‘Mundane, repetitive tasks’ should be performed by nurses, not junior doctors, says Medical Council

The Medical Council has complained about junior doctors being required to do “mundane, repetitive tasks” that it says should be performed by nurses and other health workers.

A failure to transfer tasks from non-consultant hospital doctors (NCHDs) to nurses is having a negative impact on the education of trainee doctors and on Ireland’s ability to attract and retain doctors, it claims.

The tasks include taking bloods from patients, putting in drips and nurse-led discharging of patients.

“While these tasks must be learned, completing them on a frequent and regular basis adds to the trainee doctor’s workload, quickly loses its educational value, and deprives them of potential learning opportunities elsewhere,” according to Una O’Rourke, director of education and training at the Medical Council.

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In 2016, a deal was reached under the Haddington Road pay agreement for the “transfer of tasks” from NCHDs to nurses and midwives. Under the agreement, for which nurses received a pay boost of about €20 a week, tasks were to be “undertaken by the most appropriate employee at the particular time, in the particular location”. It was left to individual hospitals to make arrangement for the transfer of tasks.

Announcing the deal, then minister for health Leo Varadkar promised it would result in reduced working hours and more training time for doctors as well as speeding up the treatment of patients.

According to Ms O’Rourke, progress in implementing the new arrangements was slow before the Covid pandemic and has regressed since. “In some hospitals, the arrangement was rebranded as ‘sharing of tasks’, but the Medical Council has been informed that, in practice, very few nurses have taken on these tasks and the responsibility remains mainly with junior doctors,” she says in a letter to Prof Anthony O’Regan, chair of the Health Service Executive’s NCHD taskforce, last March.

The Medical Council has raised concerns with the HSE about the slow or lack of implementation of the transfer of tasks and “the negative impact engaging in mundane, repetitive tasks has on the quality of clinical training for doctors, particularly interns, in HSE hospitals,” she states.

In a reply, the HSE said it was more appropriate to talk about “task sharing” than “transfer of tasks” and that independent verification had shown tasks were mostly being shared or transferred.

Ms O’Rourke urged Prof O’Regan to “assign urgency to the transfer of tasks programme being fully implemented”.

The Irish Nurses and Midwives Organisation said the agreement was about “a sharing of tasks, not a direct transfer”. An independent review found “all areas committed to have been complied with,” a spokeswoman told The Irish Times.

“There has been barriers placed to implementing nurse-led discharge. The INMO continues to advocate for individual hospitals to develop and implement a nurse-led discharge policy.”

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