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Caring experience to be compulsory for new nurse recruits

Ministers are considering whether to require aspiring nurses to complete a year’s caring experience before they are accepted onto a degree course.

In the Mid Staffordshire Foundation Trust Public Inquiry report, published last month, Robert Francis QC recommended that student nurses spend at least three months working on direct care of patients under the supervision of a registered nurse.

He said it should be a “pre-condition for continuation in nurse training” and could include work as a healthcare assistant.

Nursing Times learnt yesterday that the government was considering announcing plans to pilot such a scheme as part of its formal response to the Francis report, which will be published later today.

However, ministers are going further than Mr Francis and instead favour a period of at least one year, with students taking on a role equivalent to that of a healthcare assistant.

Such a proposal is likely to receive a mixed response from the profession, potentially sparking concerns about its impact on recruitment.

The response also sets out plans to introduce value-based recruitment to nursing courses and the development of widely-used aptitude tests.

Full details are expected in the full response to the Francis report later today, though the policy was trailed in the national press this morning.

In a statement, health secretary Jeremy Hunt said: “Frontline, hands-on caring experience and values need to be equal with academic training.

“These measures are about recruiting all staff with the right values and giving them the training they need to do their job properly, so that patients are treated with compassion.”

Another measure expected to be announced is that hospitals and other healthcare providers, such as GP practices, will be subject to a statutory duty of candour.

Among the other topics likely to be covered by the response are HCA regulation, supernumerary status for ward managers, minimum nurse staffing levels and nursing older patients.  

Nursing Times will be reporting live on the government’s response to the Francis report’s 290 recommmendations, following its publication.


Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.

Readers' comments (27)

  • Don't we already have something similar - the Cadet scheme

    However, if we accept that the concept of a academic institution-based training is flawed and returned to a (modified) 'apprentiship' model, there would be no need to this latest bag of baloney

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  • who says that these students having the compulsory caring experience are having the right experience. Obviously they were not delivering the right care experience in Mid Staffs, and I assume students were being taught there. This is a knee jerk reaction and I would go as far as saying passing the buck

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  • Good - things go in cycles- this suggestion reminds me of how I was trained at the bedside doing nursing care.The only thing is that it should not be called HCA work, but nursing work. If the nurses learned basic care, they would be able to work with the HCA's more closely. Most hospital inpatients need basic care, rather than tests and machines to help them get better. Need to think about job purpose, and not treat basic nursing in a derogatory way.

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    So does this mean that we are going to return to nurse training. and when these student nurses are doing the caring training,Will they be paid a decent living wage. and will this also mean that the training will take four years instead of three. questions questions all need answers.

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  • This is proof that nurse training is not 'fit for practice' and needs to be taken out of the hands of universities. For too long the opinion of anyone who suggests that ward experience needs to be a greater part of training has been dismissed as out of date. Education is a vital part of nurse training but there is no reason why this should not go hand in hand with work on the wards instead of leaving would be students to find placements that might not be of the best quality. These days placements seem to be dependent on where students can be stuffed - we are always being asked to take more than we can manage as placements are so scarce and students can get well along the course without ever setting foot on a ward.

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  • There is something to be said for returning to paid nurse training, with the degree to follow in the third / fourth year. There are, of course, counter arguments; such as, everyone expects a degree course, we can't get new recruits, lower status of trainees. But surely there are some good curriculum planners who could work this out. Regarding patient-centred care: what is the purpose of nurse training? What is a good grounding before specialising? Are the specialists higher status than the general wards nurses, and, if so, why?

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  • Sad to note it is being left to government ministers to put these measures in place. As a profession, we ought to be able to come up with effective and lasting solutions to poor standards of care (not that it should ever happen in the first place). It is obvious to anyone with half an eye that mainly academic training is not the answer to a profession who must address and furthermore understand, how deal with the basic needs of the patients.

    More than time to take steps and make training fit the job it is desgned to do, in an effective manner

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  • Back To Basics, AGAIN !!!!!!!!!!!!!!!

    Seem to remember that from a few years back, then we sent our students to University instead.

    Round and Round we go.

    I`m getting dizzy.

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  • This is just history repeating itself at the end of the day you are either a good nurse or you are not and no amount of training can turn you into something you are not basically I as a mentor have met students who at first were nervious but with the right encouragement/teaching went on to be very good nurses. Then they are the ones who see nursing as something to do as they did not get the actual career they wanted hence go through the motions but have no interest in patients etc. The problem is how to stop those type of people come into the profession.

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  • michael stone

    We still need to see the detail of this.

    However, there was a furore about ' the need for a caring attitude', and it always struck me that assessing such an attitude in a pre-course candidate, is hugely challenging. So I suspect this idea, probably stems from moving 'assessing' a caring attitude, to 'show you could 'express' a caring attitude, by having done it for a year, before we will let you start to train as a nurse'.

    However, a year is a long time, and nursing courses do have a fair bit of 'academic' content these days: I think this year, might usefully involve weeks with perhaps 4 days as an HCA, and the fifth day being used to 'introduce' the type of academic teaching that nurses receive - but that probably requires more direct intervention, than the goverment is going to put in (my suspicion, is they will tell appplicants to find a one-year HCA job themself, then apply for nursign courses at the end of that year).

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  • It's probably unpaid training, in your own time and of variable quality. Student nurses are (should be) receiving 50:50 clinical experience: academic study time, so that won't change. You'd thought that people would have received thorough basic training by the end of year 1, if not how are they competent and who the heck signed them off.
    Feels like some countries using a 4th year to home degree levels + state registered are just using these people as cheap labour.
    Also newly qualified nurses on occasions are working and paid at HCA rates until their registration is completed. Until registered, staff cannot work as a Registered Nurse and not be expected to take responsibilities as one.
    Staff should also not be put in positions of taking responsibility for those at least 1 grade higher up. How many instances of band 5s are left in charge of shifts in a ward? (regardless of length of service but can be as little as 6 months) just because it saves money. Everyone is working at the next level up but will not be promoted or paid for it, and still receive compassionless treatment from others, especially from those removed from clinical care.

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  • Should prospective mums + dads be compassionate, kind + caring before raising any children? Maybe a year looking after kids in a creche before being 'allowed' to have kids of their own. If kids don't turn out with the right attitudes, who's fault is that?
    Shouldn't blame prospective nurses if they don't appear how you like them to be.
    If newly qualified nurses aren't as good as they should be, what are more experienced staff doing to resolve and help?
    If experienced staff are jaded, disillusioned, corrupted by the system then whose fault is that?
    If there isn't any decent nurses left or coming through in the future, it's a scary future after we all retire and lose our marbles.

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  • Band 5s are 'in charge' of the ward all the time. Gone are the days when things could be left for sister to sort out.

    Back to the golden oldie days of good old bedside, ward-based training for students please. Start with 3 months 'basic' training learning how to look after real people and not plastic dummies in a skills lab. Get a wage for doing this, be part of the numbers, get experience of nursing sick people in a variety of hospital based environments, management experience at the end of the training, continual assessments including attitude, behaviour and appearance.
    Have an entrance test, a face to face interview with the senior nurse at the trusts you are likely to be working at, open up the course for non-academics and let's only spend time and money training students who actually want a career in nursing.
    For those RNs, students and HCAs who are already in the profession but are not worthy of the title 'nurse' in any descripton just give them an opportunity to improve and if they don't then sorry but we don't want you.
    We also need the NMC to register nurses on the day they qualify and pay their fee.

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  • Yes! Yes! Yes!....But....
    I trust jeremy hunt is not treating this most serious issues as a 'paper exercise', and forgets that the whole scheme will require a regular evaluation, and review, of each indidual nurse's performances throughout the year's 'hands on' patient care experience.
    To overlook the above evaluation,will only result in a culture of accepting the 'bad' with the 'good', which will do nothing to nurturenursing excellence.

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  • I personally think it's a good idea and wished I had gained some basic hands on experience before commencing with my degree.

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  • I have over 20 years experience as an engineer. I was made redundant and started my nurse training six months after I was made redundant, in the mean time I worked in a care home for adults with learning disabilities to clarify in my own mind that I could be a nurse.
    In m y first year I was used as an HCA with the occasional drug round.
    Not sure of the figures, but aren't a lot of student nurses are already HCA's who wish to be registered?
    What I find somewhat alarming is the idea that nursing should return to being a vocation rather than a profession, is this to ensure that salaries remain low?
    Nurse and HCAs appear to be made the scapegoats for all of the failings at Mid Staffs, when a a lot of it was down to the target driven culture to ensure its foundation status. Why haven't any in the medical profession been criticised?
    The Francis report also highlights the lack of turn over in the senior nursing posts and a dependency on newly registered nurses. I hate to point out that if the senior nursing staff have remained in post for so long then there is a strong possibility that were trained before project 2000, and hence would have had ward based training! If so where is the evidence that it created caring and compassionate nurses?
    In such an environment any newly qualified nurse would fall into the work patterns prevalent in the organisation, irrespective of their training, it would be very difficult to challenge the work ethic of the whole organisation.

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  • I have been involved in reviewing the standard of nursing care in many cases and have found that many nurses find themselves in a position where poor staffing levels has reduced nursing and care to task orientated nursing which has to be completed as quickly as possible to get on to the next task.
    What has been remarkable is that the nurses have not thought to challenge the managers and those admitting yet more patients to the empty beds even thought they do not have the staffing or competencies on the shift to provide the necessary care.
    The nurses are then overstretched and care is overlooked by prioritising the more technical stuff. Many of the nurses I met, often in Court, seemed exhausted, defeated and burned out. They were frustrated by the fact they did not have the time to give people and were aware of this.
    There will always be a few bad apples but on the whole the nurses are not at all happy with what is going on and have been unable to challenge it.
    We need to tackle the staffing levels and I think that everyone will be pleasantly surprised that the care and compassion is there all along once the nurses are given the time to provide all aspects of care properly.
    I do hope that this latest bright idea does not mean that those who have been responsible for piling on the pressure and eroding standards will be able to "escape" without sanction and move swiftly on to another promotion.

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  • Students can currently accumulate experience by working as a paid HCA rather than as a cheap pair of hands while on placement as a student. Newly qualified nurses with extra experience tends to be snapped up when looking for work.
    Personally I think people who've spent years looking after others prior to qualifying should start off with a pay enhancement for recognition of greater experiences. But in nursing everyone starts off right at the bottom of the pay scale and kept there if given half a chance

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  • Few people in medical profession seems to be criticised, as they have a degree or higher and culturally it's easier to direct criticisms and questions at lower paid staff who are around more.
    Vocations gives the impression the jobs do not have to be paid for and vocational courses aren't as tough or as worthy as academic courses. If anything they're harder, more challenging and demands more lateral thinking. If we're in a vocation, how come all my expenses, subsistence, etc isn't paid for by the state
    If the pontiff gets a palace, clean robes + clothes, meals and free trips around the globe as required to save souls and promote spirituality. Then I need a free home, free training + development, no council tax, bills + registration fees covered, free food + drink + travel / parking at work and enough money to spend and to support family ( so I don't. need another job) to save and enhance quality of lives.

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  • As a student nurse I feel that the majority of my training is based around BASIC NURSING CARE. I know myself the importance of nurses involving themselves in personal care and generally spending time with patients which the majority of nurses do! The NHS is an amazing system and very unique very few if any countries give FREE healthcare to their citizens! Yes there is obviously very bad nursing care going on but its is a minority. Why do the media or public not shout about all the wonderful positive things that nurses carry out on a daily basis?!

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