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Exclusive: NMC urged to tackle 'glaring hole' in bowel and bladder education


A “glaring hole” in training that is failing to ensure nurses are taught bowel and bladder care is putting patients at risk, a group of MPs has warned.

In a letter to the Nursing and Midwifery Council, the All Party Parliamentary Group for Continence Care urged the regulator to consider including such training in pre-registration education, as part of its current review of university standards.

The group of MPs said it was a concern that it was not a core competency for nurses, considering that fact that more than 14 million adults in the UK had bladder control problems and 6.5 million have bowel control issues, and 900,000 children and young people have bladder and bowel dysfunction.

“This glaring hole in current nurse education is putting the health and wellbeing of patients at risk”

All Party Parliamentary Group for Continence Care

The group also noted that Sir Robert Francis, who chaired the high profile inquiry into care failings at the former Mid Staffordshire NHS Foundation Trust, had described continence as the “most basic of needs”.

But a number of problems existed among nurses caring for patients with incontinence problems, said the MPs, based on their conversations with clinicians.

Nurses were not always proactively offering bowel and bladder assessments, which could mean treatment was being missed, according to the letter.

Meanwhile, some nurses may not be carrying out important procedures because they wrongly believed it harms the patient, said the group.

For example, some nurses thought digital removal of faeces caused bodily harm, when it fact it could be a core part of bowel care – especially for patients with a spinal injury – and without it, risk of harm may in fact be increased, said the group.

“We urge you [the NMC] to consider making bladder and bowel education standards a core competency”

All Party Parliamentary Group for Continence Care

In addition, an “inappropriate and undignified” “padding up” culture – in which patients were given incontinence pads instead of receiving a thorough continence assessment and individualised plan of care – “continues to blight local, regional and national drives to change practice,” said the group in its letter to the NMC.

Other consequences of poor bowel and bladder care were often hidden but “significant”. They included incontinence-associated dermatitis, delayed hospital discharges and increased costs for incontinence products, it added.

The group also raised concerns that some newly qualified nurses were unable to perform procedures – such as urethral or subra pubic cathertisation – while in other cases nurses were needlessly carrying out urine testing of catheterised patients which increases the risk of antibiotic resistance.



Rosie Cooper

The letter, signed by the group’s co-chairs Labour MP Rosie Cooper and crossbench peer Baroness Sally Greengross, said the UK Continence Society had developed minimum standards for education that could be brought into pre-registration education.

“We urge you to consider making bladder and bowel education standards a core competency within the pre-registration nursing curriculum since we believe this glaring hole in current nurse education is putting the health and wellbeing of patients at risk,” said the letter, addressed to NMC chief executive and registrar Jackie Smith.

The letter was also copied to health secretary Jeremy Hunt, Commons health select committee chair Dr Sarah Wollaston and Nursing Times editor Jenni Middleton.

The regulator is drafting new standards for nurse training this year, ready for consultation with nurses in the spring, with the expectation that all universities will run new courses by September 2019 – though some may be given the option to begin a year earlier.

The NMC has been approached by Nursing Times for comment.


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Readers' comments (2)

  • Maybe if we had less form filling we may have time to actually care for our patients.

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  • It might also help to make up-to-date information booklets accessible in health centres and doctors surgeries, preferably, given the stigma, where they can be picked up unobserved.

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