Student nurses denied observation practice on clinical placements

20 October 2009 | By Clare Lomas

Student nurses are not being given the opportunity to practice basic observation techniques while on clinical placements, potentially leading to a major gap in essential skills.

While nursing students are learning skills such as how to take manual blood pressure in academic settings, comments posted on the Nursing Times website suggest they are not able to put the skill into practice in clinical areas.

The comments were posted in response to a Nursing Times investigation, published last week, which revealed how poor practice in patient observation skills was hindering nurses’ ability to spot the signs that a patient’s condition is deteriorating.

One first year nursing student said: “Students want to learn these [fundamental] nursing skills, but on many [ward] placements there is an over reliance on the use of technical equipment and no time for students to practice. This is something that needs to be changed for the benefit and safety of patients.”

A second year nursing student commented that the lack of available equipment on wards meant students were in danger of “losing their basic skills”.

“We are taught how to use sphygmometers in university, but when we are out in practice we are not encouraged to, or given the chance to use anything other than a Dynamap,” she said.

Jacqueline Bloomfield, a lecturer in adult nursing at King’s College London’s Florence Nightingale School of Nursing and Midwifery, told Nursing Times it was “imperative” that nursing students were able to practice taking manual blood pressure on ward placements.

“This is a core nursing skill, but is not always easy to master and requires practice. There is no better place to practice than on clinical placement,” she said.

“The consistent use of Dynamaps on wards, and the lack of [manual] equipment, means students are not getting the opportunity to hone their skills,” she warned.

Ms Bloomfield added that student nurses should proactively seek out manual equipment, and that ward sisters and student mentors should lead by example to encourage student nurses to use it.

“Technology is not infallible and can fail. [Nurses] need to reiterate that taking a manual blood pressure is a valuable skill. Although wards do get very busy, if students see nurses using manual equipment, they will do it too,” she said.

According to the results of the snapshot survey of 830 people, published in Nursing Times last week, one of the main reasons for this is an increased reliance on technology, such as automated blood pressure recording machines.

Readers' comments (13)

Anonymous | 20-Oct-2009 10:47 am
I am a newly qualified staff nurse and I have just finished my degree in Birmingham. In my experience NHS Trusts and their staff have advocated the use of 'manual blood pressures' and encourage students to perform them on a daily basis. Dynamaps have their uses up to a certain point, however if patients are particularly ill, have very high or very low Bp or chronic oedema in their arms it is virtually impossible to obtain an accurate reading with a dynamap. It is at these times when a nurse must be able to record an accurate manual Bp, as these are the patients that we should be monitoring closely. I understand that staff shortages on many wards can make learning opportunities difficult, however students are the future of the NHS and we must make time to equip them will all the necessary skills to maintain high standards of patient care.
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Anonymous | 20-Oct-2009 1:51 pm
i have been qualified for 25 months and agree with the above 1st comment fully. when i was in 1st year at uni had a practical on manual BP. However i work in a busy acute respiratory ward & look after 13 patients including terminal and those on NIV or with Cancer. With support of 1 or occasionally 2 HCAs the Dynamaps save me time and i use them in cases outlined above.

when i was a student and on placement i always asked to check the manual BP 1st whenever the staff nurse wanted a manual BP, and then we will compare result. at times a nurse wolud say they will go with my result as they got nothing. when ward wasnt busy i even checked staff nurses BP to practice. my fellow students refused to practice when i gave them chance to practice on me and when we qualified they still cldnt do manual BP.

so to J. Bloomfield and anonymous [1047hrs], let every student take initiative in their own learning and lets not blame anyone or the system. we cant spoon feed everyone. [tee]
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Ruth Lister | 20-Oct-2009 4:21 pm
I qualified just over a year ago. We learnt manual observations in a large group setting with 80 of us all trying to listen to each other's heartbeats. Not exactly ideal situations to listen for suble sounds.

On placement there was a reliance on the Dynamap machine, but as these were NHS hospitals the machines were sometimes old and tempremental which the staff regocnised and if we were unable to get a reading or the reading was incongruous to the patients normal measurements, manual observations were taken also.

Tools such as the early warning score can greatly assist students to notice when a patient's observations need further attention, not to mention a degree of common sense.
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Charlie Spencer | 20-Oct-2009 5:04 pm
The manufacturer of Dynamap say that readings can be unreliable if patient has any kind of cardiac arrythmia, including AF.

I always try and do manual BP to check results when out of normal range, particularly if pulse feels irregular and encourage students to do this as well. (As a profession we're almost as bad at taking manual pulses as BP's).

I also had trouble practicing as a student, although most wards had a manual sphyg, broken cuffs, dodgey dials and no stethoscope were frequent problems.

My advice to students is buy your own. you can get a sphyg and stethoscope for £15-20.
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Anonymous | 20-Oct-2009 11:31 pm
I am a second year student nurse, in my last placement I was actively encouraged to take blood pressure manually, as the dynamap was known to be temperamental and on a few occasions broken. However I do have to say that I have found personally myself, staff shortages do get in the way of learning as quite often I have found myself treated as part of the work force, with all hands on deck and supernumerary totally out of the window.
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Anonymous | 21-Oct-2009 1:50 am
I think it depends on where you are on placement, the mentor you have, and the time you have.

As others have said above, you can get sphygs pretty cheaply and practice on your friends/family to get the hang of it. That's what I did and I got the hang of it in no time - you don't have to feel bad about pumping the cuff around your mates arm really tightly about ten times in a row! On the ward it's more difficult, for obvious reasons.
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Anonymous | 21-Oct-2009 1:29 pm
I agree with the article above. I am a first year student nurse and have only had the opportunity to take manual BP on other students, as on ward placements i was told that taking a manual bp would take too long! i find that wards rely on machines such as the dynamap too much, they are often tempremental, therefore dont provide an accurate measurent.
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Anonymous | 21-Oct-2009 7:01 pm
i am a district nurse and also find that many student nurses are not able to carry out manual blood pressures and manual pulse rates. this is essential within the community setting and i find that i have to devote much time to teaching within this area, especially related to normal / abnormal pulse rates/rythyms.
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Martin Gray | 22-Oct-2009 11:34 am
Isn't this an area that the teaching establishment should be addressing? There certainly appears to be different standards around the country in how students receive adequate and appropriate training in the basic skills, and the opportunity to practice them. To those that are mentors - it is YOUR job to make sure the student(s) under your care DO get the opportunity to practice and brush up on skills in the practcal setting.
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Anonymous | 22-Oct-2009 11:11 pm
When I was on one particular placement as a student nurse, my Ward Manager stated clearly that she didn't want to see any students using the Dynamaps to check vital signs and we were to use only the manual sphygs - yes, initially it seemed a slog... but I learned so much, especially about arrythmias and still am hot on taking a manual BP, it was truly invaluable learning experience and I think all students would learn heaps from this example.
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Anonymous | 23-Oct-2009 9:18 am
I am a staff nurse for many years, and I always have a student to mentor within this surgical settings. I would always make sure my student learn how to use a sphygmometer,a stetescope ,and other equipments used to monitor patients' observation. I have noticed that some students would automatically pull the dynamap to the bedside rather than doing a blood pressure manually even after encouraging them to do so. The ward is continuously busy so it is quicker. The dynamaps and the monitors on the wall are regularly serviced so we rely on them but as other colleagues have mentioned if we have patients who are critically ill, I would make sure that they are double checked using a sphyg. I also encourage my students to do manually checking of pulse and count respiration rather than relying on the monitor.
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Anonymous | 28-Jan-2010 9:53 pm
I am a third year student at Birmingham I totally agree with some of the comment on manually BP it is the basic care and skill that has enable existing nurses to teach future student on these skill. BUT it is up to the indiviual to ask for what they want from their placement because if you don't ask you will not get an opportunity and it also depends on your mentor who is teaching you on these basic skills.

I do agree that the basic skills in nursing are fading away or not got enough time for mentors to teach because of short staff levels or broken equipment.
At university they teach you about how to use these skill and if they arise on placements take opportunity to use and learn these skills such as manually BP, checking of pulse and count respiration
BUT the wards rely on monitors

we want to be nurse so please let us do our job properly
GOD bless
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Anonymous | 7-Jan-2011 4:39 pm
I am a student nurse currently on my first placement. All the observations I have been taking have been with using the Dynamap equipment.

However, there are certain situations if some one is very ill where they will not pick up BP or a pulse. I have grabbed every opportunity like this and asked if I can take the readings manually and have found that staff are happy to let you do it.

Just be confident and ask as other nurses know what it is like to be in the learning position you are in.
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