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GPs heed royal call on alternatives

I was simultaneously gratified and angered by Dr MV Rama Rao's letter (8 October) about jobsworth nurses; gratified that I am not alone, then angered by the realisation these issues may be endemic.

I still encounter district nurses who decline to administer prescribed medication to terminally ill patients without a signed 'yellow card' community administration request.

This is particularly galling in the out-of-hours period when medication has been specifically prescribed because a patient's condition is expected to deteriorate. Colleagues are reluctant to leave yellow cards in case the same jobsworth nurses administer the medication unthinkingly and unnecessarily simply because it is on the yellow card.

I have clarified the fact that, where a prescriber's wishes are clear, a nurse should administer any medication, but we fall on the issue of 'independent practice' which means a nurse can deviate from expected norms.

I would advise Dr Rao to complain formally about the manager and the unnamed individual nurses. If these specific nurses want the privilege of independent practice they should be prepared to be named and held to account for their actions, and not hide behind a senior nursing manager.

The vast majority of nurses I encounter perform in a highly professional manner and I hope this letter will be received in the genuine spirit of clinical governance.

Doctor/nurse polarisation is not in the interests of our patients or our respective professions. Professionalism is an attitude, not a job description.

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