Clinical Eye – our new nursing column

A mutual respect

Ishbel Straker joins us as a regular columnist to give insights on nursing in addiction. This month she asks, why is there tension between doctors and nurses?

I want to start by saying I like doctors. I like what they do, what they stand for and their practice – in fact, some of my best friends are doctors! So why am I talking about the occasionally/more often than not strained relationship between a doctor and nurses?

When I trained a decade ago, I decided psychiatry was the place for me – not only because of the subject matter, but also the relationships between nurses and doctors. During placements on the general ward I would witness nurses who had 30 years experience behind them putting their knowledge to one side in favour of a third-year medical student.

Now, don’t get me wrong, I absolutely value doctors – their skill is essential. However a mutual respect seemed to be lost in translation within the general and paediatric wards I was placed on. I was drawn to the relationship between the psychiatrist and the psychiatric nurse as it was one of mutual respect, with a clear understanding that both roles were equally important and neither could work as effectively for the patient without the other.

When I moved into addictions, this working relationship continued and progressed. Over the years I experienced some fantastic working relationships with doctors and watched the coordination of skills within the addictions services, which I feel has been the backbone of excellent care for substance misuse clients. However, I am sad to say, I have also witnessed the recent demise of this relationship and I question whether this is due to the rise of the non-medical prescriber (NMP).

The field of addiction has become the NMPs’ stomping ground on which they have thrived. We now have clinical leads who are NMPs, when ten years ago this would have been unfathomable. Services are recruiting prescribers competitively and no longer differentiating between doctors and NMPs, but deciding who has the best skills at interview.

This is a fantastic step for nurses but one that has destabilised our medical colleagues – at times affecting our relationships. I hear of doctors terrifying NMPs with the dangers of what they are doing, highlighting the risks – and I wonder, is this down to a lack understanding of the jurisdiction of an NMP or is it a deeper issue?

One thing I can conclude is that if we are to provide the best treatment we can for our under-represented client population, then we must work together. We must keep the client at the forefront of our minds and not our own agenda. We must utilise one another’s skills and not be fearful of what each other brings to the table.

Ishbel Straker is clinical director for a substance misuse organisation, a registered mental health nurse, independent nurse prescriber (INP), and a board member of IntANSA.