Qualified and competentPosted: 30 May 2011
When I was doing my primary care internship, the H1N1 flu scare was on its peak. Thousands of vaccines had been ordered and the nurse practitioners spent a lot of time vaccinating everyone. It never crossed my mind to offer to help – after all, I’d only done a venapunction on a classmate, definitely not comparable to an intramuscular injection. The very thought of damaging an important nerve due to lack of experience made me shudder – I was content with observing.
My fellow students didn’t have such qualms. They had even been asked to help out, their doctors assuring them that ‘it’s not that difficult, I’ll show you and then you can have a go’ – and I was about the only one who hadn’t done about 30 IM injections.
According to Dutch law, medical actions (injections etc) are restricted to doctors. They can delegate them, however, to other healthcare professionals. So essentially, in order to perform a medical action, you need to be both qualified (either registered as a doctor / obstetrician / dentist OR ordered by one) and competent (having had the proper training).
I know I did the right thing by not asking. My doctor also did the right thing by not asking me. Still, I feel a bit stupid for missing such a great learning opportunity…
The only thing I’ve done while not being competent, was to prepare an IV bag of amoxicillin during the nursing internship. The nurse that supervised me was a great woman, encouraging me to take more responsibilities because she knew I was capable, I just wasn’t really vocal about it. So, within a few days I progressed from just washing a patient on my own to caring for an entire room (6 patients) on my own. Knowing that I wasn’t allowed to touch the meds, I always let her do the counting/mixing /sorting / administering thing.
And then she cornered me. “Have you ever prepared an IV bag?” I’d observed it quite a few times but I’d never done it. “I think a doctor should be able to do that, you’ll find it a very useful skill. Here, do you want to prepare this bag?”
“I’m sorry, I’m not allowed to.”
“Come on, I’m here to help you and essentially I’m doing it, you are just doing the steps.”
“But…” I was severely tempted and I gave in. She’d be there all the time so what could go wrong?
Nothing went wrong, as could be expected. It was quite fun to do and I felt (yes it’s stupid) somewhat honoured for being coaxed into a restricted medical action. I did break the law, however…