The ABC of Nurses

Peter Cross and Sabina Dosani demystify the latter day followers of Florence Nightingale

Nurses are the single largest group in the NHS and the private health sector. They perform a baffling array of jobs and many possess skills and knowledge useful to medical students and house officers, so it pays to know more about them and what they do.

Auxiliary nurse
Sometimes known as nursing assistants, auxiliary nurses are not formally qualified and are delegated to do most of the menial jobs. Medical students sometimes work as auxiliary nurses. It is a good introduction to ward work, and pays better than pulling pints.

Bank nurse
Also called agency nurse. Bank nurses are brought in to make up numbers. They are nursing equivalents of locum doctors. Standards are just as variable.

Care plan
The nursing care plan is a four part document for each patient comprising:

• Assessment: identifying and formulating a patient's problem--for example, incontinence--or potential problem--for example, wound infection
• Plan: action needed to address the problem--for example, frequency of incontinence pad changes for an incontinent patient
• Implementation: carrying out the plan
• Evaluation: reassessment in the light of observations.

Documents vary from trust to trust.

District nurse
Qualified general nurses who undertake a range of nursing procedures either at GP surgeries or in patients' homes. District nurses are usually enthusiastic teachers so it is worth spending an afternoon with one while on a GP placement.

Elderly care nurse
If you are having difficulty communicating with elderly patients you might need some practical help. These nurses, formerly known as "geriatric nurses" can pass on important skills from how to change hearing aid batteries to conversing sensitively with dying patients. Some have extra qualifications in palliative care.

Forms
Nurses spend lots of time filling in forms. If a patient falls out of bed they fill out an accident form. If a tea urn scalds a medical student nurses need to fill out an untoward incident form for medicolegal reasons. Other common forms include referral forms to other disciplines, such as chiropody, dieticians, or an ECG technician. It is a good idea for medical students to be familiar with these forms as junior doctors often fill out part of them or countersign them.

Genitourinary nurse
"Clap clinic nurses" are usually found in the genitourinary medicine (GUM) outpatient departments. They will teach you how to take a sexual history in a non-patronising and sensitive way. Many are trained in pre-test and post-test counselling for patients with HIV and may let you sit in on some counselling sessions. They are often trained to give contraceptive advice. Genitourinary nurses are great dinner party guests.

Handover
Meetings occurring when nursing shifts change. Nurses on the shift going off duty pass on important information about individual patients to the incoming shift. Interrupt handovers at your peril.

Infection control nurse.
A specialist nurse adviser on a diverse range of topics from hand washing to hospital acquired infection and sharps injuries. Medical students would be wise to shadow this nurse for a day.

Jobs
Nurses do many ward jobs that are essential basic skills for medical students and junior doctors. Jobs to learn from nurses include recording a patient's blood pressure, testing urine with a dipstick, administering nebulised medication, giving injections and intravenous drugs, and recording an electrocardiogram.

Kardex
Nursing records. Equivalent of medical case notes. A Kardex contains information of potential interest to medical students: charts of blood pressure, pulse and temperature, fluid balance records, and care plan.

Link nurse
Qualified nurses with special responsibility for an aspect of patient management--for example, wound care. Responsibilities include developing evidence based practice for their link topic on their ward and educating colleagues.

Midwife
Qualified nurses with extra qualifications in care of pregnant women and childbirth. Befriend midwives as they can teach medical students about normal births. Labour wards are their domain. They are notoriously hostile to medical students who they suspect are only interested in "catching the head" to make up their delivery quota. However, if you assist with monitoring during the stages of labour they will let you deliver babies.

"Nitty Nora"
Derogatory name for school nurse dating back to when they patrolled classes for headlice. They are qualified paediatric nurses with an extended pastoral role.

Observations
"Obs" means different things to different species of nurses. To general nurses, a "set of obs" comprises taking and recording a patient's blood pressure, pulse, and temperature. To psychiatric nurses, observation levels--being "on obs"--refers to levels of monitoring patients. Suicidal patients may be on one to one observation, those at risk of absconding on observation intervals of 15 minutes.

Psychiatric nurses
Most are registered mental nurses and many have additional qualifications in cognitive behavioural therapy, psychotherapy, marital therapy, addictions counselling, and group work. They do not wear uniforms, making it difficult to differentiate charge nurses from auxiliaries and staff nurses from patients. Unlike psychiatric doctors, they do not have to complete any general training.

Qualifications
A thorny subject. "Unqualified" nurses may be studying for a national vocational qualification (NVQ). Nursing qualifications range from the old SRN (state registered nurse) to Project 2000. This is a broad based diploma qualification including specialisation in medical, surgical, mental health, child, or learning disability nursing. Some nurses have undergraduate or higher degrees. Qualified nurses are governed by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, the nursing equivalent of the General Medical Council.

Report
Another name for handover.

Special
To "special" is to provide intensive nursing for a seriously ill patient.

Triage
A filtering process carried out by triage nurses in accident and emergency departments. Patients are prioritised as green, yellow, or red according to the severity of their presenting complaint.

Uniforms
Uniforms can be useful to identify who's who in the nursing hierarchy. Unfortunately, uniforms vary from hospital to hospital. A navy blue dress, belt, or epaulettes usually denote senior nursing staff. Some bank nurses wear uniform provided by their agencies, causing confusion.

Venepuncture
Nursing term for "taking blood." Some nurses are trained to take blood and inset intravenous cannulas. Most will be willing to teach you.

Ward sister
Ward sisters, or their male equivalents, charge nurses, have overall responsibility for all patients on their ward. Hospital etiquette requires that you make yourself known to the ward sister before any patient contact.

eXtended role
Some qualified nurses specialise. Most trusts have an HIV liaison nurse, breast care nurse, stoma care nurse, and diabetes nurse. Patient education is a large part of their role and you may be able to sit in.

Yawns
Nurses hate being stereotyped as blonde bimbos or golden angels. Other pet hates include: medical students who do not clear up after themselves; arrogance; and being interrupted during handover.

Zzzzzzz
Twilight nurses are specialist community nurses who work between 6 pm and midnight. They administer night medication, assist in evening ablutions, and put people to bed at home.

Peter Cross, psychiatric nurse, Kent

Sabina Dosani senior house officer in psychiatry, St Thomas's Hospital, London
Email: s.dosani@medix-uk.com


studentBMJ 2001;09:305-356 September ISSN 0966-6494