Is it in the protocol, Nurse?

8 Mar

I think I should start by declaring an interest.  I like nurses and value their contribution to patient care.  They are often seen as being more approachable than us and those in their charge will sometimes volunteer  information which they would never have given up to a GP like: “I don’t like that doctor, he’s rubbish and I’m not seeing him again”.

Nurse practitioners are increasingly expanding their role, taking on diagnostic tasks and becoming prescribers (at which point they tend to stop wearing the traditional uniform and make the transition to GP-tweed and golf, and five children, and people carriers and labradors).  I think this is all to the good – our own NP is highly valued by our patients and we both possess skills and knowledge the other doesn’t so I like to think we’re a complimentary team.  She has forgotten more about contraception than I will ever know and I’m quite good at apostrophes.  (For those male collegues who might get around to reading this: contraception is those pill things some women take.  Sometimes).

Specialist nurses (such as those working in palliative care) are a tremendous resource and will often make suggestions which you’ve never considered and end up really benefiting patients.  I like to think that I’ve never been too proud to ring them for advice and take on board their suggestions – such as chocolate-flavoured laxatives – surely the future?

As a newly-qualified doctor, we found that nurses were an amazing source of wisdom and knowledge on the wards.  They knew the secrets of every consultant’s foibles and helped us satisfy their every whim.  They helped us solve clinical problems and made helpful suggestions, put fluids up when we’d forgotten to prescribe them and saved patients from our inexperienced decisions time and again.  Except Sandra.

Sandra had been a crisp-packer before making the transition to nursing and undertook her entire shift’s duties according to the protocol.  If it wasn’t in the protocol, she simply didn’t do it and telephoned one of the junior doctors instead.  I used to wonder if she had a protocol for making a cup of tea on her numerous “fag breks” or one for watching Coronation Street at home.  I first came across her when I was employed on the medical wards at the very outset of my inaugural job – she paged me for advice one evening around 8 o’clock:

“It’s Sandra on three.  Can you come and see Mr Thomas, he’s unresponsive?” she asked.

“Unresponsive?  Is he breathing, is there a pulse?” I asked, starting to worry.

“Erm, no, but it says in the protocol that you ‘ave to come and see ‘im” she said.

“Well, I think you need to put out a cardiac arrest call if he’s unresponsive and there’s no pulse.  I’ll be there as soon as I can.”  I set off running as fast as I could.  I was on the south side of the site about as far from Ward 3 as it was possible to be without being in someone else’s hospital.  My pager exploded into life: “Cardiac arrest, ward three, cardiac arrest, ward 3.”  I reached the ward gasping for breath.

“‘E’s in ‘ere” said Sandra, pointing into a side ward.  I almost fell into the room, virtually collapsing with exhaustion after my gargantuan physical effort.  There was no doubt that Mr Thomas was indeed unresponsive.  He lay under a sheet covering him from head to toe, a single carnation placed gently on his chest and a bible open on the bedside locker – the whole spectacle dimly illuminated by the soft overhead night light.

“He’s dead, isn’t he?” I asked, “you’ve even laid him out.”

“I know, but it says in the protocol that a doctor ‘as to certify ‘im, so I bleeped you.  I can’t say ‘es dead.”  As the remainder of the cardiac arrest team fell breathless onto the ward, I realised that I simply didn’t know what to say to her and so filled with incredulity I turned silently and left.

With the benefit of experience I know what I’d do now in that situation.  I’d reach for the lever arch file, sit myself down and have a good look at what to say to a nurse who asked me to urgently see a dead patient  – after all, it must be there, in the protocol.

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