Domhnall MacAuley: Nurses’ and doctors’ caring skills

Domhnall MacauleyToo many new nurses are “simply not up to the mark” said Peter Carter, chief executive of the Royal College of Nurses, quoted on the front page of the Times 22.9.11. They “arrive in hospital incapable of caring for patients because they have spent too much time in the classroom and not enough on the wards.” A scathing attack on his own profession. And, I cannot but agree. Patients tell me the standard of nursing in our hospitals is poor, no one really taking charge, no one taking responsibility. Fellow doctors, unexpectedly hospitalised, sing the praises of the domestic staff whom, they tell me, are the only ones who really seem to care. He risks the wrath of his colleagues. Such courage.

What about doctors? Would there be anyone brave enough to say that new doctors are not up to the mark? If it were true, would a president of a Royal College criticise his flock in such terms; that surgeons don’t always have the skills for the job, are poorly trained, juniors unsupervised, and that accidents don’t happen by accident. Or, that physicians take on responsibility for diseases they don’t know or prescribe drugs without knowing their availability or side effects. Or, that GPs may enter practice knowing little about most diseases and struggle with patient care.

Am I any better? Could I be spending too much time on the theory and too little on the practice- the medical equivalent of too much time in the classroom and too little on the wards. A GP in the past would have been available all the time. But having a portfolio career, like many doctors, means I am not available for patients every day. The surgery closes at 6pm and I don’t work for the out of hours service. I try to keep up to date but I don’t know everything and my limited clinical exposure must mean atrophy in some skills.

Nursing may have a problem. Back in the news for all the wrong reasons. But, this time its the CEO of the RCN asking questions about his own colleagues. Frank, honest, brutal. He deserves our respect but, rather than join in the chorus, perhaps its an opportunity to look at ourselves.

Domhnall MacAuley is primary care editor, BMJ