Monday, October 02, 2006

The training of the Noctor

I’ve written about Noctor’s before. This seems to be a growth area. Many of our best nurses are being lured into Noctordom with the promise of higher pay and ‘autonomous practice’.

These nurses are often some of the best, but they are being sold a lie. They are being told that the role of a doctor is easily filled and that all they need is a little ‘top-up’ training to bring them up to this level. Like Eddie Izzard says ‘I don’t want top-up I want bloody fill up’ –he’s talking about life jackets but the same principles apply.

To illustrate. A couple of weeks ago a couple of former ICU nurses, now training as hospital at night ‘practioners’, came to see me. Could I teach them how to examine patients? Yes, in theory I could, what system did they want to start with and had they identified any patients?

Noctor ‘we’d like to learn how to examine the whole patient, and we thought we might practice on a dummy’
SM ‘the whole patient, in an afternoon?’(looks askance, eyebrow raised)
Noctor ‘ well we’ve had some lectures on it, we just want to practice it’

Dr SM is in the middle of preparing for his PACES –a higher post-graduate practical examination of ‘clinical skills’ which is needed to become a member of the royal college of physicians (not much to do with Anaesthesia, but that’s another story). To do this I need to be able to examine patients well and detect the abnormalities. I have been examining patients for 9 years and I’m still far from guaranteed a pass in this exam. How on earth these guys thought I could even start to teach them some of these skills in an afternoon is beyond me. They are sensible, intelligent nurses, the opinion that examination skills can be picked up like learning to tie your shoelaces has not been dreamt up by them. Someone has given them this impression, someone who has clearly never properly examined a patient in their lives. I despair. In a few weeks, Hospital at Night will start here – the nurses will be out of their depth and patient care will suffer. But the balance sheet suggests these Noctors will be cheaper, so that’s ok then.

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