Just back from doctor's and am fuming and livid

[deckofcards]

Before I write a formal letter of complaint, am I being unreasonable?

Went to doctors' before Christmas for a routine appointment and repeat prescription. Needed a blood test and to have ears syringed (have been going deaf). Dr gave me print out and told me to make an appointment with the nurse. Went to reception and asked for an appointment with the nurse which is what I thought I had been given.

Arrived this morning, having fasted. Called in by a sweet enough girl although she wasn't wearing uniform and didn't properly introduce herself as a nurse or anything else. She took my arm and sweetly put it on a pillow, told me I had very deep veins (which I know but it isn't usually a problem but sometimes a doctor has been called), tried the other arm using elasticated cuffs that were clearly broken because they kept popping open and she later said they were no good. She gave me a glass of water to hydrate me better for the veins (which I would have thought would take more than a mintue to work). Still no joy so she went to get a colleague to help her.

The colleague was the receptionist who leaned over me reeking of tobacco and tried to find a vein. I questioned this and was told she was also a trained phlebotomist. The original one then said they would have to give up as the vein wasn't pronounced enough but she would start on my ears. I asked if she was a qualified nurse and she said, no a health care worker.

I declined her offer to deal with my ears and said that I would prefer an appointment with a fully trained practice nurse.

I went out to make another appointment and have been offered one for today with the proper nurse for my ears and have another on Thursday morning for blood tests. I am extremely grumpy that my time has been wasted.

Am I wrong in thinking that if I am told to make an appointment with the nurse and ask for an appointment with the nurse I should be given an appointment with the nurse or advised either when making the appointment that it is not with a nurse. I certainly should not embark on treatment without being appraised of the full facts.

It was clear that the person I saw this morning was not capable or experienced, it did nothing to inspire confidence that she got the girl off the reception desk to help her (and who reeked of tobacco) and I left feeling cross, upset, disrespected and messed about. I would have thought as a minimum of a health care assistant is expected to take blood or syringe ears (and I think the latter is more of an issue actually) then there should be a fully qualified nurse on the premises to supervise, not the stinky girl from reception.

Is this really what healthcare has come to and surely I'm not being unreasonable to expect the tin to contain what it says on the label.

I am minded to make a formal complain to the surgery but needed to get that off my chest first and to take some feedback - hopefully from those who work in surgeries. Oh, and the receptionist/phlebotomist told me it wasn't just my time that was wasted from their side the healthcare assistant now had 30 minutes with no patient because she wasn't doing my ears. My response to that was that had I been told my appointment wasn't being made with the practice nurse in the first place that wouldn't be the case because I wouldn't have made the appointment.

Sorry - very long but I feel better for a rant - and even more that the entire episode was totally out of order. But am I being Unreasonable to think that.

Newjob I have worked with many, many nursing auxilaries over the years who have referred to themselves as nurses.

I don't understand why she didn't try for another vein when she couldn't get one in your arm? My veins are deep in my arm and are sometimes hard to get to. If they are being stubborn, I simply have the PA take it from one in the back of my hand.

As far as having your ear syringed, I if you are talking about having your ear flushed out with water, I am not sure what specific training that requires. I've done that for my husband with a kit that I bought from the drugstore, and I have no medical training.

They're not called Nursing auxiliaries or nursing assistants anymore. Probably to stop the service users mixing up qualified nurses and HCA's.

The job title is Healthcare assistant or healthcare support worker. The uniforms in our Health board are a lot more identifiable than they were a few years ago. Hospital blue scrubs for qualifiers (who now look like surgeons) and bottle green for HCA's (who look more like paramedics)

Excuse the typo's. Getting to grips with new iPad

Be careful steff irrigating ears carries its risks. I'm not sure what you have purchased, syringing is no longer considered safe.

I attended a study day plus had to fill in paperwork and be supervised by a competent practitioner before I was able to do the procedure unsupervised. (I am hoping to do further study with The Rotherham Ear centre, you'd be surprised at how much there is to learn!) The HCAs have to do the same training and supervised practice.

YABU

The best person to draw blood is the person who does it most. So if your practice nurse spends most of her time doing healthcare advice then you probably don't want her coming near you with a needle.

A trained HCA is probably ideal if they do it frequently, and if it didn't work out today that may be because you got cross and left before the efforts to get you better hydrated with water worked out. Importantly it sounds like the woman you saw cared about doing the job well because she wanted to get a nice well-defined vein before jabbing you with a needle, lots of doctors and nurses would have had a go to see if it would work with whatever was coming up already, and when they couldn't draw anything, had to repeat the procedure, causing you distress and discomfort.

As for ear-syringing that really is trivial. It does not take a qualified nurse to do it. Again, you said the HCA was sweet. Why on earth do you think she isn't capable of squirting a bit of warm water into your ear canal carefully?

You are being precious and wasting two perfectly good nurse appointments which could be used for people who have genuine health needs. Waste of tax-payers money.

"Newjob I have worked with many, many nursing auxilaries over the years who have referred to themselves as nurses"

Which leads to tons of confusion on the wards for the patients and visitors. They shouldn't call themselves nurses. They do a great job but there are too many things that they cannot legally do. Many times patients on my unit will wait way to long for pain meds, their IV drips corrected and hung, etc etc. And they don't understand that there is only one Nurse to deal with it all because the other 4 members of staff on duty on HCAs who cannot get involved.

The other night I had 30 patients all on multiple drips and meds plus a lot else. And all the hcas could really do to help was basic care. They go into a room to do basic care, the patient says that she needs pain meds and the hcas que up to tell me this whilst I am doing tons of other meds. It's rough for all of us. Sometimes the patients get real nasty with the HCAs whom they mistake for nurses. They can't understand why the HCA cannot get their meds, answer questions or hang their drip or call the doctor.

YADNBU - Id be fuming too for all the reasons you stated

I would have refused as well.

Healthcare assistants are doing jobs that qualified nurses should be doing.

They are clearly a lot cheaper to employ but also not bound by rules and regulations covering their practice like trained staff.

I'm a qualified nurse and am very uncomfortable with the way things are going.

In a ward situation, if I am the nurse in charge, I have nursing assistants who have done courses for various things, great, but they often don't have the all round scope of practice and may report things incorrectly, if they mess up, it's my registration on the line.

'Nurse' is a protected term. I am a qualified nurse but I am no longer allowed to call myself a 'Nurse' because I am not registered to practice. I would be breaking the law to do so. I have to refer to myself as a 'former registered nurse'.

fanny you wouldn't let an appropriately trained HCA take blood from you or syringe your ear OR you wouldn't let them do it if they didn't look very good at it?

It's different in a ward situation though, as the nurse in charge you are right, it's the qualified nurse's registration on the line but in a GP practice this isn't the case. The HCAs are employed by the GPs and given appropriate training to do task orientated roles. It's not my registration on the line. My practice manager is looking at HCA's doing smears -

My role as a practice nurse is unrecognisable from years ago. It's all minor illness and chronic disease management now.

I have got absolutely hopeless veins as well. Is it something to do with how fat you are? I am vair chubby and everyone complains about my impossible to access veins.

The only time I have ever come away without huffing/puffing and more senior colleagues being called in to have a bash at mine, is when I have been to the dedicated clinic at my local hospital. They have three phlebotomists there seeing about 1 patient per 2 minutes all day every day. Those guys are GOOD with a needle and can get blood out of any body!

I have had many Drs and nurses fail to take blood from me as I have bad veins and low blood pressure.

I am now pregnant again and learning from my first pregnancy have refused to have the midwife take blood, I go to a blood taking clinic. (No I can't spell the real word...) It never struck me to ask if the women doing it were nurses or not. I would presume not actually. Good at taking blood though, which when you have previously fainted and been labelled 'needle phobic' by a clumsy Dr is all you really care about.

And I totally agree that there are places where HCW should not be being used to replace nurses/midwives - like overnight on postnatal wards caring for lots of women who need regular pain meds which they aren't qualified to give. But taking bloods seems a sensible use of HCW if they are properly trained.

I sometimes ask my patients to make appt with nurse for bloods. But that's because it's a mouthful to say health care assistant or nurse.
Having said that, if our HCA couldn't get the blood she would come and get either the nurse or the GP to do it.

I think you are being unreasonable to think you should have been given a nurse as the HCA is just as good but

You are not being unreasonable to think that they should have got someone more experienced in to take it.

But taking blood can sometimes be difficult and lots of factors make it difficult. I sometimes fail after years of experience. So it's not bad that she failed but you have to ooze some confidence even if you're finding it hard.

General practice is creaking at the seams and the HCAs are wonderful for us.

An appropriately trained person, fine. I give blood & plasma, they are not nurses doing it.

I would be pretty annoyed if I booked am appointment with practice nurse to find out it was with HCA and receptionist.

PennySillin, I use one of those squishy blue rubber bulb syringes. My husband's ears are very waxy and tend to get clogged up. I don't put the syringe in the ear, just at the opening of the canal, and the water runs in and then out again with a bunch of wax. Should I not be doing that? I don't want to damage his hearing, of course.

You do not need a degree in nursing to take blood or syringe ears. You are being unreasonable to expect so.

YABU taking blood is very rarely done by practice nurses these days. Phlebotanists are HCAs not qualified nurses anyway.

I am a student midwife, and was taking bloods in my 2nd week of my first placement, albeit supervised by my midwife mentor. Even she struggles to take blood sometimes, some people really are tricky!

I do not think this warrants a letter of complaint. At the end of the day, she asked for help, its not like she kept stabbing you blindly.

I think the OP has scarpered, anyway that's one less drain on the NHS...

OP you sound like a miserable old bat and your surgery is probably glad to see the back of you!

People seem to have got very err diverted down the track of job titles. As I understood it the OP was about bad communication and a lack of trust being instilled which made her feel uneasy and she refused to let this continue.

I have found that where there is shoddy communication, a lack of clarity and up front ness about roles and experience... there usually lurks bad health care practise.

Jobs in all sorts of industries are done by different levels of staff within an organisation. If you take your car in for new tyres, you're not going to get the senior mechanic doing the job. It will be done by someone who has done the training required to change tyres. That's how big organisations work. They manage their staffing so that the appropriate person qualified for the job does the job, and leaves everyone else to get on with what they are qualified to do. You don't expect the senior surgeon to come and change your bedpan do you?

Coming back to this late:

Does it not occur to you Deckofcards, that by 'nurse' the doctor was talking in shorthand for any health care worker at the surgery who is not a doctor

Wouldn't have occurred to me. A nurse is a nurse is a nurse. Any other HCP is something else.

And I'd be interested to know what qualifications the HCW actually had as that seems to be a catch-all for all sorts of different areas.

Jobs in all sorts of industries are done by different levels of staff within an organisation. If you take your car in for new tyres, you're not going to get the senior mechanic doing the job. It will be done by someone who has done the training required to change tyres. That's how big organisations work. They manage their staffing so that the appropriate person qualified for the job does the job, and leaves everyone else to get on with what they are qualified to do. You don't expect the senior surgeon to come and change your bedpan do you?

I do expect to get the person I booked with.
If I went to the hairdresser and booked an appointment with a salon director or senior stylist I wouldn't expect to get someone who's only been on the floor for a month.
The OP asked for a nurse as that is who the doctor had told her to book with, so that's what she expected.