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Patients at risk under radical nurse plan

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Patients would be put at unnecessary risk under proposals to allow nurses to undertake endoscopies and administer anaesthetics, the AMA has warned.

In the latest attempt to encroach on the scope of medical practice, the Grattan Institute think tank has suggested that public hospitals could save almost $430 million a year by getting nurses to take over some of the “common, low-risk” procedures currently performed by doctors.

Director of the Institute’s Health Program, Dr Stephen Duckett, said millions of dollars could be saved by ending what he said was a mismatch of skills and jobs in public hospitals.

Dr Duckett sad doctors, nurses and allied health professionals were squandering their valuable skills on work that could be adequately performed by others.

“It doesn’t take 15 years of training to provide light sedation for a stable patient having a simple procedure, or a three-year degree to help someone bathe or eat – but that’s where we are now,” he said.

The former Health Department Secretary said nursing assistants could be used to free up nurses’ time by providing basic care to patients and, in turn, specially trained nurses could assume some of the common, low-risk tasks currently performed by doctors, giving them more time to treat patients with more serious and complex problems.

Dr Duckett said experience overseas indicated that initiatives such as getting nurses to administer local anaesthetics to patients  following assessment by a doctor and under their supervision, could be a safe and effective way to make better use of the skills of doctors, nurses and other health workers.

 He said the respective roles of doctors and nurses had in some cases been established a century ago, and there was a need to update the system.

But AMA Vice President Professor Geoffrey Dobb told ABC radio the idea was based on an inadequate understanding of how modern hospitals operate.

“You never know at the onset of a procedure how it’s going to pan out, and during any procedure there is the potential for someone to have an adverse reaction to one of the sedative drugs…by way of, say, dropping their blood pressure or dropping their respiratory rate,” Professor Dobb said. “It’s only after the procedure is completed [that] you know that it’s been straight forward and uncomplicated.”

The Australian Nursing and Midwifery Federation told the Adelaide Advertiser the report ignored the fact that “large numbers” of nursing graduates struggled to get hospital jobs, and was naïve in its assumption that a big increase in the number of nursing assistants would not put registered and enrolled nurses out of a job.

Adrian Rollins