Posted by: Witch Doctor | May 10, 2008

Dr Nurse, complexity and the gambling den



DB’s Medical Rants touches on Advanced Practice Nurses and the Dr Nurse.

On dealing with complexity:

“The problem with advanced practice nurses is scope of practice. I have worked with NPs over the years. They can do a good job with straightforward problems. They often have problems when dealing with complexity. Unfortunately, one never knows when complexity will rear its head.

Although obvious, The Witch Doctor is always astonished when this point is missed when discussing healthcare. It has to be acknowledged that if a healthcare system does not have within it, the ability to deal with unexpected complexity, then that healthcare system is playing roulette with patient care.


Most of the time, when treating Well Clients, the odds will be against complexity. Some may consider this is a risk worth taking. It is roulette, nevertheless.

It should be made explicit to Clients that they are playing roulette.

And if Clients are happy to gamble, so be it.

That is Client Choice.

Patients, however, are quite a different matter.

The odds that complexity will not rear its head are stacked against them.

With patients, The Gambling Den should be closed.

And in a society striving towards excellence in healthcare, it should be closed for Clients too.

Because Patients are sometimes disguised as Clients.

This, is one of the reasons why The Witch Doctor believes we need more doctors.

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  1. Of course we require more doctors. The government though believes that doctors can be easily
    “replaced”. I have often viewed the clinical management by nurses with a number of fears.

    1. They lack the basic medical education.
    2. They are unable to think laterally [ no criticism of them but more about the manner they are educated]
    3. They work in ” rote” – and cannot think outside the box. People don’t come inside “boxes”. Each clinical problem requires a 3D view.

    So I agree with Dr G.


  2. i am in the US a RN and i am considering AP.I have worked in the operating theatre for 20 years and would disagree (of course )that we do not think outside the “box” rote occurs in both professions.I ddo not wish to replace any physician and of course you have more extensive training in the sciences. I think the AP nurse can be a useful assistant to the physician an as you do not practice nursing we can often see problems that you would not

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