confocal microscopy are all represented, together with challenging clinically oriented projects; indeed, the enthusiasm of anatomy students often puts more established workers in other specialties to shame. Further, the development of computed tomography has highlighted how vital a research role a basic anatomy department can still have in helping innovative clinicians in interpretation. In Glasgow anatomy as a science subject is gaining in popularity: five years ago there were only one or two BSc students entering our second year course each year, whereas in the current year there are 23. The corresponding demand for places on our honours course by these students is also high, and we attract many students from cognate subjects such as physiology. In a survey quoted in a booklet circulated to all schools in England and Wales in 1989 it was noted that only 6% of students in the anatomical sciences (1979-86) were still seeking employment six months after graduating2; many other biomedical subjects would be pleased with such a record. "Anatomy bashing" may currently be popular, but the subject is stronger and worthier than the so called educationalists who seek to dismiss us as old fashioned and outmoded would allow. As for a nostalgic glance to eighteenth century teaching and Alexander Munro II, thank goodness that we are no longer supposed to exist merely by our talents for entertainment based on theatrical popularity or morbid curiosity. Surely even today's government would not condone a return to methods suited primarily only to male students, often without suitable entry requirements, who had little inclination to obtain a degree-or would it? ROBERT A SMITH Department of Anatomy,

University of Glasgow, Glasgow G12 8QQ 1 Charlton B. Anatomy past and present. BMI 1991;302:1001-2. (27 April.) 2 Payne JN, Williams NA, Pethen RW. Degree courses in anatomv at Britislh universities. Sheffield: Sheffield Universitv, 1989.

Research posts for general practitioners SIR,-Professor Denis Pereira Gray draws attention to the range and importance of the topics appropriate for research by and in general practice. ' He correctly contrasts this with the dismal lack of support for general practitioners wishing to acquire and use research skills. One medical school has recently tackled this problem, at least within its own locality. In January this year two young service general practitioners took up clinical lectureships at St George's Hospital Medical School. Each doctor has three sessions with the principal responsibility of undertaking original research towards a higher degree, normally an MD. This is a pattern that we hope other schools will follow. If we had more funds available we would offer more posts. There was no shortage of eager and competent applicants. PAUL FREELING St George's Hospital Medical School, London SW17 ORE 1 Pereira Gray D. Research in general practice: law of inverse opportunity. BMJ 1991;302:1380-2. (8 June.)

Junior doctors, nurses, and drips SIR,-Dr Christiane Harris called for the introduction of a nationally recognised certificate in giving intravenous treatment for registered nurses, suggesting that the Royal College of Nursing

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should press for a uniform programme of preparation for such a certificate.' In the 1980s the British Intravenous Therapy Association approached the Department of Health and nursing's statutory bodies with just this proposal. None intended to take action. With the help of Travenol the association undertook research into existing preparation programmes. This resulted in the Guidelines for the Preparation of Nurses for Intravenous Drug Administration, launched in 1987 with the intention of standardising preparation. Three thousand copies were distributed, and many health authorities use them, some having reciprocal agreements to recognise each other's programmes. Copies were sent to appropriate nursing statutory bodies, and at best a polite acknowledgement was received. Dr Harris states that most junior doctors have little, if any, recollection of tuition in adding substances to infusions or in giving particular intravenous drugs. The same deficiency exists in basic education for nurses, and yet both qualified nurses and junior doctors are expected to fulfil such tasks. The extended role of the nurse and the "IV certificate" have failed to solve the problem since the 1970s. The real issue is that medical and nursing staff have failed to acknowledge it as a shared role. Arguments continue to be made for and against administration of intravenous drugs remaining a duty of doctors or being accepted as a nursing duty. The need to differentiate in this way reflects a pattern of providing health care that no longer exists. Medical and nursing staff have complementary skills and knowledge. If we were to devote as much energy to joint education and understanding as we do to quarrelling over the ownership of shared tasks we would all benefit greatly, and none more so than the patient. The British Intravenous Therapy Association and the educational guidelines were appropriate for the issues of the '80s. The association has now become the Intravenous Therapy Special Interest Group of the Royal College of Nursing, and the educational guidelines are out of print and unavailable. We are about to prepare a replacement for the guidelines, and I would be delighted to hear from any member of the medical profession or any pharmacist who would be willing to collaborate in a joint proposal through our respective professional bodies on the appropriate preparation, for both nurses and doctors, for giving intravenous drugs as a shared role. THOMAS HALL

Chairman, Intravenous Therapy Special Interest Group, Department of Practice and Policy, Royal College of Nursing, London W1M OAB

the United Kingdom Central Council for Nursing, Midwifery and Health Visiting; this, we hope, may result in progress towards recognition of the nurse's professional responsibility for her own actions. DEREK J DEAN Royal College of Nursing, London W 1M OAB 1 Harris C. Junior doctors, nurses, and drips. BMJ 1991;302: 1212. (18 Mav.) 2 Royal College of Nursing. Boundaries of nursing. London: RCN, 1988.

Duties of juniors and consultants SIR, -All reasonable consultants will be delighted that steps are being taken to correct the unreasonable demands that have been made for far too long on house officers.' By far the greatest and most indefensible has been the commitment to rotas that may lead to doctors working in an exhausted and unfit state. If implemented with suitable urgency and determination the new agreements on doctors' hours will soon consign this scandal to history. But let us not rush too quickly to cut down some of the duties that are regarded by certain well intentioned activists as not being appropriate to house officers. As a house officer I learnt to take blood, and I do not believe that it did me any harm to master that art. House doctors should expect to spend part of their time mastering fairly simple techniques, and most will reasonably recognise that a year of occasional dull routine will be quite acceptable if the exhaustion can be withdrawn. Yes, we do need to build appropriate in service education into the grade. Yes, it is absurd that house doctors should spend their time looking for beds while administrators lie comfortably in their own. But if we are going to have most blood tests done by phlebotomists could a start not be made at consultant clinics, as a gesture to cut down waiting lists? At least a quarter of my time in clinic is devoted to taking blood samples and writing on forms, and eliminating that abuse seems to me more important than putting a stop to the house officer's blood run. We always will need intensive apprenticeship at the bedside. Now that the hours problem is to be solved the rest should fall into place without difficulty. ROBERT A WOOD Perth Royal Infirmary, Perth PHI INX I Delamothe T. Juniors' new deal on hours. BMJ 1991;302:1482.

1 Harris C. Junior doctors, nurses, and drips. BM, 1991;302:1212.

(22 June.)

(18 May.)

SIR,-It may be because Dr Christiane Harris is in Bermuda that she is out of touch with what the Royal College of Nursing is doing.' The college has campaigned for several years for nurses to be given the authority to add drugs to intravenous infusions. In 1988 it published its policy statement Boundanres of Nursing, which recommends that nurses should be entitled to use their professional judgment to determine which activities they will undertake.2 This would extend to a range of tasks that at present, because of guidance from the Department of Health, they may perform only if their employer recognises their training and competence. It is not true that "the trainee of one hospital is never recognised by another." Last year the council of the Royal College of Nursing took the position that retraining should not be required as a matter of course. Many health authorities have indicated their agreement and have reviewed their policies. The heads of agreement on junior doctors' hours has provided a further opportunity for us to reopen the dialogue with the Department of Health and

Selective reporting? SIR,-Hart misses the point when he takes me to task for criticising a system that allows consultants to flit from private to NHS work and back again without sufficient control. ' I was not indulging in consultant bashing but was calling for common sense controls that would serve the interests ofthe vast majority ofconsultants who, it is widely recognised, more than fulfil their contractual obligations. In the same speech to the Institute of Health Services Management I urged managers to engage the professions rather than alienate them, minimising strife and maximising health gain. Unfortunately, this was not reported by the national press. CUMBERLEGE South West Thames Regional Health Authority,

London W2 3QR I Hart. The week. BMJ 1991;302:1424. (15 June.)

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Junior doctors, nurses and drips.

confocal microscopy are all represented, together with challenging clinically oriented projects; indeed, the enthusiasm of anatomy students often puts...
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