depends on the speciality. I'm the first to admit that I don't know a fraction of what a doctor knows physically, but in MH land, psychiatrists are rapidly becoming useless; a huge amount of the diagnosis, prescribing and treating is done by nurses and psychologists. Definitive diagnosis happens less anyway as there's so much disagreement/stigma plus we're largely treating symptoms anyway. This means we can't get psychiatrists so more and more tasks become nursing tasks. The "responsible clinician" might see the patient once a year while their care coordinator (nurse) sees them weekly, so they tend to defer to care co (MDT) anyway for things like meds changes.
I agree, Dunning-Kruger but a MH nurse could have the exact same masters degree (literally the same one from the same uni) in, say, advanced psychosis management as the medic. One any potential physical causes have been ruled out MH is pretty much an even playing field- we all know as little as each other!

I think this entire conversation is extraordinarily pointless

I think most posters are nurses sharing what they do. It's a bit like 'I'm a nurse AMA'

Very much so, I'm disgusted the way you're treated by the government/social services etc as it's basically making their lives easier.
I take my hat off to you all