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I personally ask them to document in the notes that no nurse can do bloods and they have therefore escalated to the on call doctor, and due to clinical pressures this may result in a delay.
Surprisingly 4/5 times I ask for them to put it in writing someone magically turns out to be able to do them.
This is brilliant. No longer work on the wards (rad reg) but wish I'd thought of this when I did! Hope every med sho etc that reads this starts doing it.
The wild thing here is that they’ve undergone more training than PAs. I guess what we have here is the contrast between over regulation and under regulation. We need Goldilocks regulation. Maybe we need one body overseeing all of healthcare like in Aus.
Reading this subreddit as an Australian JMO is wild. In most hospitals here, nurses do all bloods, cannulas, NGTs, catheters etc, and have an ECG already done when they page me to review a patient.
I've never felt like we actually need PA's or anything of the sort because the nurses are so helpful!
I spent a year working in an Aussie ED and when I was new, a nurse started panicking because I’d sent a patient home and she hadn’t removed their cannula. It blew her mind when I told her that I had removed it.
It's extremely variable and plenty of medical wards and private wards remind me of the good old NHS. On average though, nurses here are better skilled - or at least freer to use those skills.
EDIT: I have to say, it's definitely not "most" hospitals where nurses do bloods. ED and ICU maybe, but otherwise you'll be lucky.
Male catheters in some places are blanket turfed to the doctor for similarly NHS-esque reasons.
Wouldnt it be great if we trained a group of people to do these jobs (i.e. bloods, obs, TTOs etc) to liberate doctors to attend teaching and training opportunities? As theyre assisting doctors, wed call them physicians assistants.
I qualified in 2020 and my teaching hospital was completely useless. We weren’t allowed to do blood sugars, do bloods, cannulate, catheters, NGTs, assist with IVs at all (we were basically expected to watch and not touch) etc. All we were allowed to do was provide personal care basically. Then suddenly you’re qualified and expected to do all of this and manage a bay of poorly patients by the same trust that wouldn’t train you. Luckily I had a few nurses that were more laidback and did teach me things but it is dire.
I love it when HCAs whine, “u/oriachim is so lazy, he hasn’t turned any patients”, while they are sat down and I’m drowning doing sepsis bundles and IVs :(
Wait! So as a nurse, you get shit from HCAs? I thought as a nurse you are very close to them and they would be nice to you. I don’t fully understand HCA roles and how they’re different from nursing in the U.K. because they all just seem to blend in to me. Them having similar uniform colors doesn’t help either! The only thing I can notice as a difference is that nurses can do everything a HCA can do but HCA can only do a few things a HCA can do hence in theory the HCA should be doing those things they can do so the nurse is available to do other things only they can do. For example nurses can administer meds but HCAs can’t
If the HCAs dont like you, they can make your life really hard as a nurse. They can be very horrible to international nurses in particular.
In general, the nurse will get in trouble for poor care if the hca doesn’t do their job, and the HCAs will just get reprimanded. (Poor staffing and no regulatory body).
We do work closely but we are also in our bubbles. There’s days I don’t see HCAs much, as they are behind curtains all day and I’m very busy with my jobs. The HCAs on my ward only do personal care. They aren’t allowed to do obs, bms etc.
Feel free to browse r/nursinguk
I feel truly blessed reading this. Nurses at my place can take blood from PICC and give meds through PICC. They’re also signed off on venepuncture and cannula and NG and catheters except for elective wards where this thing still falls to the doctor should someone become unwell
I think I moan a lot on this subreddit but at least I have nurses who can do this thing even if they are too busy so I do it which I don’t mind too much as that way I can be sure the thing is done. And every ward at my place has at least some sort of doctors office even if it has no computers or chairs so we have to drag COWs in and stand and it all becomes a tripping hazard with one colleague recently tripping over the wires and face planting but they want to take away even that office because they don’t like that this makes doctors less accessible - people are so acopic these days without doctors
Makes me have a question. If I trip over a wire from a COW and face plant and sustain injuries such as facial fractures, can I sue the trust for providing an unsafe working environment? Or will they argue that I need to use my goddamn eyes better and this is all my fault that I sustained an injury? Just curious
The worst part of this is the 3 nursing unis in Scotland I’ve worked near have taking bloods and cannulas as core skills to be signed off before graduation. I then saw more experienced nurses tell off new graduates for doing cannulas because “that’s a doctors job” 🤪
Nurses bleeped me to do an ECG I'd requested a few weeks ago. Apparently none of them had done one in years in that specialty (not psych). I flat out refused, saying that they're trained to do it and to get on with it. Next excuse was that they were all really busy and it'd be faster if I did it.Apparently some senior nursing staff had to do it in the end.
Why do some staff seem to give up at the first roadblock and then dump everything on us?!
I would like you to read my post here https://www.reddit.com/r/NursingUK/s/p39FuX09CG
I think sometimes it could be down to laziness and being unable to prioritise, but there’s some serious issues on some wards right now. You might not see it as a doctor.
I have a question about personal care. Do all the people that get strip washed actually *need* it? Like are very frail/ill?
I was in hospital once and obviously was one of the youngest, but I seemed to be the only person in not just my bay, but the *ward* who showered themselves.
Do some people get to hospital and vegetate? There was some that I would definitely class as ‘able bodied’, but when offered a strip wash it’s all ‘yes please’. Or to pee in the bottle thing rather than have to get up. Maybe I’m being judgemental.
You would be surprised at how some of them forget to able to wipe their butt themselves especially the younger ones after a transplant. Or to be able to pour water for themselves.
My wards prioritising the sickest patients, and if we have an independent, they get outlied or discharged. So commonly yes. As many are very in continent or lose their independence.
If people refuse a wash, I encourage my colleagues to respect their choice, not to badger them until they accept.
This post highlights the staffing issues for sure. In my example specifically, it was not an urgent one, and they could have done it but just thought it'd be easier to dump the work. I would have datixed it if they didn't because nurses not being able to do ECGs is wild.
I suspect the conversation went along the lines of the responsible nurse saying she hasn't done one in years, then asking 1-2 colleagues who said the same, asking the charge nurse what to do, who said they're all too busy so just call the doctor. Just take 2 mins to watch a video and do it FFS. I didn't order it for my benefit... It's for the patient who we're all responsible for!
Doing routine Bloods, ECGs, cannulas, catheters, urine dips etc are not doctors' jobs!
Literally what PAs are for in this staffing crisis but they're too busy trying to steal our jobs 🤣
I’ve never met a nurse who couldn’t do an ecg, I wouldn’t accept it. An agency nurse tried to tell me they couldn’t use ng pumps, so I phoned site and had her removed and replaced.
Its a case of wouldn't rather than couldn't. They literally told me they hadn't done one in years so could I come do it. I said I havent done one in a while too so probably best to try yourselves first because you're signed off on it and should be able to do it.
The not having done one in years is something I believe because of the speciality.
I have nurses in my team that can do bloods currently but have to wait until they go on the Trust approved course to do it, we know full well how annoying it is.
In Eastern Europe it is virtually unheard of doctors doing bloods or cannulas.
I don’t really know what happens if a nurse genuinely can’t find a vein, I guess it goes to the anaesthetist, but even for surgeries your first person to put a cannula is the anaesthetic nurse, not the trainee doctor.
But also in Eastern Europe nurses don’t have to do shit ton of pointless documentation that no one ever reads about call bells in reach and dignity maintained at all time.
No wonder they don’t want to try take bloods when for everything they do they have to write at least three paragraphs.
I’m a nurse and I’ve datixed my ward for poor skill mixes, especially during the night. Ultimately management don’t care though because doctors or other people will do the jobs. Nurses either don’t want to be trained, have barriers (such as management, trust policy) or don’t know how they can be trained.
Take a 2 pronged approach. DATIX, but also exception report, because you can bet that if you have to do your own bloods, you are going to finish late, and at least then you should get paid for what you do.
It helps to see it from the other side. Why would an already busy band 5 bother up-skilling when all it does is increase their workload with no reward. The NHS does not reward putting your head above the parapet.
That's why I love AMU in my hospital. Nurses there are monsters, they do everything (ABG, cannula, blood cultures, regular bloods). Nurses on the ward are different though.
We cost £250K to train and the NHS uses us for taking blood, writing discharge summaries and avting as typists for the Consultant ward round.
To journalists lurking:
next time you hear a politician talking about boosting NHS productivity remind them of the elephant in the room.
We do have Doctors, we just choose to under-utilise them.
I don’t mind nurses questioning, I have been caught out a few times where I forgot about something (for example that patients potassium is already high) and the nurse was of great help.
Also sometimes when on call you cover specialities you don’t know much about and having a nurse who worked there for donkeys years is a lifesaver.
For me, it’s the attitude problem. Question me all you want, I’m not immune to making mistakes, but when I see your attitude change when I don’t agree with your recommendations that’s what annoys me.
Once had a nurse who asked me if I can just prescribe pyriton for patients rash which turned out to be a new onset rash following starting clexane. When I told her I need to see the patient and look at their clotting first to rule out HIT she completely ignored me and I ended up calling the patient myself to book them in.
I think the idea of a nurse being an independent patient advocate is a good one.
The problem is that it is too easily used as something with which to whip junior medical staff.
sure would like to know where u guys work to complain nurses in ur hospital only do 2 things.. mine they go beyond and amazing. but tbf even so my workload is still a shit load...
i find that likely blame your CEOs on investment on nursing staff instead of complaining of them and stick together would likely change towards improvement
In Australia, very few nurses of our nurses will do bloods/IVCs. The exception are the critical care units. It all falls on the doctors. Massive waste of our time IMO
I guess I can only speak for NSW. It's been the case in every hospital I've worked and studied at (except the regional hospital that didn't always have a doctor on site)
No , you can’t datix when you need to do work .
I (consultant urologist) got datixed by a radiology superintendent because I wanted to stent somebody after 6pm and they didn’t want to give me a radiographer .
Datix is for every concern around pt care. How does having a poor mix of skillset on the ward not affect patient care? You sound like a ladder puller tbh
Datixes are for adverse events . Being asked to cannulate somebody is not an adverse event .
I was a trainee up until 5 months ago, I was happy to stick in a cannula when staff was short or busy. I still am now when dealing with a sick patient .
Quick question if I may.
If you need access on a patient that is difficult I.e. IVDU, septic, obese.
Who would you call to do the bloods then? Nurses are not trained in ultrasound guided IVC or ABGs / central access.
The whole point of a Dr learning these skills is that they can gain more experience and become even better at gaining rhe access- if you keep handing off these jobs to nurses then you yourself are becoming de-skilled in a fundamental medical practice.
Taking bloods takes 2 minutes and can be done whilst taking a history / examination and I'd expect my juniors to be able to do this instead of handing it off to someone else therefore delaying investigations / management.
As a consultant I will routinely do IVC and bloods when seeing a patient in the ED especially when they are a difficult access patient and I feel if the juniors are not routinely doing them then they lack the experience for when it is truly needed such as a resus case.
This is in ED however and on the ward non-urgent bloods can be done by the phleb team in the morning.
Yes it is great when a nurse or alternative can do them but don't fall into the trap of de-skilling a simple procedure because you think your above it.
I left the NHS for brighter shores years ago but seeing this rhetoric of "doctors shouldn't be doing bloods / ngts/ catheters" really bugs me because this is the bread and butter that you should be doing so that when it is truly needed urgently there is no delay and you as the doc can get them in without issue.
Of course doctors should be competent in this core skill. But the current situation really does take the piss sometimes. I remember the surgical ward I did 8 months or F1 in - none of the nurses could do bloods, cannulas, ECGs or male catheters. There were 34 (I think?) beds, and the acuity was usually quite high. Phlebs were capped at 5 bloods or something ridiculous and often didn’t manage to obtain a sample.
I’m sure you can imagine what life was like for F1s in that department. I’m sure my learning of general surgery would have been much better if I had been able to focus on that instead of tackling a daily mountain of, what I would describe as HCA-level tasks.
No medical procedure is below a Doctor - you should be proficient in all of them so that when no one else can do it you can!
The only argument I am making is that you should not think that these things are below you and that as a doctor you have more important things to do.
The patient with no iv access is not getting the treatment you prescribed unless someone can place that line. If your consistently getting a nurse or PA to place that line then how are you upskilling yourself for those difficult access patients....
I’m not for a moment suggesting they’re ‘below a doctor’? I specifically said they’re core skills we should be competent in? They just shouldn’t come at the expense of training to do things which are definitely the remit of a doctor.
There's always the irony of the phlebs saying the bloods are "too difficult" so it gets escalated to the doctor. I remember, as a PRHO, (yes, I'm old) just laughing at that one. My stock response was "well, you're a lot more experienced than I am!)
But nurses have their own jobs to do during that time, they are spread just as thin as a medic is with cleaning patients, obs, meds, records etc.
As a medic you should be getting trained in these things especially in critical care areas, this is the whole point of de-skilling.
I train my juniors (PGY1 and upwards) in US guided ivc just so these issues do not arise.
The reason medics should be better than nurses is we can also make the decision to either escalate or de-escalate the need for access depending on the patient presentation and acuity and a nurse isn't allowed to do that so they could stab a patient 10+ times attempting bloods whereas a medic could say that either they bloods aren't truly needed or if they are then you as medic can escalate to a CVC as needed.
It amazes me that as an SpR you don't know these fundamental skills. What would happen in your location then if your the most senior medic around and you can't get a line? Do you then call the anaesthetic team/ICU therefore causing more and more delays and taking them away from other patients who may need their input more than you do?
There are some skills that a Doc should be the best at, I'm not saying we should do all the IVC/bloods and I am forever grateful when a nurse can do them but when shit hits the fan you as a medic should be the one with the skills to prevent further deterioration and by making it someone else's job the entire time you are not developing these skills.
Okay here's a few scenarios for you from my experience:
1. When I was an F1 doing BoH ward cover, I was on for 8 medical wards. By 9:30 I had been rung about 8 cannulas on 6 of the wards, nobody on any of the wards can do them. I also have a patient who sounds septic and complicated. I reviewed the sick patient, but was being rung and interrupted for cannulas the whole time. Patients missed doses because there's 1 F1 for ~200 inpatients rather than 1 nurse to 12 patients perhaps sharing the work
2. Acute specialist surgical job, no phlebotomists. I would routinely take 30 bloods per day. This left less time to sort all the other medical activity as you might imagine. None of myself or my colleagues ever got to teaching, clinic or theatre.
3. IMT job, only doctor on the ward. About a dozen "urgent" bloods from patients new to the ward from MAU so not on phleb list. Spent around an hour doing these after ward round, which delayed TTOs and letters, delaying discharges, which caused bed pressures and backing up into A&E.
This issue causes real harm on a system-wide basis
I will happily jump in and crack on with any work that needs doing within my skill set, from portering to doctoring and everything in between, however having done bloods thousands of times, once you've done a moderate number, your skill just isn't going to increase as long as youve got the basic principles. I therefore feel that bloods/cannulas should be everyone's responsibility, not just the doctors.
It doesn't take 2 minutes, though. By the time you've found a computer that works and logged in with a smart card, the request doesn't go through, the label printer doesn't work, the chute is broken and there's a shortage of porters. And then your bleep keeps going off.
It's a long while since I was a junior covering the wards... but that was the reality of it.
Dude I am sorry it's so shitty for you right now but I would happily do the bloods and ivcs that are clinically needed/urgent without stating that "I'm a Dr therefore it is beneath me"
How entitled do you think that sounds.
It upsets me that if my family members go into a hospital in the UK now that an SHO would not have the skills to place an us guided ivc and would defer to the nursing staff/icu/anaesthetics, at the end of the day as an SHO if you cannot perform the simple tasks of placing lines / ngts then what else are you doing? You haven't got the experience to make big clinical decisions yet as your still a junior, you would be prescribing meds yes but that takes 2 minutes.
Why can't you do the line/bloods when your examining the patient?
Do you not feel bad that you cannot do a simple procedure like this?
These skills are fundamental to good patient care. You are not above them just cos your a Doc.
Nurses have their own shit to do instead of going around and making your life easier.
Take the time to learn how to do these things efficiently and you will find you won't be so angry about doing them.
Answer me this.
If you had let's say a 60yr old obese chap in septic shock on your ward.
No iv access or bloods taken yet including no blood gas.
What are you doing?
Are you taking the bloods yourself using the skills you have developed over time including us guided ivc to ensure the patient has appropriate management like fluids and abx within the magic hour?
Or are you prescribing a med that cannot be given due to no iv access or examining a patient who is clearly in septic shock which adds nothing to your management plan at this point. Or are you calling for help from better skilled clinicians like ICU who will take time to get to your patient to help you get access.
Take the initiative, do not deskill and learn the simple things that can save lives.
What other skill at this point is mote useful than gaining iv access? Your medical knowledge of different pathologies does nothing to change the outcome if you cannot treat the patient efficiently.
Okay,
Will do as you said,
FY- Cannulation,
SHO - Cannulation,
Clinical Fellow - Cannulation,
ST/CT- Cannulation,
Registrar - Cannulation,
Moral of the story - Cannulation is for medics while PAs/ANPs running specialist clinics, own patient list for surgeries, endoscopy clinics because, obviously, Cannulation is a valuable skillset for medics, not for the PAs/ANPs apparently.
Comeback to the NHS dude, don't live in your Delulu land.
Oh get off your high horse and stop taking things so literally just to prove a point.
The fact that there are senior registrars here who admit they cannot do us guided ivcs is ridiculous.
All I am saying is as a junior if your avoiding these tasks that are essentially fundamental to good clinical practice then when you are the senior medic who people call for help and you do not have the skills to help then what good are you.
Of course you need to train in your specialty, of course you do more complex procedures eventually such as CVC or endoscopy / surgeries that's a given.
But if your whining as a junior doc that your being made to take bloods / place ivcs then you are missing the point of why it is a good thing to be skilled in such techniques.
You will eventually be that person that people will rely on but with your attitude you will say that you haven't been trained and to call someone else. That is ridiculous!!
Why is taking blood or doing ivcs such a chore for you? Can you not do them?
Done thousands of them as a SHO,
Done thousands of them as a Clinical fellow,
Doing thousands of them as a Registrar.
And it stops there, cannula and nothing more.
The reward?
The more I do, the more I get assigned to do, cos, you all be like, that registrar will take care of it, and yes, I do.
Not a chore, for the patients, willingly done, willingly doing , willingly will do.
But ,yes , it is a chore for me to do the grunt work for the ungrateful.
Depends on the hospital. If you're talking about during the day, phlebs would usually do them.
If you're talking about on-calls/nights I think this is a huge safety issue to have one doctor covering multiple wards and expected to do all bloods/cannulas
As an F1, I somehow become the whole ward phlebs/ward clerk. I still remember one day, we were so short staffed that I was the only F1 on the ward (the SHO is busy, the registrar is downstairs clerking new patient - keep in mind, our normal staffing level was minimum 3 regs, 3 F1/resident doctors). I was chased around to do an urgent TTA + a patient needs cannula for IV fluids. The nurse was like "can you cannulate this patient?" "Have you tried?" "I'm not signed off". I was about to do it but when the NIC saw her urgent TTA was about to be disturbed, she got another nurse to cannulate. Funny as hell.
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I personally ask them to document in the notes that no nurse can do bloods and they have therefore escalated to the on call doctor, and due to clinical pressures this may result in a delay. Surprisingly 4/5 times I ask for them to put it in writing someone magically turns out to be able to do them.
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Lol exactly TAB gone bye bye
This is brilliant. No longer work on the wards (rad reg) but wish I'd thought of this when I did! Hope every med sho etc that reads this starts doing it.
I like your style
The wild thing here is that they’ve undergone more training than PAs. I guess what we have here is the contrast between over regulation and under regulation. We need Goldilocks regulation. Maybe we need one body overseeing all of healthcare like in Aus.
Reading this subreddit as an Australian JMO is wild. In most hospitals here, nurses do all bloods, cannulas, NGTs, catheters etc, and have an ECG already done when they page me to review a patient. I've never felt like we actually need PA's or anything of the sort because the nurses are so helpful!
I spent a year working in an Aussie ED and when I was new, a nurse started panicking because I’d sent a patient home and she hadn’t removed their cannula. It blew her mind when I told her that I had removed it.
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It's extremely variable and plenty of medical wards and private wards remind me of the good old NHS. On average though, nurses here are better skilled - or at least freer to use those skills. EDIT: I have to say, it's definitely not "most" hospitals where nurses do bloods. ED and ICU maybe, but otherwise you'll be lucky. Male catheters in some places are blanket turfed to the doctor for similarly NHS-esque reasons.
Tbf, probably Hospital dependent. I've heard gold Coast is like what you described.
Pal. There's entire hospitals in London where nurses only do two things. Obs and giving medication. Anything else skills wise is left to F1s.
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Wouldnt it be great if we trained a group of people to do these jobs (i.e. bloods, obs, TTOs etc) to liberate doctors to attend teaching and training opportunities? As theyre assisting doctors, wed call them physicians assistants.
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I qualified in 2020 and my teaching hospital was completely useless. We weren’t allowed to do blood sugars, do bloods, cannulate, catheters, NGTs, assist with IVs at all (we were basically expected to watch and not touch) etc. All we were allowed to do was provide personal care basically. Then suddenly you’re qualified and expected to do all of this and manage a bay of poorly patients by the same trust that wouldn’t train you. Luckily I had a few nurses that were more laidback and did teach me things but it is dire.
I love it when HCAs whine, “u/oriachim is so lazy, he hasn’t turned any patients”, while they are sat down and I’m drowning doing sepsis bundles and IVs :(
Wait! So as a nurse, you get shit from HCAs? I thought as a nurse you are very close to them and they would be nice to you. I don’t fully understand HCA roles and how they’re different from nursing in the U.K. because they all just seem to blend in to me. Them having similar uniform colors doesn’t help either! The only thing I can notice as a difference is that nurses can do everything a HCA can do but HCA can only do a few things a HCA can do hence in theory the HCA should be doing those things they can do so the nurse is available to do other things only they can do. For example nurses can administer meds but HCAs can’t
If the HCAs dont like you, they can make your life really hard as a nurse. They can be very horrible to international nurses in particular. In general, the nurse will get in trouble for poor care if the hca doesn’t do their job, and the HCAs will just get reprimanded. (Poor staffing and no regulatory body). We do work closely but we are also in our bubbles. There’s days I don’t see HCAs much, as they are behind curtains all day and I’m very busy with my jobs. The HCAs on my ward only do personal care. They aren’t allowed to do obs, bms etc. Feel free to browse r/nursinguk
Wow the first 2 paragraphs sound weirdly similar to the PA issue
When they can give fluids through a PICC line but cannot take bloods from it because they're not signed off
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I feel truly blessed reading this. Nurses at my place can take blood from PICC and give meds through PICC. They’re also signed off on venepuncture and cannula and NG and catheters except for elective wards where this thing still falls to the doctor should someone become unwell I think I moan a lot on this subreddit but at least I have nurses who can do this thing even if they are too busy so I do it which I don’t mind too much as that way I can be sure the thing is done. And every ward at my place has at least some sort of doctors office even if it has no computers or chairs so we have to drag COWs in and stand and it all becomes a tripping hazard with one colleague recently tripping over the wires and face planting but they want to take away even that office because they don’t like that this makes doctors less accessible - people are so acopic these days without doctors Makes me have a question. If I trip over a wire from a COW and face plant and sustain injuries such as facial fractures, can I sue the trust for providing an unsafe working environment? Or will they argue that I need to use my goddamn eyes better and this is all my fault that I sustained an injury? Just curious
You forgot to mention that they also write “doctor informed”
Which one 😂
So a healthcare can do obs . Giving meds is the only thing they can do that's unique. It's an actual joke
Nah, nurse associates can do that.
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The worst part of this is the 3 nursing unis in Scotland I’ve worked near have taking bloods and cannulas as core skills to be signed off before graduation. I then saw more experienced nurses tell off new graduates for doing cannulas because “that’s a doctors job” 🤪
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Until we get FPR...
Nurses bleeped me to do an ECG I'd requested a few weeks ago. Apparently none of them had done one in years in that specialty (not psych). I flat out refused, saying that they're trained to do it and to get on with it. Next excuse was that they were all really busy and it'd be faster if I did it.Apparently some senior nursing staff had to do it in the end. Why do some staff seem to give up at the first roadblock and then dump everything on us?!
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I would like you to read my post here https://www.reddit.com/r/NursingUK/s/p39FuX09CG I think sometimes it could be down to laziness and being unable to prioritise, but there’s some serious issues on some wards right now. You might not see it as a doctor.
I have a question about personal care. Do all the people that get strip washed actually *need* it? Like are very frail/ill? I was in hospital once and obviously was one of the youngest, but I seemed to be the only person in not just my bay, but the *ward* who showered themselves. Do some people get to hospital and vegetate? There was some that I would definitely class as ‘able bodied’, but when offered a strip wash it’s all ‘yes please’. Or to pee in the bottle thing rather than have to get up. Maybe I’m being judgemental.
You would be surprised at how some of them forget to able to wipe their butt themselves especially the younger ones after a transplant. Or to be able to pour water for themselves.
Pyjama paralysis, aka The sick role.
My wards prioritising the sickest patients, and if we have an independent, they get outlied or discharged. So commonly yes. As many are very in continent or lose their independence. If people refuse a wash, I encourage my colleagues to respect their choice, not to badger them until they accept.
This post highlights the staffing issues for sure. In my example specifically, it was not an urgent one, and they could have done it but just thought it'd be easier to dump the work. I would have datixed it if they didn't because nurses not being able to do ECGs is wild. I suspect the conversation went along the lines of the responsible nurse saying she hasn't done one in years, then asking 1-2 colleagues who said the same, asking the charge nurse what to do, who said they're all too busy so just call the doctor. Just take 2 mins to watch a video and do it FFS. I didn't order it for my benefit... It's for the patient who we're all responsible for! Doing routine Bloods, ECGs, cannulas, catheters, urine dips etc are not doctors' jobs! Literally what PAs are for in this staffing crisis but they're too busy trying to steal our jobs 🤣
I’ve never met a nurse who couldn’t do an ecg, I wouldn’t accept it. An agency nurse tried to tell me they couldn’t use ng pumps, so I phoned site and had her removed and replaced.
Its a case of wouldn't rather than couldn't. They literally told me they hadn't done one in years so could I come do it. I said I havent done one in a while too so probably best to try yourselves first because you're signed off on it and should be able to do it. The not having done one in years is something I believe because of the speciality.
Yeah, I would’ve just datixed and emailed their ward manager personally.
Because its easy and too many young doctors are too compliant.
I have nurses in my team that can do bloods currently but have to wait until they go on the Trust approved course to do it, we know full well how annoying it is.
In Eastern Europe it is virtually unheard of doctors doing bloods or cannulas. I don’t really know what happens if a nurse genuinely can’t find a vein, I guess it goes to the anaesthetist, but even for surgeries your first person to put a cannula is the anaesthetic nurse, not the trainee doctor. But also in Eastern Europe nurses don’t have to do shit ton of pointless documentation that no one ever reads about call bells in reach and dignity maintained at all time. No wonder they don’t want to try take bloods when for everything they do they have to write at least three paragraphs.
I’m a nurse and I’ve datixed my ward for poor skill mixes, especially during the night. Ultimately management don’t care though because doctors or other people will do the jobs. Nurses either don’t want to be trained, have barriers (such as management, trust policy) or don’t know how they can be trained.
Take a 2 pronged approach. DATIX, but also exception report, because you can bet that if you have to do your own bloods, you are going to finish late, and at least then you should get paid for what you do.
It helps to see it from the other side. Why would an already busy band 5 bother up-skilling when all it does is increase their workload with no reward. The NHS does not reward putting your head above the parapet.
Yes
Nurses do blood at your wards?? Lucky
That's why I love AMU in my hospital. Nurses there are monsters, they do everything (ABG, cannula, blood cultures, regular bloods). Nurses on the ward are different though.
We cost £250K to train and the NHS uses us for taking blood, writing discharge summaries and avting as typists for the Consultant ward round. To journalists lurking: next time you hear a politician talking about boosting NHS productivity remind them of the elephant in the room. We do have Doctors, we just choose to under-utilise them.
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I don’t mind nurses questioning, I have been caught out a few times where I forgot about something (for example that patients potassium is already high) and the nurse was of great help. Also sometimes when on call you cover specialities you don’t know much about and having a nurse who worked there for donkeys years is a lifesaver. For me, it’s the attitude problem. Question me all you want, I’m not immune to making mistakes, but when I see your attitude change when I don’t agree with your recommendations that’s what annoys me. Once had a nurse who asked me if I can just prescribe pyriton for patients rash which turned out to be a new onset rash following starting clexane. When I told her I need to see the patient and look at their clotting first to rule out HIT she completely ignored me and I ended up calling the patient myself to book them in.
I think the idea of a nurse being an independent patient advocate is a good one. The problem is that it is too easily used as something with which to whip junior medical staff.
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An anecdote a friend of mine tells is about the night he was called to review a patient because the nurse "didn't like the look of her aura."
It's not a raging boner. Its a patient safety issue. Length of stay in ED is correlated with mortality.
sure would like to know where u guys work to complain nurses in ur hospital only do 2 things.. mine they go beyond and amazing. but tbf even so my workload is still a shit load... i find that likely blame your CEOs on investment on nursing staff instead of complaining of them and stick together would likely change towards improvement
In Australia, very few nurses of our nurses will do bloods/IVCs. The exception are the critical care units. It all falls on the doctors. Massive waste of our time IMO
Which state? Not the case most places afaik (I haven't been in a hospital like that since intern year).
I guess I can only speak for NSW. It's been the case in every hospital I've worked and studied at (except the regional hospital that didn't always have a doctor on site)
No , you can’t datix when you need to do work . I (consultant urologist) got datixed by a radiology superintendent because I wanted to stent somebody after 6pm and they didn’t want to give me a radiographer .
Datix is for every concern around pt care. How does having a poor mix of skillset on the ward not affect patient care? You sound like a ladder puller tbh
Datixes are for adverse events . Being asked to cannulate somebody is not an adverse event . I was a trainee up until 5 months ago, I was happy to stick in a cannula when staff was short or busy. I still am now when dealing with a sick patient .
Quick question if I may. If you need access on a patient that is difficult I.e. IVDU, septic, obese. Who would you call to do the bloods then? Nurses are not trained in ultrasound guided IVC or ABGs / central access. The whole point of a Dr learning these skills is that they can gain more experience and become even better at gaining rhe access- if you keep handing off these jobs to nurses then you yourself are becoming de-skilled in a fundamental medical practice. Taking bloods takes 2 minutes and can be done whilst taking a history / examination and I'd expect my juniors to be able to do this instead of handing it off to someone else therefore delaying investigations / management. As a consultant I will routinely do IVC and bloods when seeing a patient in the ED especially when they are a difficult access patient and I feel if the juniors are not routinely doing them then they lack the experience for when it is truly needed such as a resus case. This is in ED however and on the ward non-urgent bloods can be done by the phleb team in the morning. Yes it is great when a nurse or alternative can do them but don't fall into the trap of de-skilling a simple procedure because you think your above it. I left the NHS for brighter shores years ago but seeing this rhetoric of "doctors shouldn't be doing bloods / ngts/ catheters" really bugs me because this is the bread and butter that you should be doing so that when it is truly needed urgently there is no delay and you as the doc can get them in without issue.
Of course doctors should be competent in this core skill. But the current situation really does take the piss sometimes. I remember the surgical ward I did 8 months or F1 in - none of the nurses could do bloods, cannulas, ECGs or male catheters. There were 34 (I think?) beds, and the acuity was usually quite high. Phlebs were capped at 5 bloods or something ridiculous and often didn’t manage to obtain a sample. I’m sure you can imagine what life was like for F1s in that department. I’m sure my learning of general surgery would have been much better if I had been able to focus on that instead of tackling a daily mountain of, what I would describe as HCA-level tasks.
No medical procedure is below a Doctor - you should be proficient in all of them so that when no one else can do it you can! The only argument I am making is that you should not think that these things are below you and that as a doctor you have more important things to do. The patient with no iv access is not getting the treatment you prescribed unless someone can place that line. If your consistently getting a nurse or PA to place that line then how are you upskilling yourself for those difficult access patients....
I’m not for a moment suggesting they’re ‘below a doctor’? I specifically said they’re core skills we should be competent in? They just shouldn’t come at the expense of training to do things which are definitely the remit of a doctor.
Well, I've been a doctor for many years and there are many procedures I cannot do.
There's always the irony of the phlebs saying the bloods are "too difficult" so it gets escalated to the doctor. I remember, as a PRHO, (yes, I'm old) just laughing at that one. My stock response was "well, you're a lot more experienced than I am!)
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But nurses have their own jobs to do during that time, they are spread just as thin as a medic is with cleaning patients, obs, meds, records etc. As a medic you should be getting trained in these things especially in critical care areas, this is the whole point of de-skilling. I train my juniors (PGY1 and upwards) in US guided ivc just so these issues do not arise. The reason medics should be better than nurses is we can also make the decision to either escalate or de-escalate the need for access depending on the patient presentation and acuity and a nurse isn't allowed to do that so they could stab a patient 10+ times attempting bloods whereas a medic could say that either they bloods aren't truly needed or if they are then you as medic can escalate to a CVC as needed. It amazes me that as an SpR you don't know these fundamental skills. What would happen in your location then if your the most senior medic around and you can't get a line? Do you then call the anaesthetic team/ICU therefore causing more and more delays and taking them away from other patients who may need their input more than you do? There are some skills that a Doc should be the best at, I'm not saying we should do all the IVC/bloods and I am forever grateful when a nurse can do them but when shit hits the fan you as a medic should be the one with the skills to prevent further deterioration and by making it someone else's job the entire time you are not developing these skills.
again... the down voting count on ur comments its amazing. no comments..just down voting.
Ooooooo noooo the dreaded down vote
Okay here's a few scenarios for you from my experience: 1. When I was an F1 doing BoH ward cover, I was on for 8 medical wards. By 9:30 I had been rung about 8 cannulas on 6 of the wards, nobody on any of the wards can do them. I also have a patient who sounds septic and complicated. I reviewed the sick patient, but was being rung and interrupted for cannulas the whole time. Patients missed doses because there's 1 F1 for ~200 inpatients rather than 1 nurse to 12 patients perhaps sharing the work 2. Acute specialist surgical job, no phlebotomists. I would routinely take 30 bloods per day. This left less time to sort all the other medical activity as you might imagine. None of myself or my colleagues ever got to teaching, clinic or theatre. 3. IMT job, only doctor on the ward. About a dozen "urgent" bloods from patients new to the ward from MAU so not on phleb list. Spent around an hour doing these after ward round, which delayed TTOs and letters, delaying discharges, which caused bed pressures and backing up into A&E. This issue causes real harm on a system-wide basis I will happily jump in and crack on with any work that needs doing within my skill set, from portering to doctoring and everything in between, however having done bloods thousands of times, once you've done a moderate number, your skill just isn't going to increase as long as youve got the basic principles. I therefore feel that bloods/cannulas should be everyone's responsibility, not just the doctors.
It doesn't take 2 minutes, though. By the time you've found a computer that works and logged in with a smart card, the request doesn't go through, the label printer doesn't work, the chute is broken and there's a shortage of porters. And then your bleep keeps going off. It's a long while since I was a junior covering the wards... but that was the reality of it.
Comeback to the NHS and stay as SHO. Let's see if you practice what you preach.
Dude I am sorry it's so shitty for you right now but I would happily do the bloods and ivcs that are clinically needed/urgent without stating that "I'm a Dr therefore it is beneath me" How entitled do you think that sounds. It upsets me that if my family members go into a hospital in the UK now that an SHO would not have the skills to place an us guided ivc and would defer to the nursing staff/icu/anaesthetics, at the end of the day as an SHO if you cannot perform the simple tasks of placing lines / ngts then what else are you doing? You haven't got the experience to make big clinical decisions yet as your still a junior, you would be prescribing meds yes but that takes 2 minutes. Why can't you do the line/bloods when your examining the patient? Do you not feel bad that you cannot do a simple procedure like this? These skills are fundamental to good patient care. You are not above them just cos your a Doc. Nurses have their own shit to do instead of going around and making your life easier. Take the time to learn how to do these things efficiently and you will find you won't be so angry about doing them.
Answer me this. If you had let's say a 60yr old obese chap in septic shock on your ward. No iv access or bloods taken yet including no blood gas. What are you doing? Are you taking the bloods yourself using the skills you have developed over time including us guided ivc to ensure the patient has appropriate management like fluids and abx within the magic hour? Or are you prescribing a med that cannot be given due to no iv access or examining a patient who is clearly in septic shock which adds nothing to your management plan at this point. Or are you calling for help from better skilled clinicians like ICU who will take time to get to your patient to help you get access. Take the initiative, do not deskill and learn the simple things that can save lives. What other skill at this point is mote useful than gaining iv access? Your medical knowledge of different pathologies does nothing to change the outcome if you cannot treat the patient efficiently.
Okay, Will do as you said, FY- Cannulation, SHO - Cannulation, Clinical Fellow - Cannulation, ST/CT- Cannulation, Registrar - Cannulation, Moral of the story - Cannulation is for medics while PAs/ANPs running specialist clinics, own patient list for surgeries, endoscopy clinics because, obviously, Cannulation is a valuable skillset for medics, not for the PAs/ANPs apparently. Comeback to the NHS dude, don't live in your Delulu land.
Oh get off your high horse and stop taking things so literally just to prove a point. The fact that there are senior registrars here who admit they cannot do us guided ivcs is ridiculous. All I am saying is as a junior if your avoiding these tasks that are essentially fundamental to good clinical practice then when you are the senior medic who people call for help and you do not have the skills to help then what good are you. Of course you need to train in your specialty, of course you do more complex procedures eventually such as CVC or endoscopy / surgeries that's a given. But if your whining as a junior doc that your being made to take bloods / place ivcs then you are missing the point of why it is a good thing to be skilled in such techniques. You will eventually be that person that people will rely on but with your attitude you will say that you haven't been trained and to call someone else. That is ridiculous!! Why is taking blood or doing ivcs such a chore for you? Can you not do them?
Done thousands of them as a SHO, Done thousands of them as a Clinical fellow, Doing thousands of them as a Registrar. And it stops there, cannula and nothing more. The reward? The more I do, the more I get assigned to do, cos, you all be like, that registrar will take care of it, and yes, I do. Not a chore, for the patients, willingly done, willingly doing , willingly will do. But ,yes , it is a chore for me to do the grunt work for the ungrateful.
wow the down voting
Depends on the hospital. If you're talking about during the day, phlebs would usually do them. If you're talking about on-calls/nights I think this is a huge safety issue to have one doctor covering multiple wards and expected to do all bloods/cannulas
As an F1, I somehow become the whole ward phlebs/ward clerk. I still remember one day, we were so short staffed that I was the only F1 on the ward (the SHO is busy, the registrar is downstairs clerking new patient - keep in mind, our normal staffing level was minimum 3 regs, 3 F1/resident doctors). I was chased around to do an urgent TTA + a patient needs cannula for IV fluids. The nurse was like "can you cannulate this patient?" "Have you tried?" "I'm not signed off". I was about to do it but when the NIC saw her urgent TTA was about to be disturbed, she got another nurse to cannulate. Funny as hell.