To not want to see a Nurse Practitioner.

[Selks]

Have just rung the GP for a Drs appointment today after being ill for a fortnight and having a suspected kidney infection. The collective advice of MN and NHS direct said I should see a Dr ASAP.
The only appt offered to me was with a nurse practitioner. I spoke to the duty Dr and that is all they will offer me. No disrespect intended to nurse practitioners but after being misdiagnosed by the nurse practitioner before for an unrelated issue I am not keen to see them again for a condition that if misdiagnosed could potentially end me up in hospital. Dr was unwavering when I voiced my concerns.
AIBU to want to see an actual Dr?

[Mignonette]

Exactly Sidge. I have seen some breathtaking acts of collusion between the RCN and Trusts which caused irreparable harm to some amazing nurses.

[Sidge]

Oh I absolutely agree! They are spineless and I would rather represent myself than involve them...

[Mignonette]

The RCN had its teeth pulled years ago. I think they are bloody useless and I would not trust them to represent me in any malpractice/tribunal/misconduct case.

[Sidge]

Helspopje in my town I believe there are 5 practices with unfilled GP partnerships. The one I work in is one of them.

Like any nurse a NP is responsible for her own practice by the NMC registration Code. Indemnity insurance may be provided by the MDU but membership of a nursing union is often also advised.

[Mignonette]

The Nurse carries the can because she is professionally and legally accountable for her own practice under NMC regulations. Just as an OT, Physio, Speech Therapist, Radiographer, Doctor of Medicine and Paramedic all are.

The issue of indemnity will have to be worked out just as is happening w/ private MW's. It will happen.

[Mignonette]

Parsing, what I really meant was the status of the roles will merge. Typo caused by inattention. sorry.

[Helspopje]

Where are all these practices that can't recruit GPs? Amongst my friends that went down that path there are loads of fully qualified GPs out there can't get into a partnership for love nor money.

For my education, who carries the can if (god forbid) an NP makes a mistake. Regrettably it is human nature that we all make mistakes, but if my CNS does, she does it under my guidance so I am jointly accountable as I will have left her overexposed or inadequately trained for the activity that I have asked her to extend her role into. Not sure what happens with indemnity insurance too.

[Sidge]

"One day Nurses will be able to buy into a partnership (GP's won't like that) god help them"

It's already happening Mignonette. In some areas NPs are partners in practices.

Also with the difficulties in recruiting new GPs and so many due to retire over the next few years I foresee a huge rise in the numbers of NPs employed by surgeries. Practices are caught between a rock and a hard place IMO - patients expectations, volumes of consultations needing to be seen, large list numbers and demand for appointments mean that GPs need staff to see their patients. They can't recruit GPs, can't afford locums, can't afford for their patients to go to OOH (we get charged per OOH attendance) so must employ NPs who are qualified to carry out assessment and treatment.

Many NPs are hugely qualified and experienced (ours is involved with GP training) and are more than capable. I imagine the problems arise when GPs employ underqualified, inexperienced NPs or they are unsupported in practice.

[yetanotheranyfucker]

I've been hospitalised 4 times with acute pyleonephritis (which you definitely don't have, luckily) and had countless UTIs so you have my sympathy! UTIs do make you feel so rotten I hope the antibiotics work and that it doesn't progress further.

[Carriemac]

Our NPs are really useless. Every time I've seen one, either by myself or with the kids, they have followed a script on a screen, rigidly stuck to the algorithm , and twice when I queried their diagnosis and treatment they sought advice form a doctor who completely changed the diagnosis and treatment, once to have my son admitted to hospital immediately with a tonsillar absess who the nurse dip said was a viral throat needing no treatment!

[Junebugjr]

I much prefer NP's OP I've found them excellent, and the Doctors crap , twice I've been misdiagnosed, only for it to be picked up by a NP. Hope your feeling better.

[ParsingFancy]

"the roles will merge even more over the next ten years. No longer is nursing a job people go into because they don't have the grades or ability for medicine or other comparable professions."

How does that fit with what you were saying about doctors'/nurses' tasks being different and complementary?

Merging is more like the tasks being the same, but carried out by people with a variety of job titles.

[purplebaglady]

l agree that the care from nurse practitioners is often better than the care from GP. l would put a urine test in ASAP, they will give antibiotics without seeing you if it is positive for UTI. You may not need to see anyone.

[Mignonette]

Well that is wrong and your code of professional conduct is explicit re properly identifying yourself and the limits to your knowledge.

However i will say that the nurse consultants and specialist practitioners I have worked with are in possession of far more knowledge of their subjects (wound care/infection control/ than the consultant doctors. These are areas of specialism with no absolute medical equivalent.

As for what people expect re consultant' that will change over time. Of course many elderly people will expect the consultant to not be a nurse. It is up to the professional to make this crystal clear. I'm surprised she/he did not wear a name badge either on her chest or on a lanyard. Everybody I work with/come across has to wear an I.D badge, security tag, and/or name badge. That rather surprises me.

[Helspopje]

re 'consultant'. If you introduce yourself to a patient as a 'nurse consultant' well fair dos. What is distinctly off is to say that you are the 'consultant' as, for better or worse, the public and medical colleagues will think they mean the medical/surgical/other consultant and no matter how fab and capable any NP is, they aren't the med/surg consultant. An introduction such as this is misleading.

I have been on the recieving end of this and, as some of the advice was not as expected, I queried the status of the advice giver and discovered the omission of 'nurse' infront of consultant. Elderly relatives of mine have been surprised when they got their copy letter to see that they didn't see 'the head man' (don't get me started on that one.... ) after all.

[Mignonette]

Meerkat I didn't know that. Makes a lot of sense as so ridiculous to wait for a doctor.

[Meerkatwhiskers]

mignonette some nurses can pronounce and certify death. Usually in the community so they don't need to wait for a gp to come.

[Meerkatwhiskers]

Also late to the conversation.

Our surgery has physicians assistants. see here. I would rather see a NP than a PA. They are forever checking in their books and looking things up and generally not looking like they have a clue. And they can't sign prescriptions so you then have to wait ages after your appt for your script to be signed by a GP. I'm a nurse btw.

A 3 day course of broad spectrum antib is usual. If the lab is doing its job it will test the sample and then gram stain it and the result will tell the doctor which antib it will respond best to so it may be changed anyway after a few days.

Hope you feel better soon. I had kidney stones in June and nothing like the pain after a kidney punch exam

[Straitjacket]

Sorry, bit late to the conversation. Just wanted to quickly add a positive story before having to rush out and then saw your last post!

I do hope you feel better soon. I have never had a problem with my NP prescribing things, maybe it is just that system at your GP? It does sound rubbish.

[Mignonette]

Selks - Are you able to access out of hours over the weekend? Hopefully the scales will tip back in your favour by later today and that will be a moot question.

Keep a hot water bottle cosied up to your kidneys and remember to drink loads. I always glug Robinsons Lemon Barley Water by the shed load when I have any form of UTI. Might be placebo but it seems to soothe.

[Straitjacket]

I only ever see a particular NP at my GP for everything. They can basically do everything a Doctor can do. I absolutely love this particular lady, and she always, always goes that extra mile for me and my family. Even gives me a call every now and then to check how I am doing if I haven't been in for a few weeks (I have health problems).

Never known any GP to be as good as she is. She is awesome! I accept not all will be as good as her, but not all Doctors will be perfect either. Give the NP a chance if it isn't the same one as before.

[Selks]

Thanks ParsingFancy and Mignonette, I'm not feeling any better, but not feeling any worse! Early days with the anti-b's though.

I welcome the 'theoretical' contributions to this thread, and I'm happy for it to take that direction as it's been very interesting and educational. Thank you all who posted, and do keep up the discussion if you feel like it.

[Mignonette]

Yes, ditto Selks. I apologise for being a bit self indulgent there and hope you are feeling better.

Might I also suggest you write to the surgery with your concerns because if indeed the NP is incorrect and more importantly not listening to your concerns (because sometimes even the best get it wrong), then she won't be able to correct her mistakes if she doesn't know about them.

I realise that when you feel ill, this is the last thing you really want to do. However i have spoken to GP's in the past about a concern I had regarding a regular practice nurse (not an NP) who 'diagnosed' over the phone my allergy to penicillin as 'don't think its a rash from an allergy'. I went to see the GP anyway and ended up seriously unwell with a form of bullosa from the allergic reaction. He was VV concerned that I had been diagnosed over the phone and asked if i wanted to complain formally. I said not but could he ensure the nurse received some decent in house training and guidance on phone consultations. He happily did this (and was very relieved to not have to deal w/ a formal procedure).

The other surgery nurse is excellent BTW and gives good needle _ i'd never want a Jab from a GP

Get well soon Selks and drink plenty of [tea]

[ParsingFancy]

Talking of which, after choking your thread up with theoretical stuff, hope you're feeling better today, Selks.

[nancerama]

YANBU to not want to see your nurse practitioner. Some NPs may be excellent and very competent, some not so (like all professionals in all roles).

The NP in our practice made me feel like I was making a fuss over something very minor this week. I sought a second opinion from the GP a couple of days later and ended up admitted to hospital. No one quite understands why the NP wasn't more worried about my symptoms.

If you have had a poor experience with this individual in the past, it will of course cloud your judgment. I will think twice about seeing her again in future.