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Let's not go back to being trained like circus seals

The only thing more boring than hearing about a party you didn’t go to is having to look at other people’s holiday snaps: “The pink fleshy one in the thong is Gran… my, she liked the waiters! More tea vicar?”

However, we had a party last week. We don’t dance much these days - dodgy knees, sore back, you know the score. Still we launched a novel and celebrated a birthday and there was wine and canapes. And I got
to thinking: people don’t celebrate life enough. This is my mantra for middle age. We don’t stop to say to people we love, like or respect: “Hello haven’t seen you for 10 days or 10 years and I was wondering, how’s it going?”

Soppy? Maybe, but have any of you noticed how time is moving a bit quicker these days? Won’t be long before some of you lot are old. Not me obviously, but some of you certainly.

‘You may have heard about the good old days… when you learnt to nurse by copying someone who may or may not have known what they were doing’

Anyway there were an awful lot of healthcare workers or ex healthcare workers at the party and some of us did what all nurses over a certain age do at such things - talked about the good old days.

Some of you may have heard about the good old days. Before Project 2000 when you learnt to nurse by getting your hands dirty and copying someone who may or may not have known what they were doing but was going to teach you anyway. When you “trained” a bit like a footballer or a circus seal to do “skills” on people and, heaven forbid, anyone bothered you with ideas or thinking. As the great nurses of the past used to say: “If you have time to think, you’re not busy enough.”

The good old days… when caring was a vocation and even if the things done didn’t look or feel like caring, we were carers so it must have been for the best. And, anyway, if it’s wrong one of the doctors will tell us because they are better at thinking and we are better at caring. And hats. Don’t forget the hats.

A recent Nursing Times story hinting at the threat to nurse education in universities must please some people, offering as it does the possibility of a return to “training” instead of education. Removing the silliness of essays and analysis and returning instead to something more “practical” might seem like an opportunity. But frankly it is absurd.

Without critical thinking, reflection, the ability to articulate and the capacity to translate knowledge into action with sensitivity and confidence, nursing becomes less than it is and less than it needs to be.

Nursing should always aspire to be the most noble profession in the world, informed by wisdom and thought, underpinned by knowledge and skills, guided by compassion and emotional intelligence. Take it out of a context that enables that and it will shrink and fade.

That is bad, not only for patients and nurses but also for what nursing represents: care, compassion and the considered wellbeing of strangers. We should never trust attacks on education, no matter how they are disguised.

Readers' comments (17)

  • I trained just as P2000 students were starting. We certainly learned a lot "on the job" but at no point were we trained like seals or footballers.

    The theory and practical was carried out in the School of Nursing, before we got "let loose" on the ward.

    Perhaps I was more fortunate than you, but we had the opportunity to reflect and to articulate our queries and concerns. We had tutors who came to the wards and Consultants who gave short presentations on patients with "interesting" conditions.

    Our practical skills were "signed off" by the nurse in charge and we had the opportunity to discuss any practical skills we wanted to improve on, or things that we had no opportunity to learn or observe.

    I am in favour of degree learning but have concerns that some skills are better learned in a practical environment. Having all nurses degree educated will not of itself, improve the wage scales, the working conditions, or the career paths open to nurses.

    The better educated nurses are, the more will be expected in terms of the above.

    We have lived through a variety of changes in education, in service provision,in career development, and the changes continue. Unfortunatey they are not all for the better.

    Nursing is not just "a job like any other job". It does require particular characteristics and attitudes. That the "good old days" were not perfect, is true, but are things any closer to perfect now? I doubt it.

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  • Deidre, are you forgetting that even Degree Nurses spend about 50% of their training on the wards, doing 'practical' training in a 'practical' environment as well as theoretical? If the practical training is not being done properly then I see that as a failure of the wards rather than the fact the course is a diploma or a degree.

    Saying that, as I have said before, the course content does need heavliy revising yes, and I agree a lot of the time the training you get is pot luck dependent on your particular university and specific placements, good or bad. But please (everyone) let us not go back to that ridiculous mantra that degree Nurses are 'too posh to wash' or have no practical skills. It is insulting, erroneous and just plain stupid to come out with sayings like that.

    I agree with you however Deirdre that a degree will not in and of itself, improve the wage scales, the working conditions, or the career paths open to Nurses. However, with increasing numbers of Nurses becoming degree educated, with increasing numbers of younger, or rather new or recently qualified I should say, Nurses coming through and DEMANDING a better pay, better working conditions etc for the skill, qualifications, responsibility and accountability they have, that will change, if enough of us fight for it. That is one of the many reasons I advocate striking at the moment.

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  • I too trained just before the advent of P2000, and the focus of my training was on having thinking practitioners to carry out the nursing care. I feel that the push to degree only is fueled, not by the benefit for nursing but by another agenda about less trained nurses supervising more 'untrained' nurses. Anyone can do 'hands on nursing' but not anyone can do it and make a difference. I do not want to see degrees and more pay at the expense of trained nurses actually doing the nursing - including washing! whatever happened to holistic care? I have by the way done a degree since in District Nursing - post reg education has suited me.

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  • How about external verifiers assessing practical skills; daily ward/dept based teaching sessions; giving students the opportunity to carry out all nursing skills, from observing, to supervision, to being competent; the principles of asepsis; more national uniformatity in classroom nurse education; a greater presence of tutors in the workplace; putting patients first, not beds; less paperwork; and degrees?

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  • So if our education equipped us with the skills to do and to think why shouldn't nurses be given a qualification - a degree - that has wider social resonance?
    I don't understand how a degree is for some people the enemy of good nursing?

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  • I was trained pre project 2000 but already had a science degree. I agree with Deirdre that my training wasn't quite as banal as described by Mark, but I also agree with Mark that a degree is not the enemy of good nursing. However, the quality of some students i have met is poor. I recently read an essay for a student and it certainly would not be considered up to standard in a non nursing degree (this was beginning of third year), the student had just done a neurology placement but did not know the terms CVA, or aphasia (despite having nursed someone with both). I have post registration degrees and am just completing an MSc science (non nursing) and the problem as I see it is the nursing degrees are not rigourous or academic enough, and the practical training - which is just as crucial, is not good enough. If a graduate only profession can change those problems, and enough recruits can be gained who can undertake a rigourous degree and can practically nurse then we are moving forward. I dare to say, a current nursing degree is recognised as being academically inferior to other courses.

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  • Of course a degree is not the enemy of good nursing but as an 'old traditionally trained nurse' I do feel that Project 2000 was change for change sake and, as with most change, the good went with the bad. I do not have a degree but I do have a professional qualification, of which I am very proud, and in no way feel that I would be a better nurse if I had trained differently.

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  • In the earky 1980s I was lucky to do a 4 year diploma course and had a fantastic clinical tutor. We did the same placements as the RGNs but had more advanced lectures in the school. The clinical tutor engrained an important discipline into us. Never do anything unless you understand why and the consequences of your actions. This had to be applied to everything we did.
    I recently visited my mother for many months in hospital before she died. One of the problems I had was engaging nurses looking after her in a conversation about my mothers treatment. Many of them did not understand her medicines, what they were for or why she was taking them. As a result she missed does of gabapentin and ended up in sever pain.

    On reflection I wonder whether in harking back ti the old days we are reflecting on a time when wards were quieter, drug therapy was less complication, people were younger and length of stay was longer. How many wards now have a patient well enough to do the teas?
    I also wonder whether the entrants (in my day most were 18, had studied to A level) were better prepared acaedemically and intellectually for the career they were entering. I trained with 18 students many of whom had 3 A levels at grade C or above.
    Look now at the general acaedemic entry qualifications and they are simply not the same. Ultimately we are comparing apples and pears and we need to stop it and address how we go forward.
    Would I have gone into nursing now- probaly but there are more attractiove carrer options for well educated school leavers compared to 30 years ago.
    Perhaps the economic downturn will reverse the trend.
    Also why are we not campaigning for a second level nurses? This will surely slove some of this debate

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  • I trained in the 'good old days' initially as an Enrolled nurse and 8 years later was lucky enough to do a conversion course to RN.
    Both nurse training courses taught me to think critically, reflect, have the ability to articulate and the capacity to translate knowledge into action with sensitivity and confidence. Since those days I have moved on considerably in a very specialised area of care, whilst I no longer work in a general setting I know without doubt that I could still to this day provide the holistic nursing care a patient needs to the same high standards I was always taught to deliver - something I don't think some of our nurses of today will be able to make claim to in years to come - I certainly haven't seen evidence of care to that standard personally for a long time.
    I disagree with Mark that going back to the good old days will 'shrink and fade the aspirations to make nursing the most noble profession in the world, informed by wisdom and thought, underpinned by knowledge and skills, guided by compassion and emotional intelligence'. I do agree that to maintain nursing as a profession we need to have access to higher education but not at the expense of providing excellent care to our patients.
    I think we should bring nurse training back into the hospitals, affiliated to a university so they can graduate with a degree and pay them a salary for doing so - that way we may just go back to a profession that I and many of my colleagues would be proud to say they belong.
    Would I train again today - not a chance! If I had the qualifications that nurses need to train today - I'd go to university to study something less worthwhile but easier and with better prospects and pay.

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  • I AM a project 2000 nurse and i came into the profession after completing my A levels but would like to point out i am not the enemy!

    I will be the first to say that when i first qualified i probably wasnt the most practically equipped nurse but i knew the basics and had the skills to learn fast, most of those i learned in my first year i would ony have been able to learn on the ward becuase they were so specialised to that area (which is something that is far more common today). I still today take great pride in being a nurse, i have always given my patients that best care that i can (i realise here that to some people a project 2000 nurse using the word care is a shock but stick with me people) delivered it holistically and always with compassion.

    Nursing has changed and it should continue to do so. Degree level entry is the most appropriate approach in a time where nurses have so much responsibility in our day to day roles. i think we should look more at what people are gaining entry onto the courses and the content of the courses are rather than grumbling about what acamdemic level its pitched at. this criticism has been going on for years and for nurses who did the new style training some of it is offensive.

    i love my job, (admittedly it has its days) of course i get frustrated and upset sometimes but surley that happenes in every profession. having been qualified now for 12 years - would i train again....TOO RIGHT I WOULD!

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  • I trained as one of the first cohort of RGNs.

    I think we SHOULD be degree educated, enquiring and always seeking the best for our patients and our professional selves.

    However I wonder if the Degree process (if you don't arrive with one to training) is one that could be postponed until some time after being qualified? I think my degree NOW rather than then is usefully consolidating my experience thus far and makes more sense.

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  • How many years of education to physicians have? How about pharmacists/chemists? Physical Therapists? Speech Therapists?
    If we want to work in this field of professionals who have university degrees, we can't allow ourselves to be at the bottom of the heap!
    Not only do we need critical thinking skills that relate to patients, but we need global thinking skills, cultural contexts, and more math and science. Without this framework, how can we be solid lifelong learners, leaders in our profession?

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  • i will be a newly qualified paediatric nurse in a month. i've undertaken the diploma not the degree i did that due to financial considerations but will undertake a top up to degree level in the future.

    there is alot of problems with the nursing course one for starters i don't know of any other university courses which expects so much off it's students. each semester of the program equates to 16,000 words made up of a essay and practice assessment with 50% of that time working 13 hour shifts. not to mention the dissertation. most students on other courses i believe would not be able to meet that level of demand yet the degree holds the same educational merit as other courses!?

    i've had mentors who qualified before nursing was in university and mentors who went to university. i can say i can not see any major differences in there practice. if anything the older generation of nurses i have seen provide a better level of care due to there experience. the emotional aspect of nursing they are particularly good at.

    i see the positives to university but you can only get so much value out of a book compared to first hand experience and reflection as nietzsche would say.

    there needs to be a balance between the two and currently in nursing there is not.

    i do however think that nursing is progressing this way if it is not too negetively effected by political and economical factors and left to do it's own thing (but that won't happen)

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  • Jane Watkins, you hit the nail on the head there, we cannot allow ourselves to be at the bottom of the heap, I totally agree with that. I have said in many seperate threads before, Nursing in my opinion has one of the broadest and most demanding bodies of Knowledge in the field, yet we are considered not worthy enough of a degree? Or I should say a lot of older Nurses and Doctors do not consider our knowledge worthy of a degree. It is so short sighted.

    And EJML, I agree with what you say on the whole, I too have met good and bad Nurses from both training backgrounds, but I would like to say I don't necessarilly think 'older' Nurses give a higher level of care, I think that in time, the University Degree educated Nurses will have the same level of experience as those who were not University trained do now, and I think then you will notice a very large difference in the level of practitioner. Yes you can only get so much out of University, but when you couple that with time and experience, you have a lot more than time and experience on its own can give.

    Also I think that Nursing can be left to do it's own thing and grow into a strong profession IF (and it is a big if) Nurses fight for it.

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  • In all these sort of threads there is negativity against both the 'old system' and the 'new system (degrees)' on a global basis, with individuals from both sides grappling to justify they are the 'better' nurse. Don't you all think all of this is what damages the profession and contributes to what other professionals think of us? We all have something to give, different skills, some we are better at than others. No-one is good at everything. I've nothing against progression to nursing degrees, but can attitudes progress too? We should be supporting each other to give us any chance being an upstanding profession.

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  • I trained in the nineteen seventies and my training was a disjointed mess. I learned nothing about critical thinking or research.

    My on-the-job training was worse and thinking back on it I shudder to remember the way students were treated particularly if they ever questioned what they were being told. Frankly, I spent three years being bullied on the job, not trained.

    Thank heavens for the JBCNS/ENB courses I did in the 1980s and the more academic training that I have done since then. I now feel that I am a real nurse and giving quality care.

    Last year I was lucky enough to give a lecture to third year student nurses/nursing students at Birmingham University and afterwards I felt excited for the future of the profession as I had managed to talk to them about concepts I did not even touch on in my training and they responded in a mature way and showed an understanding of where these concepts fitted in with giving care.

    I'll be pleased to have them nursing me when I'm in my dotage.

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  • Steve Williams

    Marky, Marky Mark old boy. Did you really want to say that stuff? Circus seals? Really?

    Most disingenuous to say the least. To both Californian sea lions and nurses over the age of 25!

    Sea lions are in fact highly intelligent mammals and can be trained to do different behaviours such as throwing and catching balls on their noses, running up ladders, or honking horns in a musical fashion. Even adult males can be trained. http://en.wikipedia.org/wiki/California_Sea_Lion

    Well there you go... a Wiki quote that defines not only nurses (young or old – degree trained or just doddering crumblies) but also, I suspect, wannabe journo/intellectuals who occasionally vomit their ill-thought-out, narcissistic views onto these pages, hoping that young people (and the NT) will suck it up.

    Oh, I am sorry Mark old chap. I get it now. Ssshhhh... I won't mention it again! What? Well the fact that you are over 25 and just wrote this piece a) to keep your street-cred up and b) keep earning a bit of wonga from the NT... Nahhhh... Trust me Wodney... it'll never pass my lips.

    Is he having a laff? Seriously, is he having a laff?

    Yes of course he is. Mark Radcliffe is to Nursing what Andy Millman (of Extras) was to serious acting. Unlike Gervais, Mark hasn't got the benefit of false glasses and an obviously fake(?) wig but we all know where the both of them are coming from... it's satire. And that's great, except you have to understand where the line between satire expires and just plain rudeness begins... and FFS – before mike et al. & Anonymous jump in - I know I am the worst example of this behaviour – the difference is that I know when I typed in a twattish line – but I felt like a twat afterwards, and regretted it – I also didn't get for it.

    Anyway – back to the main plot as our dear old friend Mark has so endearingly laid it out for us. The central point being that all nurses who do not have a degree are like seals and deserve to be clubbed with baseball bats to a bloody death by deranged, blood-thirsty, Canadians.

    Oh blimey, I'm over thirty, I am a nurse and I am living in Canada... Is that a thumping of a baseball bat I hear at my door????? Whooooohhhhhhh?

    Of course not you twonkers – just Mrs. Throbb from upstairs asking me if her AC overflow caused some accidental spillage on my balcony... (ooooh Matron!)

    To be told now - by the ineloquent modern altruistic nursing academia - that the only way forward for nursing is to bury the past... It’s like being told that World War Two started on the 8th of December 1941...

    World War Two...

    The Second World War...

    WWII....

    Oh no, jeez, you can't go and get it on a Nintendo or Xbox from Walmart. It's not a game it was something that happened back in... Oh FFS just Google it. Better still – ask your Granny!

    Nursing is NURSING and I don't care how you ingratiate “illegitimates” dance and fawn about the emporpherical, linguistic terms of what is “real” nursing is... I just do it
    People like you just don't get it (actually the staff at the NT do) – we slog our guts out for what we think is right and fair... then we get a load of toss-pots dissing us (Marky boy you are there) and piddling upon our personal achievements.

    History DID exist before 1999

    We DID do things according to “best practice.”

    We had TRAINED nurses.

    Some of us are now your Tutors.

    One of my former Tutors is now a Professor of Psychiatry

    Currently all us “old farts” are around 55... When all of us drop of the MHS retirement/death graph – tell me, where are you going to come up with replacements from?

    Yup, “Hello Dolly” HCAs et al. May serve the public's initial gratitude but do not look to the government or your unions...

    FFS

    Is this allowed?

    No

    I am serious. I have been taken into the deep and mysterious caverns of …. THE GNC...



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