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Nurses "working beyond expertise"

Some nurses are carrying out medical checks which are beyond their expertise and training, a new survey claims.

Around 17.5% have treated patients suffering from conditions such as mental health problems, depression, diabetes and lung disease, which are beyond their competence, the poll for Independent Nurse magazine found.

And one in 10 of the 183 nurses questioned for the poll said they will still carry out Quality and Outcomes Framework (QOF) work for their employer, even if they have not been properly trained.

A spokeswoman for the Royal College of Nursing (RCN) said: "The issue about some nurses feeling ill-prepared for what they are being asked to do is not a new problem.

"It's something we have been aware of. We are aware of this happening in a number of practices but there are also a significant number of practices that take the training of their staff very seriously."

A Department of Health spokeswoman added: "Independent research published in June 2007 found that nurses appreciated being given more responsibility for delivering on targets in disease areas.

"Independent research also shows that quality of care for asthma and diabetes has increased more rapidly since the introduction of the QOF, and care for coronary heart disease, which had already increased substantially, has continued to increase."


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Do you carry out QOF work that you're not properly trained for? Please leave your comment, name and address in the feedback box below. Your details will not be published if you so request. (Terms and conditions apply)

"I am very fortunate to be in a practice where education of nurses, GPs and HCA's is a priority. The nurses have all been trained to diploma level in various areas, and are competent to carry out the clinics, which is satisfying for both the patients and staff" - Name and address supplied

"In recent years there have been, in my opinion, great changes in both the extent and depth of practice demanded of practice nurses. As a profession we have again risen to these challenges, many have spent their own time money on courses to support their employers, helping them gain QOF points meet targets (never mind the patient in all this) yet -Isn't it sad that so many dedicated caring nurses are not even supported in return, a bonus would be nice or even pay in line with qualifications but its not all about money (or we'd be doing an entirely different job!) just a little professional respect would go a long way. Being told one on one that you're appreciated cost nothing. We hear time again of low morale in the NHS. Good nurses are already being lost but as long as there are those who will take everything flung at them - appropriate or not- we will never change anything! - Name and address supplied

"I feel that it is time nurses say no to what they are not prepared to do. QOF is about ticking the right boxes. I don't see how this is possible if the nurse has no competency in a particular area" - Name and address supplied

"Unfortunately the Qof was introduced without little thought for the expertise that would be required to carry out the reviews. Once the Qofs were finalised it gave practices little time to train their staff adequately. In addition practices were not provided with extra funding to meet these training costs. Although the QOFs brings financial rewards, the majority of it is only paid after the targets are met.  The cost of implementing QOFs within some small practices has been greater than the rewards.  A nurse "working beyond their expertise" is not the fault of the individual practice but is the fault once again of a government directive, which has not been thought through" - Name and address supplied

"I am leaving a job this week after 16 months. The managing partners do not care about any of the staff, all they are interested in is how much QOF points they have got. I decided to leave because the place was not well equiped and whenever I complained all I got was follow the instructions and reset it. We are not even thanked for the hard work we put in, they moan about things that do not have any effect on patient care, which is meant to be the main focus of the practice. I wish all my colleagues good luck if they stay on. I am well out of it." - Name and address supplied

"Please could we know the source of the 'independent research' quoted by the DH spokeswoman." - Name and address supplied

"I wonder why I put all that effort (and money) into doing my asthma Diploma in the 1990s, and more recently the COPD Diploma? The patients seen by qualified and experienced practice nurses get a good service, potentially saving the NHS huge sums by reducing the need for costly hospital referrals and admissions. But some GP practices just aren't willing to pay for it, so if they can get away with having a less qualified nurse, some will do so. PCTs could do more to remedy this, for example: monitor routine practice data on hospital referrals and admissions for long-term conditions; encourage practices to display individual staff's level of qualification; encourage all staff to wear ID badges so that patients would know whether theywere being seen by a qualified nurse or HCA." - Name and address supplied

"Yes. I was asked to do asthma and COPD clinic at my last job.  I was there for one year, and would have left sooner but needed the job.  I had never held an asthma or COPD clinic before and had not even been on one day's training! The lead GP was only interested in points, and used to ask us to triage, diagnose, treat (including prescription) and give follow-up advice in under 10 minutes per patient, which is not always possible as a nurse.  But he was more interested in getting the points. He was only there 50% of the time for any referral, as he was more interested in practice based commissioning that would get him extra income.  He use to employ newly qualified GPs, as they were cheaper, who had an enormous caseload and were therefore hard pushed to support me.  The patients had a raw deal, I had a raw deal.  When I complained that I felt I had inadequate training and was working outside my scope of practice, he spent less than five minutes showing me what to do on the computer for QOF points.  The fact that I could miss something clinically was neither here nor there to him. He was too cavalier with patients health and my registration. When I became resistant to taking on more in depth consultations such as spirometry (which I could not interpret,) he basically cut my hours!  I was very relieved to get out of there, but I know that the patients at this practice are very poorly served.  There are three other nurses there who look pretty and say the things, but I know that they are not competent in all areas. They may be happy to carry on with this arrangement, but I was not. I resented being forced to leave due to fiscal restraint over training" - Name and address supplied

"Sadly, this does happen in many practices. In my opinion GPs must be prepared to invest financially in their nursing staff to reap the rewards of QOF. However, it does happen that nursing staff carry out aspects of the QOF with inadequate experience/ training. This is only my personal opinion of course and I do have a tendency to be a bit of an old fuddy-duddy - Name and address supplied