Please help!!!

iNurseUK, RN · Mar 5, 2010

Oooh. Where to start? That's quite a list:) I'll have a crack at some of these.

I consider the advantages of a National Health Service to consist mainly of free-at-the-point-of-use healthcare which is accessible to everyone. Beyond that it is difficult to find other points in favour of the NHS.

I believe that the NHS was founded upon a well-meaning but fundamentally flawed premise namely that socialised medicine would improve the health of the population and that, over time, costs would decrease. Instead the NHS evolved into bottomless money pit. As soon as one group of diseases were conquered (for example most of the infectious diseases eliminated by vaccination and antibiotics) others would take their place (the current rise in diabetes, heart disease etc) and with ever-increasingly sophisticated technologies the NHS spends more money now than ever before.

Oh and what is

What the NHS does well it does very well. Emergency services, ITU and acute medicine. What it does badly it does very badly. Elective surgical procedures (the smaller stuff like hernia repairs) older people's services and psychiatric services.

Having said all that I still think that the NHS with all its faults is preferable to the US system which seems to offer excellent care but at a very high cost to the individual. It must be very costly for someone with a chronic condition such as diabetes and surely more costly to correct the complications arising from conditions such as this if left untreated.

Phew what a rant:) Hope this is helpful to you.

What is an APN?

allnurses Guide · Mar 5, 2010

and APN is an Advanced Practice nurse. Like our Nurse Practitioners, advanced nurse practitioners

karenG · Mar 5, 2010

I'm an advanced nurse practitioner working in primary care;

so prescribing. I am an independant prescriber and for me, in primary care it means I prescribe within my areas of competency. so I can prescribe anything except controlled drugs such as morphine. I have a prescribing 'bible' called the BNF (British National Formulary) and I use that a lot! as a nurse in general practice the rules are different.. hospital nurses seem to have use a hospital decided formulary which they have to stick by; I dont. If I can justify prescribing something, then i do so.

Karen

karenG · Mar 5, 2010

I am a male RN in the United States working on my MSN (masters) and need to discuss legislation and health care issues with a nurse in another country for a class project. Thank you in advance for you assistance. Please answer one or more of the questions listed below:
1. What do you consider to be some of the advantages to having a centralized or national health care system?
2. What is your opinion of the healthcare system in the US?
3. How limited is the prescriptive authority of APN's (MSN prepared) in your country?
4. What are some of the problems with the healthcare system in your country?
Thanks SO MUCH!!!!

oh and to open a can of worms.....

one of the biggest problems we have is the perception that the NHS is there to provide health care to whole world for nothing! In primary care, we see patients who are from all over- sometimes our surgery feels like united nations! there are 110 languages spoken the area i work in and a large number of patients are from countries with very poor health care. so they are health tourists...... and its costing the NHS a lot of money. there was some stuff in the papers recently about Hammersmith hospital maternity department- they put up a very incorrect poster of the world, detailing where their patients come from and only something like 5% were actually British. so this is a big issue for us. we dont like asking people for money, particuarly when it comes to paying for health care as we have been brought up to believe that care is free at the point of delivery. however, I suspect the NHS will go bankrupt trying to heal the world!

I think we need at some point to have cards which can be checked to tell us the entitlement of people to health care; we have a large number of students from various parts of the world who have overstayed their student visas and no longer have entitlement to anything... so tell me how we police this?

soap box.. I see the NHS struggling to do everything it can to deliver high quality care and failing miserably at times because we are painting ourselves into a corner; we cant afford the NHS we would like without some radical changes. I dont have the answer and I wish I did!

allnurses Guide · Mar 5, 2010

I'm an advanced nurse practitioner working in primary care;
so prescribing. I am an independant prescriber and for me, in primary care it means I prescribe within my areas of competency. so I can prescribe anything except controlled drugs such as morphine. I have a prescribing 'bible' called the BNF (British National Formulary) and I use that a lot! as a nurse in general practice the rules are different.. hospital nurses seem to have use a hospital decided formulary which they have to stick by; I dont. If I can justify prescribing something, then i do so.
Karen

Karen as a nurse prescriber in acute hospital care I use the BNF not a hospital formulary. There may be some if the mire expensive preparations I'd have to justify but as long as clinically indicated I can prescribe pretty much the same as you

allnurses Guide · Mar 5, 2010

Midwest if you click on the link to my blog in my signiture you can take a look at my piece on nurse prescribing in the UK. It gives a history and prescribing authority details in there

karenG · Mar 6, 2010

Karen as a nurse prescriber in acute hospital care I use the BNF not a hospital formulary. There may be some if the mire expensive preparations I'd have to justify but as long as clinically indicated I can prescribe pretty much the same as you

thats interesting; I wonder if there is a regional variation then? Because in the 2 Primary Care Trusts that I have worked in, its been the case that secondary care nurses are not allowed to prescribe from the BNF and must use a hospital formulary.

problem with working in primary care for 30yrs is that you lose touch with what goes on in the big bad hospital world...

allnurses Guide · Mar 6, 2010

Karen there are some drugs that the hospital pharmacy don't stock, some of the more expensive statins, if the patients come in on them then we prescribe them and use the patients own supply whilst the pharmacy get stock in. They may well try to get us to change the prescription but if there are good clinical reasons not to then they will supply it.

The only time pharmacy has told me that there was a problem with one of my prescriptions was when I prescribed phenoxybenzamine for a patient with a Phaeochromocytoma, and that was only because there was a UK wide shortage, asked if I could change to something else, I said no and they moved heaven and earth to get the supply.

As long as it's clinically justified then there isn't usually a problem. We do have an excellent relationship with our pharmacists though and they are extremely supportive of the nurse prescribers, there aren't that many of us so they do try to encourage us to prescribe.

As an interesting side note, we have quite a few pharmacist prescribers as well which may be of interest to the OP, not sure if that is something that the US has embraced but it's not just advanced practice nurses in the UK that have prescriptive authority, we also have pharmacy and optomatrist prescribers as well

http://www.npc.co.uk/prescribers/faq.htm#1

misswoosie · Mar 10, 2010

i am a male rn in the united states working on my msn (masters) and need to discuss legislation and health care issues with a nurse in another country for a class project. thank you in advance for you assistance. please answer one or more of the questions listed below:
1. what do you consider to be some of the advantages to having a centralized or national health care system?
access for everyone,bt may not always be timely. free for those who aren't employed, over 65s and children (mostly)
availability of evidence based national practice guidelines eg nice
2. what is your opinion of the healthcare system in the us?
good access if you have insurance.
not cost effective, particularly excessive screening programmes and over use of investigations to make diagnoses.
generally facilities are more modern, newer , have more resources eg beds ,technology, staff.
much of us insured population is "hooked" on this over investigation/treatment/medication. they expect it, but don't question benefits v risks, effectiveness etc. take for eg allergies. everyone has "allergies" . my pcp here in the us asked me 4 times if i had any allergies becaue i kept saying no! surely the population allergy profile can't be that different from the uk?
3. how limited is the prescriptive authority of apn's (msn prepared) in your country?
nurses that have prescribing rights ie they have done a nurse prescribing course, which is bachlors level,can prescribe.doesn't matter if you have a masters .
nurses can prescribe anything that a doctor can prescribe. usually nps (who don't always have masters) will prescribe a limited number of drugs specific to their practice area.
in general i think it's fair to say that in the uk hospital prescribers will prescribe generics. if patients coe into hospital and they're on a brand name drug (happens less now) they will be left on it unless it's contraindicated.
we generally prescribe according to practice gudelines, ie for an acute ischamic stroke, asprin rather than clopidogrel or lmwh. we are maybe more up on best practice.
i was apalled when i read on this forum that orth' surgeons were presribing anything from aspirin (diff doses),a variety of heparins,through to coumadin (with differences in therapeutic inr range) for vte prophylaxis after lower limb arthroplasty.
this is a bit more like it was maybe 1 yrs ago in the uk where a doc could use what he fancied,especially pcps who were getting wined and dined by reps'!
4. what are some of the problems with the healthcare system in your country?
thanks so much!!!!

i've left 4 as i don't have that much time available!

misswoosie · Mar 10, 2010

what the nhs does well it does very well. emergency services, itu and acute medicine. what it does badly it does very badly. elective surgical procedures (the smaller stuff like hernia repairs) older people's services and psychiatric services.

i don't actually believe that the nhs does that well at emergency care and acute medicine. patients get shoved around all over the place when there are bed shortages, just to make sure they don't breach the gd 4hr wait.

a target that was supposed to improve care has actually led in part to poorer care. we used to get acute stroke referrals from surgery after the weekend. they'd been sent there because there were no beds on the stroke unit or medicine.

i think we do better now with elective surgery. not perfect, but better than 10 years ago.

not sure if it's the same now but there was a national shorage of icu beds. when i first worked on icu in the 90s it was unheard of to have a patient over the age of 70.

i worked in newcastle uon tyne which has regional programmes for transplantation,cardiothoracic surgery, urology, ent, oncology,renal and neurology and neurosurgery and it wasn't unusual for us to be without empty icu beds across 3 hospitals/ 5 icus (not inc' paeds).

i know they were addressing the lack of icu beds.