How can I represent nursery skills?

[whswhs]

Originally Posted by Rupert

From what I've seen here, NPs in community health centres usually prescribe medicine that you could get over the counter, so it'll be cheaper (scripts are subsidised) and diagnose things like childhood illnesses, etc.

Here in Kansas, my wife is seeing a psychiatric nurse practitioner. She has cancelled or reduced some of her former medications and introduced at least one new one. I suppose there's a psychiatrist in the background, but C hasn't seen them, if so.

[malloyd]

Originally Posted by Stormcrow

I think the skills a professional nurse would have are Physician, Diagnosis, and Professional Skill (Nurse). The last of these represents the skill of dealing with things like bedside manner, feeding patients, helping them get dressed or go to the bathroom, juggling patient accommodations, operating hospital equipment, communicating with doctors, and doing the relevant paperwork.

I'd say most of those are part of Physician, with a side of Administration.

People called Physicians in the US mostly use the GURPS Diagnosis skill, they have Physician and Pharmacy, but is isn't their main job. Most of the GURPS Physician mechanics - the taking care of patients stuff that scores them bonuses to recovering - is done by nurses.

[Kromm]

Originally Posted by malloyd

People called Physicians in the US mostly use the GURPS Diagnosis skill, they have Physician and Pharmacy, but is isn't their main job. Most of the GURPS Physician mechanics - the taking care of patients stuff that scores them bonuses to recovering - is done by nurses.

I totally agree. When I think about my problems, my surgeries, my courses of treatment, etc., it just about always looks like this:

1. Go to clinic/hospital for problem.
2. Seen by triage nurse who sends me to the right doctor – or home.
3. Seen by doctor, who sends me for tests.
4. Nurses take various samples which go to various technicians for labs. Other tests run directly on me by technicians.
5. Doctor looks at test results and creates course of treatment.
6. 1. If pharmaceutical, pharmacist takes over from there (here, they're allowed to practice and prescribe).
   2. If surgical, surgeon takes over from there, but nurses are who I see in recovery, other than to sign the form for my release.
7. Periodic follow-up visits to nurses for blood-pressure readings, removing sutures, whatever.

Nurses do all the hands-on stuff other than surgery: initial interview, sample collection, monitoring, and follow-up care. Doctors do all the diagnostic stuff (initial guess, test analysis) and the high-liability stuff like surgery and release. And technicians do all the work of actually running tests and informing me about medication.

Indeed, I've had doctors mostly step aside to let nurses draw blood, insert IVs, and all the rest. Most doctors seem to prefer not to do "wet" stuff like that if they can humanly avoid it.

[Tyneras]

I wonder if some confusion is caused by medical dramas that make the doctors far more hands-on than they are in reality, often combining a doctor and multiple nurses into a single character. Not to mention not strongly differentiating doctors and surgeons a lot of the time.

[transmetahuman]

I have a general practice primary care physician here in California USA that I've never seen in the four or five years I've "had" him. I see his nurse practitioner, and she prescribes my meds and sends me to specialists as needed. She did consult the doctor once on something obscure, but my impression was that she was just tapping him for his experience in that area, not that she needed to go through him.

If a treatment involves more than Rx medication, it's always through a specialist - as far as I know, they're not set up to do anything at my PCP's office beyond checking blood pressure, height/weight, pulse and blood oxygen level using three gadgets total. Well, they probably have Band-Aids somewhere.

I quite like my nurse practitioner, I just think it's funny that I've never actually seen "my doctor".

[Kromm]

Originally Posted by Tyneras

I wonder if some confusion is caused by medical dramas that make the doctors far more hands-on than they are in reality, often combining a doctor and multiple nurses into a single character. Not to mention not strongly differentiating doctors and surgeons a lot of the time.

Probably.

In any field with highly trained people who get big pay in return for taking on big risk (physical, legal, financial, or reputational), dramatizations focus on the risk, making that look like the whole of the job in the popular imagination. There are more stories about race-car drivers than about crack pit crews, too, and about astronauts than mission-control personnel. That doesn't mean that nurses, pit crews, and mission control don't do most of the work most of the time; it just means that the work they do isn't as "sexy" as craniotomies, hairpin turns at 305 kph, and space walks, even if it's just as important or more so 95% of the time.

Not that it's a great example of medical realism, but I'm always amused when I'm watching Grey's Anatomy with my girlfriend and patients are in these hospital rooms crowded with surgeons doing stuff that I've only ever seen nurses do when I've been in hospital. Meanwhile, the nurses are these mostly nameless figures with no screen time. When real life would absolutely, positively call for a nurse, they throw an intern in there instead. Which I'm positive would be a lawsuit waiting to happen in real life.

[Celjabba]

Here in Luxembourg and in Belgium, many family doctors don't have a nurse and are quite capable of (and equipped for) doing hand-on stuff if needed.

At an hospital (emergency room, surgery, ...) or for follow-up care at home, it's another story and my experience mostly match Dr Kromm.

Nurses couldn't diagnose or prescribe treatment or medication, although very recent laws (2018 in Belgium) have created a new "advanced nurse" training. Those can.

[Kromm]

Originally Posted by Celjabba

Here in Luxembourg and in Belgium, many family doctors don't have a nurse and are quite capable of (and equipped for) doing hand-on stuff if needed.

That used to be the case here, too. In the late 1960s, through the 1970s, to the early 1980s, I distinctly remember my family doctor having the gear for things like burning off warts, suturing cuts, and syringing out ears; a procedure room for what we'd call "minor outpatient surgery" today; a large, secure cabinet full of medications which he'd dispense directly; a big ol' oxygen tank; and a small lab for running basic tests. I recall getting injections and stitches there, smearing blood on test strips and peeing in bottles, and so on.

Sometime in the '80s, that changed.

Every doctor I've had for about the past 30 years has had basic diagnostic instruments and that's it. They weigh me, take my blood pressure, check my heart and breathing with a stethoscope, peer into my ears and down my throat, palpate organs, and not much else. Since about 1990, I haven't had anything break my skin or involve bodily fluids, and I've received no medication, in a doctor's office. All of that happens at hospitals or specialized clinics, and just about always with a nurse or technician in attendance, not a doctor.

I'm not sure how or why that happened, honestly, or which situation was in effect for longer (I'm 53, so it's about 40/60 in my experience). But today, family doctors don't do that stuff here.

[Kalzazz]

Nurses get to wear scrubs while doctors often seem forced to wear formal attire like ties and sweaters

When I was a kid doctors always wore lab coats but now I almost always see them wearing a sweater

Being able to wear scrubs while working almost seems like a perk.

What do nurses use the big front pockets on scrub told for? I know as a decon tech (another job blessed with the can wear scrubs perk) we love the big pockets because anything you set down is assumed to become contaminated, so you never set stuff down

[johndallman]

In the UK, general practitioner doctors have a bit more diagnostic equipment, such as ophthalmoscopes, but they don't usually have labs or dispense medicines. My local practice has a couple of nurses, who take blood, change dressings, and things like that.

Last time I went to Casualty, I'd nearly chopped off a fingertip, and the triage nurse decided to apply some first aid herself to keep blood off the floors. The nurse I saw for treatment called the duty surgeon, because it was necessary to do some dismantling before stitching. He was quite pleased with the job he did and called some students to look at it.

When I had eye surgery in July, I saw several nurses who were preparing patients and looking after them for recovery. I saw my actual surgeon for a final check and to sign the consent form before surgery, and the anaesthetist, who seemed to want to make sure there were no errors in transmission of information. They were the responsible people and did the surgery (I was under general anaesthetic). I talked to them for five minutes each in a six-hour stay in hospital; everyone else was nurses.