OR NURSES IN RAP's

Discussion in 'Professionally Qualified, RAMC and QARANC' started by Retractor, Feb 15, 2003.

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  1. As I understand it, a significant number of Infantry RAP’s now have a QA Cpl on their peace establishment but that, to date, the QA’s have no been able to fill them.  I believe that when (if ever) they reach a point close to full manning they will start to fill these posts.  As nurses get Cpl rank at the end of training this must mean that a significant number of newly qualified nurses can expect to spend a couple of years with the Infantry.  Having worked with the infantry on several occasions, I know how uncomfortable an experience this can be (although I personally enjoyed it!).  Are the Junior Rank nurses straight out of training happy to do this?  And under Common Conditions Of Service (COTS) they will be paid the same and promoted at the same rate as their RAF and RN colleagues who will be working in fairly comfortable hospital environments and cracking on with gaining experience central to there overall career.  I can see the interviews now for two nurses who have been qualified for three years, both want do the ITU course.  

    Navy Nurse:  “Of course LNN Bloggs you have gained all the relevant experience in the past year working in the ITU and you’ll probably be promoted to PONN at the end of the course too.”  

    Army Nurse:  Cpl Smith do you really think those 2 years with the STAFFORDS is relevant experience for an ITU course.  I suggest you get a couple of years ward experience under your belt first.”  

    Not looking for an argument, but just wondering is there an issue here at all?
     
  2. I think you have hit on something Retractor.. although i didn't know about RAP's having a QA Cpl assigned to them.. ODPs have a similer problem ..
    There is a slot now for a ODP Sgt in the Med regts but we can't fill them all at the moment (or for the forseeable future) due to all the Jnr ranks leaving the trade and our training can't keep up e.g. 14 leaving this year and we only turn out 5 and that is from a trade of 80.
    Manning and Records have stated that there is no problem as the people that are leaving are going off to work agency (add 10 grand to the wage) and agency will dry up...   The demand for agency ODPs has increased by 50% in the last 2 years thanks to the working time directive..

    Sorry back to your post ..

    I'm sure they won't post fresh nurses to the RAPs. Possibly RGNs who have done a years consolidaton first?.
    The Common Conditions of Service document .. where is it kept as i've never seen it .. is it accessable from the net?
     
  3. Ventress

    Ventress LE Moderator

    Serving in Bosnia in 1999 we had so many Cpl RGN's attached to our Armd Fd Amb, they had to stag on the gate at Sipovo, guess how many ND's they had?

    Excellent point about the Naval Nurse and the Army nurse- I can see the problems. Also what Infantry biase does a Cpl QA have when flung into a Bn RAP- apart from those chaps who transfer from 3Para to be a nurse- not much. (Sorry Iron, but you know its true)

    When Col G gets her way for a all Officer Corps there will be plenty of Cpls and Sgts who are never going to commission; so they should look forward to a few postings to the Inf and Med Regts! Nothing better than warry nurses (Sorry Iron apart you of course)

    I look forward to the Party Line from Redcrossrupert and Glue-ear, because their posts make me chuckle!
     
  4. I have now seen two references to Col G wanting an all officer nursing corps; this is new to me.  Is that an all RGN/RMN commissioned corps.  HCA’s I assume are not in the running for this.

    Is there any evidence to suggest that we need more nursing officers?  I know the Army is very short of nurses especially other-rank nurses but is commissioning the best solution to the problem?  Could it make the situation worse?

    I believe that there is no shortage of people who want to train as nurses in the Army, indeed I am told we turn a lot away.  The real problem is retention.  Might I suggest that this is because there is too little career progression for other rank nurses.  If on the other hand it was normal for the nurse in charge of a ward to be a SSgt, newly qualified nurses could have a realistic career goal and sensible career progression with some real responsibility as a SNCO's.  The number of commissioned nurses slots could be reduced to say 50 or 60.  The quality of these personnel would be much higher, comparing with any officer in the rest of the Army.  They could then fulfil the more demanding clinical jobs and undertake a boarder rang of command and staff appointments, without being continually derided by the MSO cadre.  Only the best would be selected AND APPROPRIATELY TRAINED.

    Before anyone attacks me on the basis that all Physios or all blah, blah, blah are commissioned.  I think that the army as a whole is suffering from officer inflation (we have nearly twice as many officers per head than we had 40 years ago) not just the AMS.  Not everyone can or needs to be an officer.  Remember we are approaching nearly 25% of the population being graduates.  A degree is a requirement in many occupations when 10-20 years ago all you needed was an apprenticeship.  Officers must be in charge of something, be leaders and execute an executive function.  Frankly many AMS trades / professions are never going to that on a day-to-day basis.  Perhaps the way ahead is the US Army’s Warrant Officer system?
     
  5. Newley qualified nurses in RAP's not a good idea they need time to adjust to being registerd practioners at the very least . The QA cpl in an RAP should be someone who is up for their 3rd tape and therefore has a good few years experience. The qualifications for a QA at RAP level should be along the lines of the New RNO course and  be an indepent practioner. IMHO the RNO course should be aimed at all ranks and be a Regimental nursing practioners course.
     
  6. I take the points that both QMan and Nurse have made.  Although, I think an RGN 1 year post qualification could be a great asset to a RAP.  If medics and nurses in particular are ever to have SNCO's recognised as being of high quality by the rest of the Army then time at regimental duty would be a real asset and increase visibility.  What I would like others opinions on is how high a priority should filling these appointments be?  Clearly many nurses will struggle at first when attached to an Infantry unit (fitness, military skills, culture etc).  Should we be leaving these posts gapped and then try to fill them at the last moment as units go on operations?  I suspect that if we do this many of these individuals are sure to fail.  The AMS will look incompetent and the individual will have their own morale totally undermined.

    My question (irrespective of weather you think they should be there at all) is should filling these posts be a higher priority than manning the MDHU's?
     
  7. Ventress

    Ventress LE Moderator

    Put Paramedic trained CMT's into the RAP's. RGN's shouldn't go further forward than the DS.

    As for the opinion of the AMS being tarnished for lack of management- there isn't enough Brasso in the world to get rid of that!
     
  8. QMan,

    Is there a mistake in your last post?  Should it say RGN's "shouldn’t" go an further forward of the DS?  Not being a smart arse just trying to be absolutely sure what you are saying.

    Even if this is your opinion (ie no nurses forward of the DS) now that the decision has been made should filling these posts be the priority?  Won’t this give the best possible chance for these people to succeed irrespective of the politics that led to the decision to place them there?

    I agree with you that CMT paramedics should be placed in the RAP.  But why are nurses not likely to be an asset?  Is there nothing they can bring to the party?
     
  9. Ventress

    Ventress LE Moderator

    I have amended my previous post.

    I believe RGNs do not have the desire or field expeirience to go into a Bn RAP, its bad enough dragging a MO from location to location whilst he's still trying to cram his doss bag away. I have worked with and spoke to several RGN's on this matter and they agree they would be disadvantaged against RN and RAF nurses who's only field work would be driving by the side of one on their way home. I know there are exceptions and there a couple of RGNs who would slip into a RAP role superbly. But do you make the post male orientated or open to all. Because I know the Greenjackets would be amused to see a RGN Female Cpl turn up. Because as you may or not know the RGJ love to move like the good old days -on foot and carrying most of their kit!

    The priority for the AMS is make its mind up and get the funding and fill all the slots it said it will. If that means putting RGN's into RAP's then do so. My opinion is they have no place in a RAP as a CMT can easily carry out the tasks required by a RMO and any casualty sitiuation- but also having the secondary skills required to make the RAP work. Or would you like to devalue the CMT to a Logistic Medical Orderly, who puts up the tents and fixes the 432's
     
  10. QMan,

    Again, irrespective of what you or I may think about the wider employment of women, the male/female part of your argument is no longer tenable.  We have had female RMO's for with the Infantry for at least 15 years, I think something close to half of the CMT cadre (at least Cpl and below) is female and therefore a significant number of medical Sections (ie alternate RAP's) must already contain women indeed many of the clerks who work in infantry battalion HQ's are female.

    I agree with you about the difference between the Army nurses and their RN and RAF colleagues, this is why I think Common Conditions of Service are w**k.  

    The all up strength of an Inf RAP is now 18 or 20 personnel depending on role (up from 11-12).  This is likely to include 1 x RNO and 1 x Cpl RGN.  No one is suggesting that they should become the majority trade in the RAP.  You mention nurses and MO's generally poor field skills, I agree they are.  But isn't putting them in the RAP environment just the place to improve these skills?  If you take the line that certain clinical professions such as nurses or doctors don't need these skills, then this argument can logically be extended to CMT's once they achieve paramedic's status.  RMO's will continue to work in forward units irrespective of what happens to nurses.  Even if nurses never go further 'forward' than the DS, in the future diffuse, non-liner battle space they will have to be reasonably competent in basic field craft if they are not to be a liability.  How will they gain this experience if they have no opportunity to do so?  If these people do not receive this training, they will have to be looked after and protected by someone else; who?  The CMT?  Are we going to invest large amounts of money in CMT advanced clinical skill training if all they are going to spend most of their time doing is protecting / administering those clinical staff who lack in basic field craft training / experience.  Or are we going to split the CMT trade into those who are basically stretcher bearers, humpers-and-dumpers of kit and security personnel for medical instillations (including the RAP) with a second group who are advanced paramedics?

    The spectrum of operations that the British army is now involved in and the environments in which they take place means that we need a balanced clinical team with every fighting unit.  In the end, most of the problems dealt with in RAP even on operations are not trauma cases.  I am not decrying the CMT's ability to deal with routine sick or bedded down personnel, but a team that includes CMT's, doctors and nurses must be a better balanced option.
     
  11. Ventress

    Ventress LE Moderator

    So lets re-cap:

    Refractor, you say:

    RGN and MO field skills poor- must do better

    CMT: Not the be all and end all in the RAP

    Well the Corps will have to ensure the said group improve their Field skills, we both know that will never happen as the JM and SMQC are diluted into an acedemic holiday. That includes the EOC which is still a joke with those attending.

    The CMT, will until the CEG takes an intrest in its developement be the poor relation in the RAMC. We were promised all sorts of training and developement in the 1980's and all they did was change the name from Medical Assistant. By the 1990s DCS 15 had raped the AMS and we are were we are now. But you are right the CMT will be looking at being split into Medical Logistics and Medical Clinicians, i.e: One stream going into Medical Centres and MDHU's and the rest being the 'humper and dumpers' as you put it, in CS Med Regts and Fd Hosps.

    I have no problems with females in the Army, if they can cut it then go for the stars. If not........

    At the end of the day, my opinion is, as we said, we all have one- RGNs (Male or female) should be in a DS awaiting casulties treated and stablised by CMTs and RMAs (If any remain).

    Also just to throw this in, RGNs dont have the base medical field knowledge at this time. Again there are exceptions (My good friend Iron for example), but a RGN Sgt would have problems with a DS and all its complexities. Also we know the opinion that nurses have of CMTs- dont worry there is no love lost on that score.
     
  12. Fully agree with your criticisms of JMQC and SMQC and I am especially critical of EOC, and like you I regard these courses as being at the heart of some of the problems the AMS have with boarder acceptance in the Army.  I also agree that far too many nurses have an arrogant and condescending attitude towards their CMT's, colleagues, one that I fear will only get worse if they adopt an all RGN officer Corps.  

    But I am still not convinced of your arguments against having nurses in RAP's are valid.  Nurses and CMT's do different jobs that I think do compliment each other.  Combat units have periods of time in barracks, exercise and operations covering the complete spectrum from MACC to war fighting.  In most of these cases the skills that nurses have can come in very useful, especially if they have received training in Occupational Health.  You seem to be wedded to the idea that the majority of personnel seeking medical attention from the RAP will be trauma cases preparing for onward evacuation.  This is not the case, even in modern warfare.  

    You mention that nurses don't have the ' base medical field knowledge' at the moment.  Again, I'm not being an arrogant tw*t but I'm genuinely not sure what you mean by this.  Are you saying that they do not have the clinical knowledge?  If so I would have to disagree.  It depends on what they have done and what specialist training they have received.  When it comes to trauma or medical emergencies, an RGN with extensive experience in an A&E resuscitation room would be of more use in a RAP than a CMT (with current training).  But an RGN who has spent 3 years on a medical ward at Frimley may be of less use.  But as I have said, even today on operations, except when directly in contact, the majority of personnel seeking medical attention at the RAP are not going to be trauma patients.  If on the other hand the point you are making is that their military skills, (map reading, weapons handling, construction of field medical facilities from RAP to Fd Hosp) is poor, well I agree.  Yes an RGN Sgt would have problems running a DS because they don't have the experience the opportunity to gain this experience is denied to them.  Again I'm not clear what you are suggesting, but it seems to me that you are saying they should work in the DS but not be allowed to gain the necessary experience to become the Tp Sgt / SSgt.   If I was to accept that, it would follow logically that highly trained CMT's in the 'Clinicians' stream should also be denied this opportunity; after all they are being paid to be clinicians exactly the same as the nurses.  Also, by this same logic they would not be suitable to work in RAP's because their only experience would be in med centres and MDHU's.  Thus the people with the least practical clinical experience the 'Medical Logistic' CMT would be the people at the sharp end when the patient needs someone with the greatest clinical acumen.  I cannot see this is a good idea.
     
  13. Ventress

    Ventress LE Moderator

    Thank you seeing me half way.

    Let me explain, the RGN with A&E knowledge would be excellent in a RAP, I fully understand what can be expexted to come through a RAP tent flap. But if the RGN has been casevaced because their lack of field skills have precipitated a cold injury for example. (And I have evaced nurses from Fd Hosp locs with hypothermia due to lack of basic skills.)

    CMTs run Medical centres- nurses work in them, there's a difference. I know very few CMTs SNCO's who get their hands dirty in a Med centre (sorry Bratwurst-you know its true mate) CMTs are the Enablers- they enable the clinicians to do the business, which I dont have a problem with-someone has to put the tents up.

    Whether the casulties has NBI or a GSW, if the RGN doesnt have the basic field knowledge, their lack of light discipline, their inability to interface with the CSM at
    A Ech or lack of knowledge of BATCO or the resup procedure, the casualty wont get treated. And yes a monkey can learn those skills. A CMT learns them as a Pte to LCpl to Cpl to Sgt to SSgt, like an apprentiship. They have seen all the problems that are not covered in manuals or pamphlets and have had an apprenticeship in Field Skills. A RGN pasing through doing the obligatory 2-3 years with a Bn isn't going to have the skills. Which I learnt from a task book back in 1980ish, in which I demonstrated the necessary 'skills'- to be a Med Asst. (Very similar to the RN MA now who have to complete a task book) I would think a Sgt RGN would have in-barracks skills to run a DS but the beast I ran in GW1, I think would be out of the 'knowledge sphere' of a RGN.

    You are quite right CMT's fall into the trap of med centre and TA hopping, thinking their first posting to 2 Armd Fd Amb 18 years ago will suffice-thye too are the wrong people to put anywhere a RAP.

    I think I will agree to disagree, and say everyone has a place and a place for everyone, but when I am DGAMS there would be no nurses in RAP! (And like your hoping, that will never happen!)- mores the pity!

    I am a CMT and unfortunately I have seen how the RGN world sees the CMT, and like you said especially by the officer cadre, RGNs should stay in their area of expertise and leave the CMT to theirs!
     
  14. Before we start losing our heads over this could someone please direct me to the manning levels of an RAP ?

    I am aware that the manning of an Armd Med Sect has a RNO and a QA Cpl in it but I have never seen or heard of the RAPs having them but I will investigate this further tommorrow !

    Nurses! roughing it! what next! issue them all with Pace Sticks ? Mad they've all gone Mad I tell you
     
  15. And QAs in med sects has worked for me - via too many crap jokes about armoured nursies.  They bring a whole pile of stuff to the party (professionally, I mean). As far as field skills go - they're like the doc - bring 'em out when they're needed and keep 'em locked in a Lacon box the rest of the time.