So-called clinical governance

#1
How's this for a piece of silliness. I am a TA Major, physically very fit and dual qualified RGN/RMN. I also have a PhD and language skills (Russian). However, because I teach in higher education (teaching clinical stuff) I am not considerd 'clinically current'. Despite having volunteered for Herrick 10a have been told that I can't go. In addition, I work on a NHS nurses bank in acute medical nursing 2-3 times a month to keep my hand in, and no, I don't find that I've forgotten everything or can no longer remember which orifice to put the thermometer in.

I was deployed on Telic 3, having volunteered. I had no problems there and came away with a very complementary insert slip. I can't help but feel that 2 med. brigade is run by jobsworth idiots who understand nothing at all about clincal competence or professional responsibility. Don't get me wrong, I can see the point of having to be doing the job every day if one is a surgeon nor would I have the temerity to put myself forward for work on ITU but I have no problems doing general medical or psychiatric nursing in the NHS so why not the army?

In the meantime poor bloody regulars will get dicked time after time for deployment. Of course, in the long-term, what this also means is that unless one is 'on the ward' there is no place for senior nurses in the TA, whether educationalists or managers. Yet, funnilly enought the regular army seems to be lifting with people who also do little or no clinical work but still make these decisions.
 
#3
Runner said:
How's this for a piece of silliness. I am a TA Major, physically very fit and dual qualified RGN/RMN. I also have a PhD and language skills (Russian). However, because I teach in higher education (teaching clinical stuff) I am not considerd 'clinically current'. Despite having volunteered for Herrick 10a have been told that I can't go. In addition, I work on a NHS nurses bank in acute medical nursing 2-3 times a month to keep my hand in, and no, I don't find that I've forgotten everything or can no longer remember which orifice to put the thermometer in.

I was deployed on Telic 3, having volunteered. I had no problems there and came away with a very complementary insert slip. I can't help but feel that 2 med. brigade is run by jobsworth idiots who understand nothing at all about clincal competence or professional responsibility. Don't get me wrong, I can see the point of having to be doing the job every day if one is a surgeon nor would I have the temerity to put myself forward for work on ITU but I have no problems doing general medical or psychiatric nursing in the NHS so why not the army?

In the meantime poor bloody regulars will get dicked time after time for deployment. Of course, in the long-term, what this also means is that unless one is 'on the ward' there is no place for senior nurses in the TA, whether educationalists or managers. Yet, funnilly enought the regular army seems to be lifting with people who also do little or no clinical work but still make these decisions.
Maybe they thought you were too modest? :roll:
 
#4
That's a possibility. At the moment I have a sub-unit command but when my tenure ends I may look around me for something else, but what? Problem is, I don't know whether this is a local phenomonon or general. I know that many units simply don't have many slots for psyche nurses, which is one of the reasons I've concentrated on the medical nursing.

I suspect that what is at the heart of it is that someone at the top takes the view there are too many nursing officers in the army in general and the TA in particular and they are using clinical governance as a blunt instrument to purge a lot quickly. After all, why deploy a Major or a Captain when the job can be done by a corporal?

Another thought is to try to find some other area in which I might be valued such as a university OTC. But, hey-ho, I'll plod on for the time being and see whether I can't volunteer again at a later date.
 
#7
Runner said:
I was deployed on Telic 3, having volunteered. I had no problems there and came away with a very complementary insert slip. I can't help but feel that 2 med. brigade is run by jobsworth idiots who understand nothing at all about clincal competence or professional responsibility.
I think you'll find that your failure to catch the selector's eye for the Ward, was nothing to do with 2 Med Bde. Can I suggest you talk to your own unit and its assessment of your clinical currency and suitability for an adult general nursing role.
 
#8
Yes 'cos the DMS is just tripping over people with your experience willing to deploy on another tour. Those hearty lads and lassies of the DMS; they just love all those tours. Thank god for CG eh...makes you proud to be an Ex Pat.
 
#9
Just in case there is any confusion, this is not about who goes and who does not go on deployment but about who decides who is 'clinically current' and how. After all, the NMC regards me as being a practising nurse and their PREP document is fairly clear about what constitutes 'practice'. That, however, seems to be ignored. Its also about whether anyone who is not on a ward or community clinical setting has a place in the TA. What will be next? 'OK, you work in theatre but it doesn't count as it's only listed surgery and not emergency'?
 
#10
I suspect that what is at the heart of it is that someone at the top takes the view there are too many nursing officers in the army in general and the TA in particular and they are using clinical governance as a blunt instrument to purge a lot quickly. After all, why deploy a Major or a Captain when the job can be done by a corporal?

Maybe there are too many nursing officers in the TA in fact are there any nurses in the TA that arent officers.
The bottom line is that if you are a captain or major and you volunteer to deploy in a LSN that is for a corporal then you should be prepared to carry out the role of a corporal, and by that i mean secondary stuff like guard duties cleaning work parties etc. the problem is when a unit fills these slots with officers cause he or she is desperate for a medal or its their mate and they turn up in theatre and dont want to pitch in then that person is simply making the job harder for the remaining ncos and ptes.
ask any regular that went out with 201
so yes there are too many nursing officers in the AMS.
so in response i would say that you chose to do the job part time if you dont like it then resign your part time commission pack in your day job and join the regular army. where you will soon find out that we dont have the luxury of picking and choosing deployments and just go when were told.

I would like to say that i cant fault 201 clinically as they were excellent just dire at everything else.
 
#12
I find it rather difficult to accept that someone who holds your rank and professional position fails to accept the requirements of our nursing staff.

Would the Int Corps be interested in your linguistic capability?... just a thought!
 
#13
In what areas are you not clinically current??? could you not do any attachments/additional training/work shadowing to bring you back up to speed? or is it a case of those that can do ...those that can't ..teach!!!
 
#14
Ah the Clinical Governance sledge hammer rears its ugly head again.

I remember when APHC first started and some bright spark in charge of clinical governance thought that CMT's were not clinically current.

Next thing you know they are trying to ban all CMT's from the treatment rooms in medical centres. Didn't last long though.

I say stuff em. They'll all get found out in the end as pen pushing under achievers trying to justify their existance.
 
#15
madmedic said:
Ah the Clinical Governance sledge hammer rears its ugly head again.

I remember when APHC first started and some bright spark in charge of clinical governance thought that CMT's were not clinically current.

Next thing you know they are trying to ban all CMT's from the treatment rooms in medical centres. Didn't last long though.

I say stuff em. They'll all get found out in the end as pen pushing under achievers trying to justify their existance.
Is that the Ex Mil-Civ orgnisation that promised so much and has woefully under-achieved? Designed to bring Military Medicine into line with NHS Best Practices it means that not enough nurses or those that are employed are looking after families and not soldiers and in fact rely on medics who the AFPRB deem to be not worthy of a higher band?

Medics who do so much of the Primary Health front end business yet are not competent to prescribe Paracetamol or Petroleum based products.
 
#16
OOH, damn CG, could not get staff on TEL 1 or kit that was in date but we got a TA nurse Major for CG, cos that really helped plug the holes.
 
#17
The problem with using CG to purge TA nursing officers (even if that is desirable) is that there is no telling who will go and who will stay. So far, those I've spoken to who are thinking of leaving are excellent officers who are more than willing to deploy but who feel there is no place for them now or in the future. In the meantime, others will stay, come what may, and have no intention of deploying, so long as they are picking up their bounty.

It wouldn't be so bad if there were any sensible guidelines. For example, if the status of being a 'clinically current' medical nurse was defined by, say, 30 days of clinical practice on an acute medical ward then one could achieve that. (After all, I'm defined as soldier by a minimum of 27 days military practice). As it stands, I'm unaware of any such guideline. Its like playing a game in which only one party if privvy to the rules and changes them periodically without warning.

There is a growing NCO cadre of TA nurses and in any event, the TA medical services are an aging population. Those who are currently Majors and Captains are mostly in their mid to late 40s and the queue to join is not a long one.

My experience of deployment is that TA officers did undertake the same duties as ORs, regular and TA.
 
#18
Ian,

I see you ignored the PM. Your choice. Experto Credite.

Runner said:
(After all, I'm defined as soldier by a minimum of 27 days military practice)
Actually, this is a good area to highlight the situation you are so publicly moaning about. You are NOT defined as a soldier simply by turning up for 27 days. 'Empty' training days are as meaningless for soldiering capability as empty miles are for running performance. (To use an analogy you might relate to.)

To be 'defined as a soldier' [sic] for TA purposes you have to achieve specific competencies in certain areas (MATTS1-8) and have each of those assessed as meeting the required standard (levels 1-3) for specific roles. If you are a TA soldier attending throughout a routine training year the standard you have to achieve is therefore different to that required of deployment.

Clinically, people are assessed both against their in barracks role (OC for instance) and against specific deployed roles on Ops. It is entirely feasible that currency can meet the general requirements of one but not the specific requirements of the other. This has been explained to you on a number of occasions and suggesting that you are being disadvantaged by some form of smoke and mirrors is somewhat disengenuous.

Clearly, the fluid nature of Ops means that the requirements of posts are constantly evolving. Marry this with the unique backgrounds and employments of individual TA Nursing Offrs and you can see why it is important to judge each case on its individual merits rather than setting a generically quantifiable but meaningless CG bar. The bottom line is about providing an appropriate quality of care for our fallen comrades rather than finding jobs for the boys, however keen and willing they might be.

As for the ageing TA Nurse population - this is a separate area itself worthy of discussion. The AMS is not unusual in that it needs more indians than chiefs - more staff nurses than managers or lecturers. The irony is that any civilian nurse who has the gumption to get off their backside and join the TA will probably also have the gumption to get promoted in their civilian job and move up the management/lecturing chain and away from regular hands-on clinical work. Even more ironically, their TA Service might contribute to their civilian managerial and leadership development. The problem the TA then has is what to do with them. We can only employ so many OCs. And to suggest that managers can easily revert to their former role is akin to asking a former football player turned manager to turn out for his first team again. Some might be able to do it quite well - others clearly couldn't.
 
#19
Andy, you make my point very well. What I have to do to be a soldier is clearly defined. But what I have to do as a nurse isn't. The NMC is clear about it but on top of that the army has superimposed another requirement, apparently to be on a ward or other clinical environment all the time.

The point where your football analogy breaks down is precisely that it is possible to work on a ward and I do and have no difficulty doing it. That, however, seems to make no difference as far as the army is concerned. And no it hasn't been explained. Far from people being treated on a 'case by case basis' CG is interpreted inflexibly and used as a blanket criterion. The reason for 'publicly moaning about it' is precisly because there seems to be no other way of raising the debate.

The logic of the army's position is, though, that we should only recruit ward/community based nurses but there is no clear idea of what they should do if they are promoted above the level of charge nurse. Presumably leave the TA. The fact is, that skills of many nurses are not lost overnight and the problem of 'skill fade' is not the same for a nurse as it is, for example, a surgeon. And I can think of no evidence base which suggests otherwise.

The demography of ward based nursing is that it is something, rather like soldiering, which many people do for a relitively short period in their lives. The army will, therefore, have a diminishing pool of people to draw on as indeed does the NHS.
 
#20
Hello Runner

Isn't this just another example of nurses and nursing not really understanding whats going on around them? I speak a one myself and it never ceases to amaze me how we as a profession get hold of an idea or concept and totally f*ck up its meaning and how to implement it. Clinical governance is (according to the Department of Health):-

".........the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish".

Sounds pretty simple and straight forward to me although I'd have called it Quality and Safety rather than Clinical Governance as its easier for people to understand. Quite why any of that means that a practising TA N.O. can't go and look after medical patients in the Stan I don't know.

The best bit of this though is the army deciding that you are not clinically current because you work as a nurse tutor! I assume this means that you've taken this bad news to your civilian employers and have offered your immediate resignation.
 

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