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'Is three years long enough to prepare our nurses for practice?'

Posted by:

26 March, 2012

When I was a student there were very few options for dressing a wound; eusol and paraffin, paraffin gauze, hydrogen peroxide or a dry dressing.

And guess what? Wounds rarely healed. The field of tissue viability has developed significantly over the last 20 years and now wound management requires considerable skills including detailed assessment and product selection.

This growth in nursing knowledge is not confined to tissue viability and the challenge is to squeeze more and more into the nurse curriculum so that newly registered staff will be able to hit the ground running.

Happy Newly Qualified Nurses’ Week!

You can read our FREE content on how to manage the transition from student to qualified nurse here

I remember being petrified on my first day as a staff nurse; a different uniform brings an expectation that you know what you are doing, have all the answers and are able to make decisions. You have passed your exams so you must be a competent practitioner.

But registration is just the beginning of the journey to becoming a nurse.

New staff nurses must be nurtured so they not only consolidate their practical skills but are able to live up to the guiding principles and ideals that brought them into the profession in the first place. Failure to give this support leads to frustration, disillusionment and ultimately loss of good nurses from the profession.

Perhaps nurse training just isn’t long enough. Extending it to four years to include a 12-month postgraduate preregistration experience would enable nurses to consolidate their theoretical and practical skills and begin the transition from novice to expert in a protected environment.

This would follow the pattern set by other professional groups. Pharmacy is now a five-year course with a one-year postgrad prereg course where pharmacy graduates gain essential practical experience.

Why can’t nursing replicate this model?

Readers' comments (36)

  • They would just get used in the ward setting whether they were registered or pre-registered. What would they be paid? Band 4 perhaps.

    It's a wonder anyone wants to train at all these days, given that we are being shafted from all angles; by the press over our alleged failings, by the government over our pensions, by a pay freeze that is likely to go beyond the 2 years originally stated, by major cuts in funding, staff and services and my the very flawed health bill that will destroy the NHS.

    All very negative when you look at it; depressing out look for nurses at any stage in their career.

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  • Sorry about the typo; it was meant to read, 'and by the very flawed health bill that will destroy the NHS.'

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  • Little One

    Dearie me, please don't suggest making our course even longer. It's hard enough as it is. Educationally, emotionally, psychologically and financially. We have preceptorship courses to aide in the transition from student to staff nurse, maybe these should be of a mandatory length?

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  • I think 3 years is long enough, but it depends on the quality and content of the training. Having discussed this with student nurses I'm not sure they are getting all they need. Looking back on my 3 years of training I can honestly say I felt ready to cope with the pressures of the job by the end of it.

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  • It is a nice idea but is it affordable.

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  • If you trained for 4 years as some countries do, you still do not learn until you qualify. Once you are really left in charge of your patients without hiding behind your mentor then you learn.
    On my first hight shift when I was left in charge after the late shift went home I wanted to cry but I got through, my patients survived, and my confidence grew. I have not met a newly qualified nurse yet that isn't apprehensive about their new status.
    As far as extending the training time well you never stop learning do you?

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  • Anonymous | 27-Mar-2012 8:21 am
    In another country where I worked a group of newly qualified nurses came in and more or less took over the management of my ward from day one. there were only two of us left from the previous team which had functioned extremely well delivering high quality care in a relaxed a friendly atmosphere which many of our patients and doctors acknowledged with great satisfaction, but got up the backs of our management! My colleague and I were forced into the office despite having our own case loads as the new nurses were obviously unable to answer queries on the phone or for anyone who came onto the ward. We also got lumbered with all the management/administration of the daily running of the ward. but as far as nursing care was concerned they were fresh out of school and knew it all and all the latest methods and would not be helped or told anything at all as they considered us totally old hat and not to be listened to! I quickly gave up offering any help or suggestions where it was apparently not wanted or needed and just left them to it. but then if there was an emergency or they came across a situation with which they were unable to cope they would come running for help. when we did manage to get out of the office, where the phone was constantly ringing and there was always something that needed our immediate attention, to actually tend to our patients they would watch us and tell us that 'it is not done that way anymore' in front of the patient, and that management has said you have to do it this way now! This often happened when coming back from one or two days off, when we told that a procedure had changed leaving us feeling fairly useless with our old fashioned methods which had previously served our patients well.

    I was all for them teaching us newer and up to date methods but it was the condescending way that it was said and done that was disagreeable. They were supported by management and we got no support in this awkward transition at all. We were eventually made to feel we were in the way. The only problem was management were non-clinicians and had probably never seen a patient below the sheets and some of their directives were totally unrealistic, non-evidence based, unsafe or did not fit in with the current organisation of the ward. These new nurses also took over the mentorship of the new students (and two of them took over the off duty planning of which they had little understanding but managed to work it to their advantage and shut themselves away in a room for a couple of hours periodically even when we were short handed on the ward) and we were more or less left to be office workers under their supervision. My colleague left but i stuck it out, as it was difficult for foreigners to change to another post, until I was needed back home in the UK due to changes in my family circumstances.

    It was a sad ending to my previously enjoyable and successful career but a taste of malfunctioning teamwork - obviously the storming phase of the cycle.

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  • 3 years should be long enough, it was for many years. I don't need to go on about the 'old style training', it's all been discussed before. Why anyone would want to train for 4 years to go into nursing is baffling, I'd have thought it more sensible to reduce the length of training and entry requirements to bring back the SEN role but that's been discussed before too.

    Is there any evidence that hands-on nursing care or the reputation of nursing have improved since the introduction of diploma/degree courses.

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  • Most student nurses are keen to get out and start earning as many of them have had to support themselves with HCA work on days off to survive, pay their rent etc. 3 years is enough, although what they have to look forward to now is anyone's guess. I hope I don't get ill and need a hospital when I get old. They will probably be staffed with HCA's by then, who will also do the drugs, manage the wards etc, some of which will be band 4, with band 2's doing the basic care, and band 3's the technical care. Band 4's will be in charge!! Where will the registered nurses be? god only knows!!!!!!!!!!!!

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  • "lets go round again".....inwardly sigh! this used to happen in those oh so "dark ages" us older nurses keep being accused of reminiscening on,with so called rose tinted glasses.I look back in shock at some of the things we used to do and am glad we have moved on from that,BUT some things did work really well and looking after the newly qualified was one of them.When we qualified we were ALL given jobs in our school of nursing hospital.We were offered mainly 6months in general medicine then general surgery to get the feel of our new roles.Then we could choose what we wanted to do,stay put or begin our roles in more specialised fields.There was no obligation to stay after qualifying,it wasn't an extension of our "training" but nobody was without a job.The general experience helped build foundations following training.
    I do think 3 years is enough it's impossible to "cram" everything in,because care initiatives and best practise change all the time,this you learn as you go through your career as a qualified nurse,thats part of the job.

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  • tinkerbell

    it isn't until you qualify that the real learning begins.
    Being able to prioritise and time management skills as a nurse in charge. Being able to put all that theory into practice and then some. Realising that the theory doesn't always match the reality and then improvising and using your own initiative to get the best outcome.

    Going from unconscious incompetence to conscious competence takes a long time. Like when you drive a car and no longer have to consciously remember what you are doing with the gears, brakes, clutch, accelerator.

    That is why the older nurses have so much to offer the newly qualified, all those years of experience in the field. The huge jig saw puzzle with most of the pieces finally falling into place. Maintaining the highest standards you can whilst being up against it at every turn from management.

    Training, for however long, can only take you so far but at some point you have to dip your toe in water and extending the time training is not required. The learning never stops. Qualifying is the next level up and the learning is always ongoing. You learn so much more in the field where it is real.

    3 years is plenty time for the majority, depending on how keen they are to learn and whether they have built their knowledge base on a good foundation.

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  • cheryl mundur | 27-Mar-2012 11:25 am
    tinkerbell | 27-Mar-2012 11:50 am

    Couldn't agree more with both of you. I wouldn't want to go back to some of the things we did when I trained, but I do feel that we have definitely thrown the baby out with the bath water. The content of today's training is a continuing concern on a variety of levels, and needs to be addressed. We have fantastic people coming into the profession and we owe it to them to give them the best possible nurse education and training.

    Three years is plenty. Let's just get the content right.

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  • tinkerbell

    Mags | 27-Mar-2012 12:03 pm

    Well if something works the first thing that you can be sure will happen is that will be scrapped to try something new and whacky and trying to reinvent the wheel.

    We keep having to round on this merry go round, how does one get off, i'm feeling terribly dizzy.

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  • Considering that in Scotland it is the norm for many degrees including Nursing to be over 4 years. Should we not be looking to see how it works or not there.

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  • Anonymous | 27-Mar-2012 9:25 pm

    The BSc Adult Nursing course is 3 years here in Scotland.

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  • I agree with above posts, Nurse training's long enough at 3-4 years. Lets let the transition to all degree nurses happen before we start tinkering again.

    Training can't prepare anyone for the real thing. It's like learning CPR, or a fire drill. You're doing everything you will be doing, but when you're there and it's real things are entirely different. We can keep adding years but people are never going to be fully prepared, not really. Perhaps a probationary year in these times of scant employment would be good! Scotland has the 1 year job guarantee for me mind you, if I need it. 2 shifts a week is certainly better than being unemployed!

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  • Many Staff nurses don't receive adequate training or teaching in their chosen fields - that is if they even get to work within their chosen fields, most of the time you just get an interview but you don't know where you will be placed.

    If there is a lack of knowledge and confidence amongst the trained staff then the student nurses won't learn much on the wards either.

    Bring back clinical facilitators to work with students on the ward assessing their essential nursing skills, allow time off for trained staff (and students if they want) to attend specialist training courses and study days.

    Bring back more clinical placements for students - not skills labs and weeks in uni.

    Bring back the two tier system allowing thousands of would-be excellent nurses to do their training and be recognised for their hard work.

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  • It ain't what you do, it's the way that you do it. Lengthening the course will not work, it's the content of the course that counts. What the student nurse gains from being on the course will affect his/her confidence, and future nursing practice.

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  • tinkerbell

    Anonymous | 28-Mar-2012 11:37 am

    Well said. So many potentially first class nurses are going to be left out.

    Some things can't be taught, compassion, warmth, respect.

    If i remember correctly, in the mist of time, when i trained we spent 3 months on each placement and then 2 weeks back at nursing school. We spent 6 months in rostered service to pay back for our training.

    We were the pilot study group for project 2000 in 1987. We had to sit exams and have continual assessment and sit our state final exams too.

    Our feet never touched the ground during our training, we hit the ground running. But it was a good training ground and i came out knowing a lot more than some of the students who are qualifying now do. I can understand why some students lack confidence. Arrogance is thinking we know everything but confidence is being sure of our abilities. By the time i had finished my training i had a good idea where my strengths and weaknesses lay and what i needed to improve on.

    Before our final state exam my friend and i spent 6 weeks cramming in our rooms in the nurses home.

    There was only one student in our group who failed the state final exam and she was probably one of the best nurses in our group, she just couldn't write it all down and completely collapsed under the strain of the exam. She passed it on her second attempt as i think we were allowed 3 goes at it.

    By the time i qualified i had a good knowledge base to build on and a good practice base to build on. I think they had the balance right and that helped me feel more confident.

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  • Tinkerbell - sounds like we had the same training, although I didn't do P2K. I didn't have any school qualifications so sat the DC entry test which, after 2 attempts, I passed and got on the RGN course. I was interviewed by the Chief Nursing Officer at the hospital I trained at and there were only about 25 of us on the course, a couple didn't finish their training and were weeded out pretty early on.

    We were all guaranteed a 6 month job at the end of our training, I think most of us chose to get a job on our final placement ward, we got full funding and days off for ENB courses and were treated as staff nurses as soon as we had paid for our PIN (which we got on our finish date). We didn't have mentors, 3rd year 'senior' students looked after 1st and 2nd years, D grades looked after 3rd years, E grades looked after the D grades and so it went on.

    Things were not perfect, we worked our backsides off, weren't allowed in the office for breaks on some wards, it was much more formal - no first names for staff or patients and the money was c**p but I do believe that people actually liked and respected nurses then, I don't feel that way now and every shift there seems to be a problem with someone, usually about something very trivial like the bedside tv doesn't get enough channels or the tea is late or isn't hot enough.

    I don't know that I would go into nursing now, if I did I would probably choose an SEN course if I could, who wants the grief of having to do ward management.

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