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Newly trained nurses 'not up to the mark'

Chief Executive Peter Carter said that many newly trained nurses are “simply not up to the mark” having not spend enough time on hospital wards.

In an interview with The Times, chief executive Peter Carter said new nurses had spent too much time in classrooms rather than gaining practical experience.

He added that the amount of untrained workers had grown “exponentially” over the last 10 years and many were performing tasks without formal training, thereby putting patients at risk.

Mr Carter said: “What we have on hospital wards, and particularly in domiciliary care and care homes, is an unregulated, untrained workforce who are picking up so much of this on the job as they go along. Frankly, it’s nothing short of a disgrace.

“We require regulation and training in just about every other walk of life. Gas fitters have to be registered; but somehow when it comes to patient care we’ve got this unregulated, untrained workforce and then people wonder from time to time why there are problems.”

A spokesman for the Department of Health said: “The government intends to establish the Professional Standards Authority for Health and Social Care (currently the CHRE) as the national accrediting body for a system of assured voluntary registers for groups that are currently not subject to statutory professional regulation, which includes healthcare assistants.”

Readers' comments (41)

  • Well, Carter and the RCN have changed their tune as they welcomed an all degree profession by 2013. If you want an all degree profession, you need to attend university and you can't be in uni and getting ward experience at the same time. You reap what you sow, Carter!

    Just another instance of Carter dodging the real issues that concern RCN members at the moment!

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  • Who the hell does this buffoon think he is? Of course we spend time in the classroom, but student Nurses spend half their time on the wards too! There are problems with Nurse training yes, but it is simplistic and idiotic in the extreme to lay the blame wholly on the 'classroom' aspect of the training. Regardless, newly qualified staff Nurses are exactly that, QUALIFIED AND REGISTERED STAFF NURSES!!!! To compare them with an untrained workforce is an insult! Newly qualified Nurses need support whilst they gain their first few years of experience, of course, but that has always been true of this and any other profession. Experience only ever comes with time served, regardless of training. Why doesn't carter try answering to the fact that the RCN are not ensuring that all trusts/workplaces are conforming to the preceptorship for example? Would it be perhaps because this would involve him doing something useful for a change? The sooner our profession is rid of this fool the better, because every time he opens his mouth, he damages our profession.

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  • So is Dr Carter talking about nurses, or untrained care workers? Practical experience is of course necessary but when I'm a patient on a ward I want a nurse who's spent a long time in the classroom so they can identify my SIADH, my non-convulsive status, my life-threatening AAA. And to know which of my drugs is prescribed at the wrong dose or interacts with curent medication, as well as having the confidence to challenge the doctors who may have got it wrong.
    Untrained care workers are a completely different issue, and of course they and their clients would benefit if they had more training, rather than less, in whatever setting is appropriate.
    Sometimes I despair that we are represented by an RCN which appears to peddle such inflammatory nonsense, denigrating the vital academic aspect of nursing as if all the job entails is keeping people clean and fed. This is of course vital too, but ill people need professional nurses around them who can understand their condition at the clinical level.

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  • This is NOT what Carter should be talking about!! Where is the required robust response (too much alliteration!) from the RCN to the scandalous attacks, by the media, on the Nursing profession???


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  • The course is 50% theory and 50% practice so actually quite balanced. This is a much higher % of practice than courses in other countries for example Australia. Dr Carter really should be pointing out what a fantastic job nurses do in a very difficult climate. The fact that he adds to the negative media coverage is scandalous and leaves a question over whether he is suitable for his job.

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  • michael stone

    I hate to defend Dr Carter, because the RCN refuses to give straight answers to the questions I ask it - so I'm defending him through gritted teeth !

    But he was interviewed on R4's Today yesterday, and I think his position was actually this:

    1) He wants HCAs to better trained and regulated

    2) He commented that ALL newly-qualified nurses face a steep learning curve when they begin nursing post-qualification, but what he said is that SOME nurses are not being adequately prepared by their courses. He was actually saying that SOME university courses do not include sufficient on-ward experience, to enable the nurses who are trained on those courses to cope with the 'shock' of real nursing. He was blaming the universities, NOT the nurses.

    Oddly, I assume that only NMC-approved university courses can lead to registration, but I don't think I heard him blame the NMC.

    I don't know if that is helpful - it might be.

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  • Well said Mags and the two anons above me, I could not agree more with all of you.

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  • As said above, yes Mags and Anons, that is exactly what I am thinking. I am thinking about whether to write a letter to the BBC to ask for a bit of 'balance', please! I expect uninformed ignorant nurse 'bashing' from the Daily Mail and the Daily Telegraph (read a lot by patients so they probably worry them!) and I can choose not to buy that toilet paper, but not so much from the BBC which we all pay for. The brief report on Radio 4 was very sensationalist, saying that patients are 'frightened' with the implication that they are frightened of us the nurses. It made me feel guilty for my profession even though I and my colleagues would always endevour to alleviate patients' fears as soon as we've got a minute to talk to them. As ever the majority have to feel they need to defend themselves because of a minority of bad nurses who seem to get all the attention. Radio 4 and 5 (Adrian Goldberg investigates re: poor standard of English of some NHS staff - very sensationalist I thought!) both appear to be biased towards negative reports about the health service and about 'the wards' and nursing generally. Is there some sort of gagging order about unsafe nurse:patient ratios? Why is no one (and especially the unions) talking about this? And am I right to suspect the government are more than happy to let the biased press carry on denigrating the NHS and particularly the largest section of the workforce??

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  • As a student nurse I have to say that whilst I am saddened by this interview I cannot disagree with Mr Carter's sentiments. I feel that the education I have received in the university setting has been woefully inadequate. Lectures attempt to instil in us qualities such as altruism without giving us the vaguest idea as to practical procedures.

    I think back with shame to my first placement, with 5 weeks worth of lectures on more in abstract topics such as societal inequalities I knew nothing about the practicalities of bed bathing, bed pans, manual handling procedures and the like. As such I was taught by a very experienced HCA who had very definite and (I later discovered) completely unsafe ideas about how things should be done. I was horrified when I realised that I had learnt dangerous methods and was endangering my patients by using them. Given that university lectures completely lack practical education students are ill equipped to identify potentially unsafe procedures. Those who lack the initiative to find out for themselves will simply pick up bad habits from often poorly educated HCAs.

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  • Anonymous | 23-Sep-2011 9:19 pm I understand completely what you say, I spent half of my own training feeling the same. The only advice I can give you is hang on to staff Nurses, specialists and Doctors like a lympet, learn from them and read, read, read. Do not let wards fob you off to be an unpaid HCA. You are supposed to learn from your placements too, that is where we learn the most, so be a little pushy, ask questions, ask to watch or join in, do whatever you need to do. However, remember that you still need the theory behind those practical procedures too. THAT is where the uni's SHOULD come in, It is THIS that the universities should be concentrating on, the A&P, pathophysiology, pharmacology, etc etc, not bloody communication or research methods (they have their place, but not filling up entire bloody modules).

    However, I digress, as I said earlier yes there are certainly problems with the training, but this fool should be DEALING with the problems that face our profession, not simply issuing statements that add fuel to the already hate filled media propaganda against our profession.

    Michael Stone, apologies I missed your post earlier. Anyway, I think I may have heard or read a different interview than you? (It wasn't on the radio anyway) because from what I came away with was the distinct impression that he WAS denigrating newly qualified Nurses. No distinction was made between some and most. He won't say a damn thing against the useless NMC, no more than he will do anything useful to help improve our training and our profession as a whole. He's an embarrassment to our profession.

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  • Poor article - mixes Dr Carters comments about new nurses and healthcare support workers. Nurse education opportunities and in-house training of all grades of staff varie enourmously - even in high acuity specialities you are expected to learn on the job with no or little formal mentorship. Experienced clinical experts have all gone off to be nurse specialists and don't spend much time with the grunts. Clinical Practice Educators, never met one who knew arse from elbow, seems another route for the promoting the time served inept.

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  • Has a nurse educator both in university and in clinical practice I have exoerience on both sides of the fence. I feel there is an unfair expectation from the universities that clinical practice will pick up whole or most of the practical side of nurse competencies. In an ideal world this would be the way to go with practice based tutors whose sole reponsibilities were to make sure that student nurses came out of "training" fully competent in all aspects of nursing care. At present this is left to under-staffed over-worked "mentors" who can barely get through their own allocated work per shift. Ward managers also would appreciate newly qualified nurses to "hit their wards running" so that they can make an immediate impression on the workload of the wards. Alas in the past we could insist on at least 4 weeks induction for these new nurses so that we could get in there and give them as much support as possible but this has also been reduced to 2 weeks because of "ward pressures" (vancancy freeze for past year). In my trust monies have been allocated (believe from SHA) to introduce a new preceptorship scheme so we may see an improvement in support for newly qualified nurses.

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  • To respond to an earlier contributor who mentioned the media denigrating nurses. Has anyone else noticed that the "Tory" press are releasing regular articles about certain groups within the public sector eg. teachers, nurses etc. to try and influence the way the public sees our professions. This is a cynical attempt to sabotage the pensions negotiations and any threat of strike action. I spoke to an RCN rep who said nurses would not be backed by the public because of the bad press that we were receiving.

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  • Anonymous | 24-Sep-2011 10:16 am I agree with what you say, especially about the unfair expectation on wards and staff. Unfortunately this is simply the way it is and students and Nurses have to make do, getting experience and learning opportunities where they can. But I cannot share your optimism for increased support I'm afraid, my own trust allocated money for the preceptorship scheme, but it didn't materialise in practice, only in name. It was shocking, and left to individual Nurses to support newly qualifieds. Yes the education needs to improve, yes there are ways placements can improve, but it is the culture we have to work within, the lack of suppport from the very top that is doing students and Nurses the largest disservice. There is an attitude of who cares if they get support and training as long as they can make up the numbers? If something goes wrong, it is easy to blame the individual isn't it? It is this culture, this attitude from the very top that needs to change the most.

    Anonymous | 24-Sep-2011 10:44 am yes, that hasn't gone unnoticed and has been mentioned on other threads. Anyone with common sense can notice it, it is hardly subtle. However, that bloody RCN rep should be ashamed of themselves, if it DOES come to the fact that we have no support from the public, so what? Does that mean we can never take action to defend or improve our profession? I don't think so! But more importantly, the RCN rep and the RCN as a whole should be COUNTERING the bad press to ensure we DO get bloody support! The RCN really makes me sick.

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  • I was trained in a very thorough and comprehensive Surgical Technology program in the US, but I must now retrain as an Operating Department Practitioner (ODP). Although this is not Nurse training, the way that the ODP program is organized through the universities is very similar. The problem is that the universities do not prepare the students for clinical practice by teaching them all of the basic clinical skills before they go into placement. Where I was taught in Miami our clinical skills were learned from a highly experienced Nurse instructor and thoroughly rehearsed to her standards in a skills lab before we entered placement. Beyond A&P, Microbiology and infection control, we learned about the different cases we would be doing, how to gown and glove, set up the sterile field, instrument names and surgical routines. When we entered clinical practice we were expected to demonstrate what we had learned under controlled supervision; we were expected to be a net asset on day one.
    In the few weeks before we entered placement as ODP students our only exposure to surgical instruments was an obscure half hour lecture on “form and function,” No one even demonstrated how to safely load a knife blade before we were foisted on mentors at the hospital. UK Students are expected to lean via the stand and gawk method until a mentor feels comfortable letting them practice on patients. I relied on my Miami training many years earlier, I had been taught so well I remembered things like patient positioning that had not been my role as a Surgical Tech. Despite being assigned to a number of very experienced mentors the task ahead of these NHS staff is almost impossible because they must teach raw recruits from scratch while still trying to do their regular job. But they are not professional teachers and there is no consistency or continuity between what one student and another will be given the opportunity to learn. Because there is such an excessive reliance on NHS staff do all of the teaching any disruption in mentorship will doom an otherwise promising candidate to ultimate failure. The so called competencies represent a frenetic box ticking exercise with no room on the restrictive forms to provide any meaningful reflection.
    Despite the extreme brevity of our half hour “sound bite” style practical sessions, which include note taking, there are always excessively long time periods devoted to redundant, tedious ramblings on tolerance, communication and how people feel about healthcare and a multitude of other obscurely related subjects. There was a morbid, three hour, sob-a-thon on death and dying, with accompanying mood music! These universities have seriously lost the plot. The NHS pays universities to teach and they are then forced to train students on-the-job from scratch! As the pressures on the NHS workforce continue to increase there is no slack for practitioners to maintain this additional burden on resources. The universities want higher fees to sustain this lack of teaching and extend the tuition gravy train with Nursing becoming a degree program by 2013 and other programs to follow. The NHS is also getting set to trim bursary support which will drive more disillusioned candidates to quit these programs in disgust. The appallingly low standard of training I am currently receiving in the UK makes me frightened to enter an NHS hospital. This is not about bad Nurses it is about universities who have created lofty academic programs that are totally out of touch with the reality of patient care,

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  • Anonymous | 24-Sep-2011 10:16 am

    Good points. The training of Nurses should be a combined effort. Our students are being let down by the current training they receive, for the reasons you state. We have discussed, on other threads, the concerns over the content of the course and this has been backed up by input from students and tutors alike. Although, he/she is not particpating in a Nursing Programme, I have to agree with Anonymous | 25-Sep-2011 4:06 am,
    " This is not about bad Nurses it is about universities who have created lofty academic programs that are totally out of touch with the reality of patient care,"

    Then there is the lottery that is life in 'placement land'. Serious staffing issues, inconsistent practices amongst mentors and little support for students and mentors alike. As mike | 24-Sep-2011 12:59 pm says,
    " There is an attitude of who cares if they get support and training as long as they can make up the numbers?"

    Inadequate preparation for life in Nursing. Our Nurses are only going to be as good as the training they receive and it isn't just about money (although there still isn't enough of that!).

    Anonymous | 24-Sep-2011 10:44 am

    " This is a cynical attempt to sabotage the pensions negotiations and any threat of strike action."
    I couldn't agree more. And Mike is right. Where the hell are the RCN in all of this? Indeed, the other unions aren't exactly shouting from the rooftops either. Not good. And I see that there is another anti-nurses article and opinion in today's Sunday Times. No change there then.

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  • Anonymous | 25-Sep-2011 4:06 am I absolutely agree, it seems the Nursing and ODP training are more closely related than you think! I think we can still have lofty academic programs with a degree based system, but the focus HAS to be on clinical care/A&P etc not all the crap that is being pushed into it now, that is what they are getting so, so wrong.

    Mags, there's another one in the times? Oh ffs!!!! We should all get together and write a condemning letter or an essay to all of these newspapers in answer to all of this crap, signed by as many who want to contribute, and dare them to print it alongside a retraction! It's not as if the bloody RCN will do anything!

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  • mike | 25-Sep-2011 12:31 pm

    Excellent idea Mike!

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  • I have to agree with the posts about the poor content of the lectures student nurses, like myself, are getting when we are in University. I have had hours and hours of lectures on social issues in health and even lectures on healthcare systems in other countries none of which are useful when working on a ward, in the community, or anywhere else.

    Very little time has been spent on A&P or on clinical skills, which is a huge shame since the clinical skills labs have such great equipment. It's a resource that just isn’t used properly. I have lost count of the number of times the excuse of ‘NMC requirements’ has been spouted to us when we question the subjects that are being taught.

    There is a very large disconnect between the university and placements. To me it seems that the teaching staff have been out of the healthcare environment for so long they do not appreciate the realities of the modern healthcare environment.

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  • im affraid i agree. we spend too long writing pointless assignments that will not help us to become competent nurses. I am currently on my sign off placement working 37.5 hourse per week and travelling an extra hour per day plus having to write an assignmet on a care plan that is no longer used!!!! what am i learning from that???? when i could be researching the area i am on placement or spending more time in practice. I feel completly let down by my nurse training and the school of health for lack of support.

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