Health: Sisters are doing it for themselves: Why shouldn't a nurse tend a cut finger? Stephen Ward reports on a new unit where accident patients don't have to see a doctor

Daniel Warren, aged 11, sits with his mother in a hospital waiting room. He cut his finger with a Stanley knife while doing woodwork at school. Now his finger is wrapped in a blood-soaked bandage and he waits nervously for attention.

But Daniel will not be seeing a doctor; not at first anyway. If the wound is not serious he won't see a doctor at all.

Instead, he will be treated by a specially trained nurse practitioner at St Albans City Hospital's Minor Injuries Unit, which opened last year.

Daniel's finger is inspected by Rita Dunkerley, a registered nurse with 20 years' service in the hospital's accident and emergency unit - before it closed in March last year. The departure of the A & E department to the nearby Hemel Hempstead Hospital has stunned local people. It has meant that St Albans has become a test bed for nurse practitioner units which could become increasingly common as market forces bite further into the NHS.

Mrs Dunkerley asks Daniel to bend and straighten the injured finger and decides the cut is not too deep. She cleans it and seals it with steristrip to keep the loose flap of flesh in place, so that the wound heals with the minimum of scarring and the least risk of infection.

Daniel's mother, Deborah, says: 'I didn't know what to do. The school secretary told me I could go to the hospital because they had a minor injuries unit.' After the treatment she adds: 'I am quite happy. I needed to get Daniel seen quickly and it has been done perfectly satisfactorily. I am not at all worried that we have not seen a doctor.'

Philip Nye, director of nursing at St Albans City Hospital and Hemel Hempstead Hospital, says that there continues to be resistance to the new unit at a local level. 'There is still ill feeling when you ask people what they think, because they see this as a city that has lost its accident department. We say: all right, but let us look at what is here and what is here is meeting the bulk of the need.'

The unit is one of a handful around the country and is open 24 hours a day. It is staffed by six nurse practitioners - qualified nurses who have received additional training in diagnosis. They each work a 12-hour shift rota and there are two on duty at any one time, aided by one health care assistant. The nurses have been regraded so that their salaries are higher than before.

The unit is housed in the old casualty department of the hospital where Anita Lees, who has 19 years' casualty experience, is sister-in- charge. 'We don't have a doctor here,' she says. 'We are trained to make a diagnosis and to carry out certain treatments. In an accident department every patient must see a doctor. Although initially a nurse may see a patient with a cut, she would have to say: 'I will just put a temporary dressing on you and then you can sit in the waiting room. When the doctor has seen the other patients he or she will see you'.

''A patient with a minor injury might have to wait several hours. But here we can deal with them straight away. It is much more efficient and you don't have all the distractions of serious cases that you would get in an A & E unit.

'We are allowed to deal with patients who have injured limbs, twisted ankles, injuries to hands and arms; we can take X-rays of patients from the elbow down and from the knee down; we undertake stitching of wounds providing nothing vital has been cut such as tendons or nerves, take pieces of floating debris out of eyes and a whole range of things that children put in their noses and ears.'

The nurse practitioners also deal with some acute infections, such as those in the nail. 'We are able to lance those,' Mrs Lees says. 'And during the summer we get a lot of insect bites and stings.'

In more serious cases, the nurses will arrange an immediate transfer to the casualty unit at Hemel Hempstead, although they are able to give life support and resuscitation if required. Any other case that needs a doctor is referred to the appropriate unit - a child with a very inflamed eardrum, for example, will be referred to a GP. 'There are protocols laid down for these cases, but the nurses are able to use their own judgement and work safely within their competence,' Mr Nye says .

Since April the number of cases seen by Mrs Lees and her team amount to a staggering 6,165, about a third of those seen by the old casualty department. In addition, the number of patients who have returned to have their treatment assessed has reached 2,306. Peak times are around 9am, between 11am and 12 noon, and 4pm, just after schools finish. Twenty-five per cent of patients seen are children.

In October, the unit was given authorisation to carry out X-rays; since then more than 100 people have been given X-rays, although these are usually done by radiographers. Nurse practitioners have to be trained before they are allowed to undertake these extra tasks.

The training for nurse practitioners lasts eight weeks and was set up locally with the University of Hertfordshire. 'We have two weeks in a classroom doing anatomy and physiology and then work alongside a senior accident and emergency doctor,' Mrs Lees says. 'We assess a patient in front of a doctor and are trained by that doctor in the technique of examining, which as ordinary nurses we were not taught to do. This involves looking at things in a systematic way so that we don't miss anything.'

The nurses, she says, find it satisfying to carry out tasks they have felt they could do for years. Their new role is raising self-confidence and self-esteem, which have diminished in the past few years.

'People always said we need a doctor to do this and even we nurses began to believe it,' Mrs Lees says.

Another patient, Andrew Wallace, has come in with an abscess on his finger, swollen with pus.

'My wife remembered that this unit existed, otherwise I would have had to wait another day to see my GP,' he says. 'It is very painful, I couldn't have waited any longer. I am grateful this unit is here.'

The St Albans unit has attracted attention from health authorities throughout the country, as nurse practitioner units are being considered as the next step forward in the NHS. The units would take the pressure off A & E departments, allowing more of them to amalgamate. This in turn would mean larger accident and emergency departments, able to attract more specialist doctors because of the higher throughput of patients.

Mr Nye says: 'Nurse practitioner units have grown out of meeting local community needs, and each one is different, with its own peculiarities. What makes this unit different is that it has replaced a major accident unit.'

He would like to see nurse practitioners taking on further responsibilities - such as being able to refer patients in need of follow-up treatment to outpatients' clinics at St Albans City Hospital rather than sending them to casualty at Hemel Hempstead first.

'We would also like to see the Department of Health giving nurses the power to prescribe drugs. We want to increase the range of duties undertaken by nurses. But we also have to ensure that the safety of the patient is not put at risk.

'There is always a tension when you are breaking new ground, but we must push forward.'

(Photograph omitted)

News
people'It can last and it's terrifying'
Sport
Danny Welbeck's Manchester United future is in doubt
footballGunners confirm signing from Manchester United
Sport
footballStriker has moved on loan for the remainder of the season
Sport
footballFeaturing Bart Simpson
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
New Articles
Olivia Colman topped the list of the 30 most influential females in broadcasting
tv
News
Kelly Brook
peopleA spokesperson said the support group was 'extremely disappointed'
News
The five geckos were launched into space to find out about the effects of weightlessness on the creatures’ sex lives
i100
Life and Style
techIf those brochure kitchens look a little too perfect to be true, well, that’s probably because they are
Sport
Andy Murray celebrates a shot while playing Jo-Wilfried Tsonga
TennisWin sets up blockbuster US Open quarter-final against Djokovic
Arts and Entertainment
Hare’s a riddle: Kit Williams with the treasure linked to Masquerade
booksRiddling trilogy could net you $3m
Arts and Entertainment
Alex Kapranos of Franz Ferdinand performs live
music Pro-independence show to take place four days before vote
News
news Video - hailed as 'most original' since Benedict Cumberbatch's
News
i100
Life and Style
The longer David Sedaris had his Fitbit, the further afield his walks took him through the West Sussex countryside
lifeDavid Sedaris: What I learnt from my fitness tracker about the world
Arts and Entertainment
Word master: Self holds up a copy of his novel ‘Umbrella’
booksUnlike 'talented mediocrity' George Orwell, you must approach this writer dictionary in hand
News
i100
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    SQL Implementation Consultant (VB,C#, SQL, Java, Eclipse, integ

    £40000 - £50000 per annum + benefits+bonus+package: Harrington Starr: SQL Impl...

    SQL Technical Implementation Consultant (Java, BA, Oracle, VBA)

    £45000 - £55000 per annum + Benefits + Bonus: Harrington Starr: SQL Technical ...

    Head of IT (Windows, Server, VMware, SAN, Fidessa, Equities)

    £85000 per annum: Harrington Starr: Head of IT (Windows, Server, VMware, SAN, ...

    Lead C# Developer (.Net, nHibernate, MVC, SQL) Surrey

    £55000 - £60000 per annum + Benefits + Bonus: Harrington Starr: Lead C# Develo...

    Day In a Page

    'I’ll tell you what I would not serve - lamb and potatoes': US ambassador hits out at stodgy British food served at diplomatic dinners

    'I’ll tell you what I would not serve - lamb and potatoes'

    US ambassador hits out at stodgy British food
    Radio Times female powerlist: A 'revolution' in TV gender roles

    A 'revolution' in TV gender roles

    Inside the Radio Times female powerlist
    Endgame: James Frey's literary treasure hunt

    James Frey's literary treasure hunt

    Riddling trilogy could net you $3m
    Fitbit: Because the tingle feels so good

    Fitbit: Because the tingle feels so good

    What David Sedaris learnt about the world from his fitness tracker
    Saudis risk new Muslim division with proposal to move Mohamed’s tomb

    Saudis risk new Muslim division with proposal to move Mohamed’s tomb

    Second-holiest site in Islam attracts millions of pilgrims each year
    Alexander Fury: The designer names to look for at fashion week this season

    The big names to look for this fashion week

    This week, designers begin to show their spring 2015 collections in New York
    Will Self: 'I like Orwell's writing as much as the next talented mediocrity'

    'I like Orwell's writing as much as the next talented mediocrity'

    Will Self takes aim at Orwell's rules for writing plain English
    Meet Afghanistan's middle-class paint-ballers

    Meet Afghanistan's middle-class paint-ballers

    Toy guns proving a popular diversion in a country flooded with the real thing
    Al Pacino wows Venice

    Al Pacino wows Venice

    Ham among the brilliance as actor premieres two films at festival
    Neil Lawson Baker interview: ‘I’ve gained so much from art. It’s only right to give something back’.

    Neil Lawson Baker interview

    ‘I’ve gained so much from art. It’s only right to give something back’.
    The other Mugabe who is lining up for the Zimbabwean presidency

    The other Mugabe who is lining up for the Zimbabwean presidency

    Wife of President Robert Mugabe appears to have her sights set on succeeding her husband
    The model of a gadget launch: Cultivate an atmosphere of mystery and excitement to sell stuff people didn't realise they needed

    The model for a gadget launch

    Cultivate an atmosphere of mystery and excitement to sell stuff people didn't realise they needed
    Alice Roberts: She's done pretty well, for a boffin without a beard

    She's done pretty well, for a boffin without a beard

    Alice Roberts talks about her new book on evolution - and why her early TV work drew flak from (mostly male) colleagues
    Get well soon, Joan Rivers - an inspiration, whether she likes it or not

    Get well soon, Joan Rivers

    She is awful. But she's also wonderful, not in spite of but because of the fact she's forever saying appalling things, argues Ellen E Jones
    Doctor Who Into the Dalek review: A classic sci-fi adventure with all the spectacle of a blockbuster

    A fresh take on an old foe

    Doctor Who Into the Dalek more than compensated for last week's nonsensical offering