Nurses take charge

By BBC Health Correspondent Richard Hannaford

For years nurses have been seen, in the old phrase, as handmaidens to the medics - but that traditional role is being turned upside down.

With advances in technology and a belief that nurses can quite easily do a number of the tasks previously done by doctors, there has been a sea change in nurses' fortunes.

In fact, as the Royal College of Nursing meets in Harrogate, to discuss the professions future, some nurses look like replacing doctors altogether.

One example of that is Laura Doig. A sister in charge of the Endoscopy Clinic at St Thomas's and Guy's Hospital in London, she's now learning how to perform the procedures she's seen the doctors do for many years.

Patient consultation

Nurses can quite easily do a number of the tasks previously done by doctors

She's now able to see patients herself, make a diagnosis and refer them to the relevant specialist.

In future she believes she will be able to have her own patient list. Patients will be referred to her. She will even be able to treat them for routine conditions.

A few years ago a nurse in Plymouth caused a national furore when she - with the aid of a surgeon - helped take out an appendix.

But Laura Doig is already doing some minor surgical procedures on her own.

Having been shown how to insert feeding tubes directly into a patients stomach by a senior consultant. She's now an expert in the procedure herself.

Responsibility

Laura is one of many nurses who're taking on more responsibilities. There are already some nurses learning how to anaesthetise and sedate patients, in the areas of psychiatry others are providing some forms of therapy.

And it is not just happening in hospitals - there are examples in the community as well

Catherine Baraniak is really not sure what her new title is. A nurse by training - she's recently set up the Meadowcroft NHS health centre in Derby where she provides General Practitioner services to the community.

She has a contract with the local health authority to provide health services to the general public in her area.

She employs a GP and two other nurses and runs the whole show. Patients are encouraged to see the nurse initially - and if appropriate are then passed on to the doctor.

She sees patients herself, diagnoses minor ailments, and treats them.

And on occasion she's even sent them to specialists for their opinion - something that would have been unthinkable only a few years ago, and for some doctors still is.

However, most local consultants have accepted her referrals, writing back to her and explaining what they have recommended.

Among nurses Laura Doig and Catherine Baraniak are hailed as pioneers, and champions of a profession that is at last becoming more confident and assertive about its own value.

But they still have many obstacles to overcome, including staff shortages and concern over pay.

Some doctors and nurses also view such developments with suspicion, believing they have more to do with governments getting cheaper medics, instead of providing better care to patients.

Nevertheless, the history of the past ten years has seen a huge change in the role and status of nurses - and there is no sign that that rise in nurses power and influence has yet reached its end.