General practice nurses are super nurses, not doctors’ helpers

Frustrated with their status and often feeling undervalued, is it time to reconsider the general practice nurse role?

Frustrated with their status and often feeling undervalued, is it time to reconsider the general practice nurse role?

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At a time when general practice nurses (GPNs) are extending their roles in chronic disease management, minor illness and prescribing to meet the growing needs of primary care, research shows they think their role is poorly understood and undervalued.

Role status is an important marker of workforce satisfaction, and the NHS is starting to recognise that factors such as resilience and job satisfaction have been largely ignored in workforce strategy until now.

The NHS has said GPNs are an important element in the multiprofessional future of primary care because of the cost benefits of their work and the high levels of patient satisfaction with nurse consultations.

Status defined by comparison with GPs

But GPNs feel misunderstood and frustrated about their status, and we need to understand why. To find solutions, I have been asking nurses what they think.

GPNs take pride in being able to help people, and they feel that one of their most valuable skills is being able to take an holistic view in any consultation. They strongly identify with the idea that caring is a big part of nursing.

They define their status by comparison with GPs and see themselves as offering care that GPs no longer offer due to time constraints. GPNs have told me that their status is enhanced by undertaking roles such as prescribing medication – seen as being equal to a GP – and diminished by continuing in traditional nurse roles such as smear taking, which is seen as being an assistant to the GP.

Lack of regulated career pathway or proper pay scale

Increased status is marked by role titles such as nurse practitioner and specialist nurse, with such nurses sometimes referred to as mini doctors.

Despite attempts by the NHS to create development pathways, younger GPNs are leaving because they feel they lack status, a regulated career pathway or a comparable pay scale.

They blame this on a system in which they are directly employed by individual GP surgeries. This direct employment means there can be significant barriers to gaining a generalist skill set due to lack of training budgets and capacity.

Multi-tier nursing system affects job satisfaction

They value generalist skills and see them as essential to patient satisfaction and holistic care: the term ‘super nurse’ has been used to describe such a role. There is an assumption that GPs possess a generalist skill set but that many GPNs have been required to gain skills in one chronic disease area only.

Most GPNs would like to be multiskilled but feel that the effort needed to gain and maintain extra skills is prohibitive.

GPNs have chosen nursing as a career yet can only improve their status by gaining medical skills. This is creating a multitier nursing system that does not foster teamwork and can affect job satisfaction and possibly retention.

Dangerous divisions in GP nursing

This perception has led to the use of terms such as mini doctor, and there is a danger that GP nursing is becoming divided into those who perform medical work and become valued partners on one hand, and on the other those who assist the GP by doing traditional nursing tasks such as smear taking and are regarded merely as useful helpers.

There is an urgent need to reconsider the GPN role with regard to employment conditions, development pathways and the status needed to attract and retain high quality nurses and ensure a future for primary care in the face of ever increasing demands from government and the public.

All areas, not just education and academic development, must be given equal attention if GPNs are to be properly valued partners in the healthcare team. As one nurse put it, ‘as super nurses, not mini doctors.’

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Jan Glaze is a general practice nurse in Berkshire and a former midwife. She says general practice nurses are frustrated with their status and feel undervalued. They should be seen as super nurses, not doctors’ helpers.Jan Glaze is a general practice nurse in Berkshire 

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