We cannot appreciate them enough, not just for their efficiency but for their kindness and the bonds they build with patients.
Consider this piece a summer bookend to Professor Louise Stone’s article from December – we unknowingly wrote the same ode as an end-of-year reflection in the same week.
Here is my (hopefully) non-controversial truth: when we have medical emergencies in general practice, I prefer to have an experienced nurse by my side rather than another doctor.
That is not to say that doctors are useless – we’re pretty okay – but a calm, competent and kind nurse is an absolute godsend.
I work twice a week as a solo doctor at our group practice in a little team of three women: a nurse, a receptionist and me. I am used to medical emergencies and seriously unwell walk-in patients, because our clinic is situated inside a shopping centre, and people love going to the shops while unwell. I am especially used to being the solo doctor at the time of these medical emergencies.
I am experienced and confident in decision-making and can generally lead a resuscitation or guide the management with clear and safe decisions. That is, after all, what I am trained to do. I cannot, however, draw up intramuscular medications or prepare a nebuliser or run a stat bag of intravenous fluids anywhere near as quickly or effectively as our nurses can. I fumble and search and sometimes just stand there confounded by tubing. I have no idea how to operate the IV pump – other than to silence it (obviously – are we even allowed to graduate medical school if we haven’t learnt how to silence an IV pump?). I’m not sure any of the doctors even know where the IV fluids are kept in our treatment room.
I can recall, with immediacy, hundreds of medication dosages, and tell you adjustments for renal function or weight, but I would take a good few minutes trying to draw up and dilute the same medications. The nurses can do it in seconds, with equal immediacy, recalling the steps for dilution or reconstitution, with a low error rate.
Would it be comforting to have a second doctor around for emergencies? Sure, and a registrar or junior doctor might say it was essential. But I, as a senior doctor, would prefer a nurse, while the registrar would prefer me. The registrar would seek the expertise of an experienced decision maker, and I would seek a doer of the decisions.
Related
I work with some really fantastic nurses. They have so much care for the patients and relate to them authentically. General practice nurses do this especially well. Our GP nurses largely live in the local community and have kids who attend the local schools or play in the same local sports clubs as the patients. Unlike the doctors, as we overwhelmingly live quite separately (physically and metaphorically) from the practice neighbourhoods, the nurses know about the local disease outbreaks, or break-ins, or community stressors because it is their community too.
The patients relate to the nurses genuinely and affectionately. They build strong and longitudinal relationships with the GP nurses. I have seen countless women have their antenatal bloods collected by a particular nurse, and subsequently had the same nurse administer the pregnancy immunisations, then postnatal bloods, and then years of their child’s care. The patients wait for their favourite nurse. The nurses see the patients grow and live and die, just as we do. The nurses to go their funerals, and write the cards, and remember their life events; we, the doctors, often do not have time or space to do this and we set hard boundaries that the nurses more easily soften.
This is not to say I have never had a terse or strained relationship with a nurse – of course I have. There was a time as a hospital resident that I was belittled by an older, very senior nurse for months, and it certainly played a part in me leaving the hospital system. Quite sadly it’s not uncommon for young women doctors to have these experiences, and of course they happen in primary care too. But overall, I like how we function in general practice – I like having an equal footing with the nurses. It is more collegiate, more enjoyable and therefore better for patient care.
I respect the GP nurses with whom I work. They have a culture of learning and supporting each other. They collect “interesting” ECGs in a folder and constantly share guideline or updated clinical protocols with us. They appropriately question my decisions if they sound erroneous or miscalculated or outdated and do it without confrontation or blame. I appreciate it when they seek me out to double-check a plan – it is a line of safety – and I do not feel undermined or threatened. I trust the nurses to protect the patient. And I trust them to protect me.
I have had plenty of crap days where I have been at the clinic until 11pm, sorting out the aftermath of an unwell patient or an emergency, and the nurses have not left my side. They have sat with me for hours, debriefing successful and unsuccessful resuscitations. They show us more kindness than we, the doctors, extend to each other – I truly believe that. Again, it is not to fault the doctor, but to recognise the strength of the nurses’ humanity, patience and compassion.
I have been at this clinic since I was a first term GP registrar and the nurses have seen me grow and grown with me. When I joined, I was the first woman doctor – the clinic started small and had only three male GPs at the time, so when I started, desperately missing my close female friendships of the hospital years, the nurses became my confidantes and friends. They listened and protected me and gave me a lot of emotional comfort. That is not nothing. That is everything.
Please consider our pieces as a gentle prompt to reflect on the practice nurses in your life. Just as we, GPs, are frequently underestimated, taken for granted and degraded, so, too, are our nurses.
A very happy new year to you, GP nurses. I always want you by my side.
Dr Pallavi Prathivadi is a Melbourne GP, adjunct senior lecturer at Monash University, 2024 RACGP mentor, and newly appointed member of the Eastern Melbourne PHN Clinical Council. She holds a PhD in safe opioid prescribing and was a Fulbright Scholar at the Stanford University School of Medicine, and previous RACGP National Registrar of the Year.
