By Melissa Jackson
BBC News Online health staff
As NHS trusts stand poised to implement a strict regime to limit junior doctors' working hours, one hospital has pioneered a scheme where nurses take the pressure off their senior colleagues.
Mel is a new breed of nurse
Nottingham City Hospital is one of 19 establishments to run a pilot scheme to identify ways that trusts can comply with the new rules, which restrict doctors to a 58-hour week.
They have employed three senior nurses in their cardiac intensive care unit (CICU) who are trained and authorised to do some of the work that doctors would normally carry out.
This frees up the doctors to concentrate on more pressing matters, although they are always available should a situation arise where a patient's condition needs treatment outside the nurses' agreed area of responsibility.
These senior, H-grade nurses are called CICU practitioners and Mel Doyle is one of the three-strong team.
Mel has been in the nursing profession for 11 years and her career aspirations drew her towards staying in clinical practice instead of branching into management.
This job suited her perfectly. It is a senior role and she is still in the front line of patient care.
She said: "Our role is looking after patients after cardiac surgery, including by-pass grafts and valve replacements.
"The nurses look after patients on the unit on a one-to-one basis, but if there is a problem and the nurse in charge of the unit can't deal with it, then they would call us to deal with it.
"If we can't deal with it, then we would call in a registrar or consultant."
Authority and autonomy
The CICU practitioners have gone through specialist training for the job.
They were taught by anaesthetists how to put intravenous lines into arteries and veins of heart patients.
Until they were trained up, only registrars and consultants were qualified to carry out such tasks.
They also went on a course for the care of critically ill surgical patients, which doctors complete as part of their training.
They are also allowed to prescribe drugs for patients from a list approved by consultants.
Mel said: "A nurse may come to us saying a patient needs painkillers and we can put pen to paper, without having to call out a doctor to do it.
"From a doctor's point of view, it gives them the opportunity to spend time off the unit, whether it would be time in theatre or doing work of their own.
"If we are covering the unit, they don't need to be here all the time.
"From the patient's point of view it expedites the process.
"We are here all the time and if they need something they can get it straight away."
She says it also benefits the nurses on the unit because they are a point of call between the doctors and the nurses.
When the scheme was first set up there was some scepticism among senior colleagues.
Mel said: "Some of the doctors said: 'It's not going to work'. Others were very supportive.
"We support them and they support us and if, for whatever reason we are not there, they notice the difference."
The team currently provides cover from 0730 to 2000 Monday to Friday and on Saturday mornings.
However, the scheme has been so successful that it is expanding and the hospital is recruiting three more staff to provide 24-hour cover.
Mel and her colleagues had special training
A new £20m cardiac unit is opening at the hospital next year to provide more intensive care and high dependency beds.
Mel is convinced other hospitals could follow Nottingham's lead.
She said: "We have proved it can work here.
"It's creating an overlap between nurses and doctors' roles.
"It's bridging the gap in the hierarchy and pushing nursing forward to show what we are capable of."
Nottingham City Hospital's cardio-thoracic clinical director, Ian Mitchell, has praised the scheme.
He said: "This has been a very successful project.
"The working lives of our doctors on the unit have improved because these nurse practitioners have taken on some of their previous roles and lifted the pressure of their responsibilities.
"It has also improved the way we care for our patients because the nurse practitioners are always on the unit and therefore work very efficiently and provide greater continuity of care."