Im an Advanced Nurse Practitioner and whats the point

[Imhereyetagain]

Im an ANP in a GP surgery and I dont think the role is valued or appreciated. On the one hand patients moan that im not a Dr, and on the other Drs moan about the ANP job role existing. Im just so tired and bored of it all, and think about leaving.

My daily work is running an ANP emergency list, which really consists of any single, acute, undifferentiated problem. So things like chest infections, urine infections, simple dermataology issues, acute abdomens etc etc. I could go on but I think that illustrates my daily work fairly well. The more complex stuff goes to the duty GP.

Im just...tired.

I totally agree with the second bit of your reply here. Its really confusing.

Its frustrating that PAs are even being mentioned tbh. It sort of tells me the roles are being conflated.

They're not 'hers' - she doesn't own them.

Absolutely. I have a brilliant ANP at our surgery and can't speak highly enough of her.

The hard argument is to emphasis the importance of the skill based of medics with our sighting others such as specialist nurses. Both have important roles but I think there is a real problem if we start equating skills and roles of different profesions. Working with patients I see that a lot patients with understandably little medical knowledge are putting a great deal of trust in what they are being told by a health care worker and a lot are placards by empathy when in reality breadth and scope of knowledge is the important thing.

This is just my point of view and experience, but we have a ANP at our surgery and he's fabulous. Seen him a fair bit with the kids and he is excellent, speedy and efficient care. It helps that our practice seem to use him very well and appropriately. We see a GP when required.

I do wonder whether the way you are feeling is a symptom of burnout and general stress because of the state of GP services and the NHS as a whole? I'm sorry you're feeling like this. I too work for the NHS and feel very hopeless and burnt out. I'm comforting leaving for private practice. I'm exhausted. Tired of it all. So I really empathise

The ANP at my surgery is certainly better than the GPs. I've had no issues on the rare occasions I see her.

The GPs on the other hand, not interested. Their attitude wouldn't be tolerated in any other industry/profession. For example, one refusing a dermatology referral for psoriasis affecting my whole body, and telling me the only answer is to moisturise. Had the brilliant luck that he went off sick and a locum filled in when I dared to chance a second opinion, he referred me, took 2 years but I was prescribed tablets and I've been clear for the first time in 45 years.

I think ANPs at the GP surgery do a great job

Would you prefer to work on a hospital ward?

Nice reply, some people are missing the point entirely, ANPs don’t pretend they are doctors, they are experienced nurses with additional training and skills which compliment and support the doctors, in secondary care probably more so than in primary they focus on a specific area and are highly skilled in that, primary care ANPs have the same issue as GPs, they cannot, no matter how good they are or how well trained they are, they cannot know everything ,that’s why specialities exist

Likewise.

Every ANP I've seen has been knowledgeable and thorough, and interacted well with me. Similarly with paramedics, which my GP surgery sometimes also has as first line consults, in the same way as ANPs.

PAs, though, I now refuse to see. Every single one has been a poor interaction. They have missed things, or explained very poorly and talked down to me, had to refer to the GP anyway.

I trust an ANP way over a PA.

Thats the point - nobodys equating ANP to Dr training. Thats the problematic point of view.

I also think it’s a brilliant role. In the last couple of years I’ve needed antibiotics a few times and I am always happy to see the nurse, only the last time I must have said something to receptionist did I get diverted to the GP. Which is good as she prescribed further treatment that I don’t think a nurse would have. But I had to wait all day for the dr appt whereas I know I’d have seen our nurse quicker! I do think that there are a lot of people who don’t understand the role though.

I'm a senior specialist nurse in a hospital. I'm planning to leave this year. I've given every ounce of my strength and energy to the job, the pay doesn't reflect my level of training and other workload burdens (e.g. emotional stress). I also don't see the point, you have my sympathy.

The ANP at our surgery is worth her weight in gold. She always has lots of time to go through everything, never asks “so what do you want from this consultation today” which doctors seem to now, and follows up when she thinks it’s necessary instead of leaving it to the patient to get back in touch,

DS2 is doing his Masters in advanced practice. His intention is to stay in the hospital, ideally on the team he’s on now but I’m not sure if that will work out.

As a patient I value the ANP role as it's meant I could get seen quickly without feeling I'm bothering a GP as knew it wasn't a high level issue.

Also - we have a Paramedic Nurse at our surgery (never heard of one before) and she's bloody marvellous. So thorough. Checked me out really well

Hit a nerve there, eh? I am making the point that if I have an issue with a particular part of my body, I shouldn't have to jump through ten thousand hoops to see someone who has specialised in that body part and can deal with the issue instead of spending time trying to get appointments with a series of generalists who just refer me up the food chain to the next generalist. One accessible generalist and a prompt referral to a specialist.

Imhearyetagain

I am sure there are nuances and maybe this is the point. Medicine is extremely complex and we need to have reassurance as patients that we are seeing the most appropriate person. It can't be denied that in terms of breadth of knowledge and training GPs do offer more. I can understand that for a lot of routine activity or common ailments it makes logistical and economic sense to use more ahps and nurses but I think as patient advocates we are right to not to accept this philosophy unreservedeky.

When consultants and GPs were striking we were constantly being made aware of the value of clinic and and how their unique skills were indispensable in healthcare. It does seems a little worrying in that in some areas getting access to such indispensible proffessionals is difficult to say the least.

I have seen great PAs but I am concious they can't be a full substitute for a GP and I think I have the right to hold that view.

My DH saw a GP once after he had a fever but feeling really cold for 3/4 days, he looked awful. Told him it was constipation after pressing on his belly.

The day after taking some laxatives, I got him seen by our ANP as he really didn’t look well. She sent him to A&E as it turned out he had a ruptured appendicitis. So I sent her a card and some chocolates.

I appreciate ANP, I tend to find they are more compassionate and human at times. People are quick at complaining but never at praising.

It doesn't seem fair that you are doing a doctors job, but earning a fraction of what they do.

I was working as ACP in GP practice; it was what I always wanted. I left 12 months ago to go back to working for a trust in non-ACP role and don’t yet regret it. It has its own frustrations of course, and who knows where I’ll be in 5 years. But for now it allows me to keep sane and a better work life balance. Looking back the boundaries (mine or their?) weren’t clear. GP practice is just so hard at the moment, too long to go into reasons here. I felt so guilty leaving like I was letting down my colleagues, but in the end the hours too much, work life balance too poor, personal cost too great. GP practices work unbelievably hard my colleagues were on their knees.It was definitely more stresssful than the NHS trust.

The NHS is challenging whatever sector now as people expect more, they want easy answers to complex (and often socioeconomic) problems but also get rightfully upset and frustrated cos it is poorly funded and managed.

It took a lot of courage to leave, and I’m sad it didn’t work out but don’t regret it.

Imhereyetagain

So if you don't equate levels is training the implication is that there are professionals that are more skilled in terms of dealing with certain conditions. The problem with patients and medical staff generally is that as possible have said you don't know what you don't know. The concern then becomes that serious conditions are met imperfectly or some diagnosis slips through the cracks.

Possibly I am coming from a perspective where I do think self diagnosis is to be avoided and an utterly reliant on professional opinion when going to the GP. It just makes sense to have expert opinion available as widely as possible.

It probably is economics that prevents this.

The moaners will be the worried well who feel they need a regular GP slot to reassure themselves that they are being looked after by someone. As a nurse you may have reached a level of compassion fatigue for such an attitude but their disgruntlement doesn't hurt you.

Er, no. DD’s partner is a GP. She has complex health problems and he tells her, what HCP she needs to see, before she does an e consult, requesting an appointment with a GP. At times, she is given an appointment with an ANP, who either misdiagnoses her problem, or tells her they can’t deal with it, and she needs to see a GP. Either way, she ends up, making another request to see a GP, thereby wasting time and delaying treatment.

She also was a pharmacy dispenser and healthy living champion at her place of work, yet she was sent for talks by NA or ANPs (can’t remember which) about healthy living, but she used to come away complaining she knew more about the subject than they did and anyway advice on CFS is simplistic!

If this happens to her, she can’t be the only one - but other people may not have the advantage of living with a GP.

I have worked in hospitals. Its something id consider again if the role was right. Not necessarily in an ACP role either. In my experience hospital work was so much harder, but perhaps thats because I was very junior band 5 nurse at the time!

I do know what you mean

It's not that GPs aren't proper Doctors. Of course they are.

Its not that Nurses aren't proper Medics. Of course they are

But if you have a specific medical condition which requires a deeper exploration, that isnt explored by the GP as they don't have the specific skills to take on that exploration

I had a health issue last year. I had no idea what the problem was, despite googling!

The ANP and multiple GPs had no idea what the problem was and they kept prescribing medication which didn't work

I asked to be referred on and in the end the GP agreed.

The wait was so long to see the specialist on the NHS, that I paid and was diagnosed and sorted in one appointment

All better within 3 weeks of diagnosis

So......GPs and ANPs are bloody marvellous, and I genuinely mean that.

But if you have a health condition which isn't easily diagnosed and sorted, they do struggle and then they become gatekeepers, path finders and referrers

Honestly I'm not bothered what you think, I won't change my mind that my personal view (not claiming to the correct view) is that ANPs should not be diagnosing mental health conditions.