Are student nurses too posh to wash?

6 November, 2009 | By Gabriel Fleming

The debate over what student nurses should and should not do on clinical placements has given Beyond the Bedpan plenty to think about

Student nurses of yesteryear were made of sterner stuff. The would rise at 3am and walk 18 miles to their clinical placements, over hot coals and under heavy fire from the Germans.

Once there they would roll up their sleeves and make tea for everyone, before getting down on their nobbled knees to scrub blood and excrement from the floors with their own toothbrushes.

All this would be done with a smile and a cheerful, giving nature that channelled the spirit of Florence Nightingale.

Nowadays, they get up at 11am from a drunken stupor and, on the rare occasions that they can be bothered to go to work, demand a lift from their long-suffering parents and show up in hotpants and leather boots.

Change a bedpan? Make tea? Pull the other one, they scoff, before happy-slapping the nearest HCA and taking over the responsibilities of the senior nurse consultant.

That’s one way of looking at the debate currently threatening to crash nursingtimes.net, and possibly the whole internet, with its sheer volume of traffic.

Another way of looking at it is that these poor, long-suffering lambs of the nursing profession are treated as cut-price HCAs by their unscrupulous superiors, who ignore their learning requirements in favour of banishing them to the cleaning cupboards.

So who is really getting the short end of the stick here? The truth, boringly, lies somewhere in between.

Student nurse placements are supernumerary roles, meaning that they are explicitly there to learn, and not to be traditional members of the hospital workforce.

They arrive on placements with clear instructions from their universities about precisely what they should be learning. If they are not being given the opportunity to meet these objectives, it is only right that they speak up.

But it can go too far. In the research that started this whole debate, one student was reported to have told a staff nurse: “I keep being asked to do things which won’t help me learn - clear up poo, mop up blood, give patients tea and toast. I realised that I needed to more focused to learn, and I don’t do those sorts of things now.”

But cleaning up poo, making tea and providing “basic care” for their patients is and always will be a fundamental part of nursing. The fear is that if these skills are neglected, students will go on to become the type of “hands off” nurses the profession dreads.

A student reader is unequivocal in her riposte: “What a load of hogwash. I’m a third year student and I have no problem with performing fundamental care on patients and I understand its importance. What I do not like as a student is being constantly used as an HCA - there are other things to learn along with fundamental care. Please stop attacking us students.”

Good point, well made.

Readers' comments (62)

Stephen O'Connor | 7-Nov-2009 9:49 am
As a nurse teacher for 20 years (and yes... I have worked clinically as well for most of that time before you ask!), I would take an extremely dim view of any student who didn't see the provision of nursing care (forget the 'basic' or 'fundamental' description - it is ALL nursing care) in any shape or form, but I get equally angry that the NHS still hasn't got over the fact that students are not there to be a source of cheap labour. I DO speak up in either case, so as you say, the truth lies somewhere in the middle. It is a 'some' (and I choose the word carefully!) students (and 'some' qualified nurses!) don't seem to know the meaning of nursing anymore. Time to go back to basics. Doe anyone actually remember Henderson's definition? It is ALL nursing care folks. Not just the high tec stuff!
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Anonymous | 7-Nov-2009 10:18 am
I fail to understand the relevancy of the photograph used for this article to the subject matter. Is it supposed to represent a typical student nurse? Perhaps there are some sweeping generalisations being made in this debate as illustrated by the picture. How disappointing for everyone!
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David Collins | 7-Nov-2009 11:16 am
I am sorry but since the move of nurse education into the university system there has been a decline in the standard of nursing. Yes there are a lot of caring nurses around, but yes student nurses do feel that basic care is below them. I have been trained for 30 years now and still do a full assessment of my patients, I hate to think of how many nurses do not look at patients pressure areas, or check to see that they have been eating and drinking. To be honest I never saw a pressure sore during my training, today they appear to be a fact of everyday nursing

The question I would pose is what do some nurses want to do?
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Graham Dalton | 7-Nov-2009 11:28 am
I am another third year student! Just finished a placement on oine of the busiest wards I have ever comer across.

The team work was excellent on the ward and I could see this from the first few days. I made the decision that I would work as hard as any other member of the team, HCA, or nurse. After 14 hour shifts I would return home to an assignment, but still have a big satisfied grin on my face. I had spent the day making people feel better and indeed actually get better. I did more paperwork than I knew what to do with! It was great!

That was the whole reason I came in to nursing. Its not a job, it is a way of life. :-)

Despite all the 'menial' tasks I still managed to achieve all my competencies. I say roll your sleeves up and get stuck in.

What I would moan at is one nurse in hand over claimed that she had to clean up a patient and bed bath him twice that day as he was doubly incontinent. In fact it was an HCS and myself that had cleaned him twice. Some students show up the nurses as they are often to qualified to wash!!!
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Anonymous | 7-Nov-2009 11:51 am
I am offended by the photo used - that looks more like a patient than a student nurse! Also I would like to point out that I am aware of the importance of basic care needed - but I really don't need to spend 3 years practicing making toast and washing patients - I will be just as competent and enthusiastic when I qualify as I am now. I want to use my placement time to learn more complex clinical skills so I am competent with all aspects of nursing. If it is quiet (which is a rarity) then I am more than happy to muck in and help the HCAs, especially as it gives me a chance to learn from them too. On a recent mother and baby placement which was only for a day, the first thing I was asked to do was to help the HCA with OBS and beds. I said that was ok but I pointed out that that was not the point of this day on the maternity ward - I was there to have a day observing a midwife and that I had already done 3 months being involved with daily tasks on a surgical ward. At that point a senior midwife walked past and jumped in to back me up and immediately posted me off to observe another midwife's morning checks. Later I sat in with the baby doctor's clinic and observed advice and support sessions with the new mums - fantastic! OBJECTIVES MET!
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Anonymous | 7-Nov-2009 12:34 pm
I am dissoppointed the picture they used for this topic which is never ever presented me as a student nurse... a few object may be in this life style but it doestin give right to put this kind of picture.. yes I agree basic skill are fundamental and we all neet to meet patient basic skills and look after them holistically...some clinical area use as as a part of NHS staffing and this load couse stress and delays to meet our learning outcomes... something is not right and need to be look at it .
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Anita Hobson | 7-Nov-2009 1:03 pm
I trained when student nurses were employed by the hospitals and as such could be expected to be a "pair of hands" Having said this, it was definitely the best way for me to learn. Having an allocation of patients every shift meant I had to learn how to plan my workload, prioritise and be flexible to meet the ever changing patient need.
A few years ago it seemed that newly qualified nurses were ill equipped to function as such because they didn't work with patients when a student; they wanted to see every diagnostic test, operation and procedure going. They did not spend time learning how to give the "basic" care day in, day out. To become good at what you do tale repition. Washing a patient once or twice doesn't make you an expert. However, it has got much better recently so perhaps some universities are addressing the problem.
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Anonymous | 7-Nov-2009 1:36 pm
It is not just if a student can wash a patient but how they do it! After 30 yrs in the profession I am still having to teach second year students how to perform basic tasks.It amazes me that they will wash a patient without removing nightwear or stripping the bed and leave the window open allowing a draught to freeze the patient. As for my nurse tutor saying hot water and plenty of it, many students dont seem to know the meaning of hot water.
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Anonymous | 7-Nov-2009 1:42 pm
I am another 3rd year student nurse who feel offended by the photo and article. I am a mature student, a mother who does not go out drinking (not that it is wrong), turns up for all lectures and every day at practice. I work very hard both at the University and on the ward whatever it involves. I would never ever dream to say I am not doing basic care firstly because it is part of the job I signed up for but also it helps to build a rapport with clients. Does it mean that I am a nurse from the Mars??????
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Deborah O'Byrne | 7-Nov-2009 1:58 pm
Our duty is to care for our patients, holistically. Fundamental personal needs must be as eagerly embraced to the coordination of medical interventions and drug administration. As a very newly qualified nurse it has become only too apparent how student nurses must be included in all the skills associated with qualifying as on registration many duties are EXPECTED of you.
It appears 'placements' for student nurses relies upon who your mentor is, whether they embrace the role or address it as an additional chore. For example I was showed and explained the contents of a resus trolley only once in three years training, that in retrospect is at the core of acute nursing.
It is imperative that student nurses experience varied duties within their placements for them to be able to survive the transient period of preceptorship. Universities requesting evidence of applicants working within the role of HCA/NA/HCW would fullfill the certainty that nursing students are more than capable of fundamental care. This would leave placements open for the additional teachings of the necessary additional knowledge and workings of the nursing enviroment that can only be absorbed and learnt from willing and eager participators. For 'gold standard nurse training'. the NMC and NHS must appreciate that qualified staff need time to exercise this need.
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Anonymous | 7-Nov-2009 4:05 pm
I think its high time nursing goes back to teaching hospitals. In my days, lecture theaters and practical areas were on the teaching hospitals. Before students were sent out on placements, they would cover academic and theoretical learning at the school of nursing, then they would have their clinical instructors, who would take them to through the expectations and levels to be achieved on their placements. They would take them to the wards and demonstrate the pactical side of nursing. Students will then be allocated to the different departments on a rotation. A mentor will be allocated on every clinical area to support the student nurses. At the end of every placement, the student was assessed by a clinical instructor. Students were never considered to replace shortage of staff. The level of learning was clearly defined at every level and expectation of learning outcomes emphasised. Students were assessed at every level and would acquire skills like asceptic techniques (dressings), before they qualified. Of course they were continuosly supervised troughout their training. It puzzles me a lot that I get to assess students' asceptic technique but when they qualify, I have to teach them again and reassess them again before they are allowed to do the dressing as a staff nurse. I have done drug rounds with student nurses and have asked them to study their drugs. But when they are newly qualified, I have to start all over again to teach them drugs and do drug rounds and assess them again... Intially I used to wonder what was going on but eventually I realised that their education plan does not equip them to be competent as soon as they qualify at least the basics of nursing. I wonder what stuff they are actually learning in class, and oh by the way, when they qualify they are mentored by equally incompetent "mentors" who have never been assessed or educated to be mentors. There 8 activities of daily living defined by Nancy Roper. All nurses at every level should be able to carry them out without feeling any resentment. I was once faced by a final year student nurse who had never done a bedbath and was really shocked that I was happy to give a bed bath and was also very profesional about it. She resented the idea of sitting down and assist a patient to feed. She liked to do drug rounds but was too lazy to study and acquire knowledge of the drugs she enjoyed administering. I am not sure how she got to the final year, but I guess you know what happened to her at the end of her placement. I also guess that you know where I trained...Ehh ee, not the U.K. It is sad nursing in the U.K is sooooooo political.
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Anonymous | 7-Nov-2009 4:21 pm
as a senior nurse my day to day tasks have become more complex, I am also just finishing my degree. However, neither of these have been of use on their own, they have complemented the foundation of basic nursing care I received as part of my nurse training. I dont know useful I would find it to be able to perform a diagnostic investigation for a patient & know the evidence that supports it, but not have the same level of knowledge about how to maintain their dignity during the procedure, promote their comfort & help them clean & dress themselves afterwards.
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Anonymous | 7-Nov-2009 5:44 pm
I am a sign off mentor for mental health students and during their placements on my ward they work closely with me. I work on a very intensive challenging ward and everyone from clerk to ward domestic gets their hand dirty and gets stuck in. A truly team effort.
As I do my day to day assessments and care planning the student nurse is by my side. During the first interview stage I establish a free relationship with the student and constantly get them to ask questions and challenge the care that is given to the clients. It is part of my duty as a mentor to enable the student to pass their core compentencies which has been set by the university. This includes basic nursing care. So cleaning up "Poo" is a part of a student nurses role.
My philosophy is simple I as a registered nurse ensure the dignity of my patients and get the student constantly think "Code of Conduct" and to use the Code of Conduct at all times. If they then still think washing patients is below them then they should think about getting a new career!!!
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Anonymous | 7-Nov-2009 6:05 pm
As a senior lecturer in nursing, I am very concerned about the attitudes of alot of students who qualify and are then responsible for the care of future patients. The system allows them to scrape through with 40% passes academically so, if they don't want to put the effort in, they don't have to. Also, they are mostly working with mentors who do not have the time to adequately supervise their practice and so some students who should not be assessed as competent slip through the net and qualify. From time to time, mentors will express concerns about students but usually this is too late as they have already signed off competencies leaving university staff without a leg to stand in trying to resolve this situation. Yes, there are some very conscientious, hard-working, caring students but I'm sorry to say they seem to be the minority. If we're working towards an all degree profession, some major changes need to take place: such as making the process of recruitment more selective; assessment in practice more rigorous; and raising the bar in academic assessment. If we're going to gain more respect as a profession, we have to start ensuring we have more professional credibility by producing qualified nurses with a caring, respectful attitude to their patients as well as a good knowledge base and a keenness to continue developing that knowledge base. It is up to bodies such as the NHS, RCN, and NMC to ensure this can be facilitated by increasing staffing levels; maintaining staff development; and creating a more rigorous approach to assessing students in practice.
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Joaquin Buitrago | 7-Nov-2009 6:18 pm
Unfortunately, this comment is reinforced with a picture that portraits “wrong image of the student nurses”.

In order to stop putting the nursing profession down, next time that you we all want to criticize a colleague, think: “Would a medical doctor, an attorney, a military officer, or an engineer, say the same about their colleague?”

Please support, protect, and encourage student nurses to continue as excellent clinicians, researchers, and leaders in the profession.
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Anonymous | 7-Nov-2009 7:19 pm
on my first placement in my first year I heard the ward manager say cancel the bank staff we have two students now. fortunatley I had 24 years experience as an auxillary nurse before I started my training, unlike the second student who had never been in a healthcare setting before
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jjjez@hotmail.com | 7-Nov-2009 7:28 pm
Oh give over! Of ocurse they would. Why do we always insist of defining who is a good nurse based on their behaviour?

Medical and Surgical Consultants are tolerated beyond reproach in their manner, the words they pick and choose (or neglect to choose).

People gossip and bad mouth each other in every profession, of course it has a negative effect but is naturally occuring in humanity in general.

What this is about is the current rejection of the notion form students that they have had quite enough of the basic care thankyou. This is supposed to be a professional course aimed at providing practitioners that are WELL ROUNDED and they are telling you that they don't feel ready for the acute care.

Do you think that the platform students stand on in the clinincal environment is anywhere near the par you are then trying to get them to achieve once qualified?

Do you honestly believe that the real problem isn't that they don't know enough about the 'medical side' (bogus term, my bad!) but that students don't know enough about basic nursing care.

In my 8 years in the NHS i have seen pressure ulcers reduced from fairly prevalent to rare beyond believe and well tackled, even at my dump of a hospital.

THe experience isn't well rounded enough.
Nurses can't recognise A WIDE RANGE of symptoms, which to be honest is criminal.

And last of all, by not being able to accompany the mentor all the time, much of the experience can be lost.
The variation is huge in experiences. I think this is what has to change.
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Anonymous | 7-Nov-2009 8:02 pm
I can see the argument from both points of view. It is all very well student nurses providing fundamental nursing care but if they then qualify and are unable to administer IV fluids and medication, insert NG tubes and catheters and give injections I think people would ask the question "What did you learn in the 3 years you were a student?". A student nurse needs exposure to the whole array of skills a nurse needs to master and have adequate practice to become competent. Not to mention the sheer volume of paperwork they need signed off before qualifying. (showing they are competent in these skills).
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Anonymous | 7-Nov-2009 8:05 pm
I agree with a lot of the previous writers comments however it is not only the experience of the mentor the student has to gain the knowledge from. If a mentor is not on duty that shift then it is the responsibility of the other qualified staff to ensure that the student nurse is nurtured, not left alone or feeling like a spare part. The nurse manager who cancelled the agency or bank nurses because they had student nurses on placement should be taken to account for their action/actions which is beond contempt in my opinion. Students listen, learn, pick up bad nursing practice from those nurses who think student nurses should not be around. How the heck can we educate the new work force if there are nurses who think like that. Come on you qualified nurses remember you were students once apon a time. If you had a bad experience in /or on placement when you were training just let it go leave it in the past. Become a good role model. Don't slag off the students. Help them develop into good Nurses. You can change your views about student nurses, so the profession can also develop. Soon, you qualified nurses everywhere will retire one day and maybe need the help and experience of one of those student nurses you helped to train. Really it is up to us qualified nurses to ensure our students get the best quality teaching.
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claire prendergast | 8-Nov-2009 12:31 pm
In my opinion, it is all about balance. Of course we need to learn basic nursing skills and i believe most students are willing to perform these. The problem comes when placement after placement we are used in the same way! The nurses are often understaffed and unable to give us their time to teach. Consequently we are given jobs which will keep us busy and quite frankly out of the way!
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