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"[I]t is likely to be an inferior service"

April 15, 2006 -- Today This Is the West Country (UK) ran a short story by Laura Thorpe describing complaints by physicians about plans to end a local night nursing service because of security concerns. The piece, "GP raps plan to axe night nurses," is striking because it relies on the comments of one general practitioner (GP) making clear that nursing is distinct from medicine, and that physicians will not be able to provide the care in question as well as the nurses can. The piece might have explored more issues that would seem to be raised here, such as what the nurses think, and why nurses are less able to work alone at night than physicians. But we thank those responsible for this report telling readers that nurses have unique and valuable skills.

The piece reports that the South Somerset Primary Care Trust plans to end a local "out-of-hours nursing service" running from 10:00 p.m. till 8:00 a.m. because the Trust believes "it is unsafe for nurses to work alone at night." After the change, the pieces says, GPs will see the patients in question. But the piece reports that local GPs say the move "may...compromis[e] patient care." In particular, the piece relies on Dr. Berge Balian of Crewkerne Health Centre, who is chairman of "the Somerset local medical committee, representing GPs." Dr. Balian is quoted as saying that the change will mean "a different level of service, it is likely to be an inferior service." Specifically, Dr. Balian notes that the Trust has (in the reporter's words) "confused" the two services (medicine and nursing), and that "the level of care from a GP would not be the same as that from a nurse, who is more experienced at dealing with changing catheters and changing dressings." The piece also reports that affected patients are "scared and angry" about the decision, quoting one whose husband has a terminal disease and who evidently relies on the service.

Of course, the GP complaints may stem at least in part from a disinclination to perform the additional work that the plan will likely entail, which may include tasks that physicians are not typically asked to do and may dislike. We assume physicians like Dr. Balian already have plenty to do. But what actually appears in the piece is a pretty clear statement that what nurses do is different from what physicians do, and that physicians are (naturally) not as skilled at the tasks that nurses do more. The average reader might not regard changing catheters and dressings as the most technically difficult endeavors. But media products commonly assume that nursing is merely a lower subset of physician work, and that of course a physician can easily do anything a nurse can do. The fact that popular television shows commonly have physician characters providing all bedside care reinforces the notion that nurses are helpful but unnecessary physician appendages. We assume it would never occur to a viewer of "Grey's Anatomy" or "House" that a nurse could do anything better than the heroic physician characters who provide all significant physical and psychosocial care.

Of course this piece might have explored the basis for the Trust's move. Have there been specific incidents in which nurses' security was threatened? Why are nurses especially vulnerable--because they are likely to be female? If so, how do they differ from female physicians? Has there been consideration of adding security? And what do the nurses themselves say?

However, despite the limited nature of the report, we thank Ms. Thorpe and This Is the West Country.

See the article "GP raps plan to axe night nurses" by Laura Thorpe in the April 15, 2006 edition of This Is the West Country.