More power to nursing practitioners

I’ve spent the past 12 months being investigated, referred, treated, referred again and treated again within the NHS. It’s been an interesting experience – enlightening, frightening and frustrating – and if it hadn’t been for the good offices of an emergency nurse practitioner, it could have been much more dramatic.

As a patient, but perhaps more specifically as an ex-nurse (I still sometimes wonder whether nurses can ever be ‘ex-‘), I’ve gained some insights into the stresses and strains of a typical day in the NHS.

I offer my insights here in the hope that they’re of some use. I should say now that these thoughts apply mainly to my experiences in the emergency department and the outpatient clinic. The situation may be different on the wards.

• How difficult it is for patients to be assertive. Even if, outside the hospital, you are fit, young, and confident – like the fitness coach with whom I shared a four-hour wait in an outpatient clinic – there’s something about the environment that robs you of any backbone whatsoever.
• Nurses and particularly doctors are always so busy. They also seem good at letting us know how busy they are.
• Most patients are tolerant and respectful of hospital staff. We are reluctant to bother you needlessly.
• However, there is a widespread perception that the system is creaking at the seams.
• On the front line there seems to be an inverted pyramid of responsibility. That is, more junior healthcare professionals seem to have so much more to juggle – bleepers, telephones, forms, requests from other staff and so on – than their seniors. How do they concentrate properly? Do they concentrate properly?
• Patients never see the same doctor twice. And the information we are given varies subtly from consultation to consultation.
• Most professionals are highly skilled and also caring. I can think of one or two exceptions, but at least 50% look utterly deprived of sleep.
• Inter-professional rivalry is still alive and living at … well, I’d better not say where.

Actually, I should qualify the last point. In my experience, the more senior hospital staff appeared to have little trouble accepting and respecting the input of the multidisciplinary team. The strain seemed to show most at the margins – that is, where the potential for crossover is greatest.

The problem that led me into the hospital system was fairly minor (and apparently fairly non-specific), but it eventually resulted in a relatively uncommon secondary diagnosis: complex regional pain syndrome. It took the determination and care of an A&E nurse practitioner to insist, against the wishes of an on-call registrar, that I needed to be followed up quickly to get me into the ‘system’, rather than being knocked back onto my own devices.

I’m also grateful to the dedication of a physiotherapist team, and their willingness to refer back quickly and decisively to medical specialists, which immeasurably improved the quality of my recovery.

This leads me to my last observation, which of course is based only on my experience. But that experience shows that, unless you have a very clear and treatable diagnosis, it’s difficult to get past the gatekeepers (the on-call specialists) of the health system. However, I was lucky in my situation – which was medically very unclear – because the presence of a strong nursing advocate made all the difference and probably saved me from much more serious, indeed potentially devastating, complications.

About the author

Ed Rowe trained at St Mary’s Hospital in Paddington, London, in the late 1980s and practised in general surgery. He now works as a medical copy editor and a stay-at-home dad.