Friday, August 24, 2007

But how strange the change, from major to minor

I spent most of the day in the minors department today, as opposed to the rest of the week where I was in majors. Now unlike most of my colleagues, I don't actually mind working in minors, I believe it is part of my job and I tend to get annoyed with people who work in A&E for all the adrenaline rush of a Casualty episode, and sometimes minors can be as interesting as majors.

I do however, get annoyed wth Emergency Nurse Practitioners (ENPs) telling me how to do my job in the minors department. Unfortunately minors seems to be overrun with ENPs, apparently it speeds things up and allows for more patients to be seen, in essence though it slows things down and means that I cannot get on with whatever I am attending to. Today I was told by an ENP how to check for concussion and that the patient that has arrived in minors didn't need a CT scan to rule anything out as "minors don't refer to CT, if triage think they need a CT then they get sent to majors" and "they've only had a minor bump on the head". Just a minor bump on the head that left them forgetting all of yesterday evening and meant that their left pupil wasn't reacting at the same speed as their right one today.

The same ENP then called me away from my patients 8 times in the space of 4 hours to ask me my opinion on her patients. I have no problem with people requesting a second opinion, in fact I'd rather have an ENP ask me my opinion on a case than assume they can deal with it and miss something dangerous. The department has quite a lot of ENPs in minors though and if everyone of them asked for my opinion (or another doctor's) twice an hour then the doctors wouldn't get round to seeing any patients.

ENPs are meant to be able to see patients alongside doctors and therefore clear the minors waiting area in half the time, but if this particular ENP was anything to go by then the waiting area would clog up and go twice as slowly. I'm sure they do a very valued job and I'm probably being unreasonably unfair but when I start to assess or treat a patient, I quite like to complete the treatment without that many interruptions (within due reason) and I don't like being interrupted by the same person so often. Maybe she saw me as a soft touch, or maybe Friday was just my turn to be her oracle. I guess I'll never know.


Merys said...

I've started working in A&E lately as an auxiliary, and one of our ENPs asked me to go and help a man out of a car on my last shift. She said he'd had a car accident and his friends had brought him in.

In fact, his friends had pulled him out of a car that had rolled over 5 times, and he was currently sprawled, laid across the back seat in pain.

Oddly enough, I didn't pull him out of the car as I'd been instructed. It's always nice to receive some kind of briefing before hand, and know when you're out of your depth.

Ironically, the only injury he sustained was a torn earlobe...

Mousie said...

While the majority of our ENPs are great, one of them asks the doctors about absolutely everything she deals with.

It always makes me wonder why we bother employing her at all, the patients might as well see the doctor in the first place.

Having said that, I've also met several doctors who can't make a decision / discharge a patient / read an ECG unless they've discussed it with four other people first.

Just stumbled upon your blog and very glad I did. Hope you are well and back to blogging soon.