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'Clearing up poo will not help me learn' - student nurses reject basic care

  • 158 Comments

Student nurses are rejecting essential elements of bedside care because they feel it is not a worthwhile learning experience, research published by Nursing Times has found.

The research found widespread conflict between student nurses and qualified staff over the tasks students should do on placement.

Tasks normally carried out by HCAs, such as making tea, washing patients and cleaning, were not seen as valuable learning opportunities for student nurses keen to gain experience with more technical roles like administering drugs.

As a result, many senior nurses feel that students are qualifying with significant gaps in their basic skills. One interview participant said: “I sometimes feel in despair that by the time students have qualified, they still haven’t gained some of the practicalities and common sense - things like time management, basic assessment skills - that we would have been doing on our first round.”

One student was reported to have told a staff nurse: “I keep being asked to do things which won’t help me learn - clear up poo, mop up blood, give patients tea and toast. I realised that I needed to be more focused to learn, and I don’t do those sorts of things now.”

Click here to read the research in full

Poll

Are student nurses wrong to reject basic bedside care while on placement?

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  • 158 Comments

Readers' comments (158)

  • What a load of hogwash. I'm a third year student and I have no problem with perfoming fundamental care on patients and understand its importance. What I do not like as a student is being used as a HCA constantly, there are other things to learn along with fundamental care. Please stop attacking us students, I'm sick of the whole too posh to wash debate now. Next you will have ward sisters complaining because NQ's do not know how to do med rounds, set up IVI's etc because all they did in uni was wash patients.

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  • As a third year student, I'd say the issue is not that students refuse to get involved with personal care but that ward staff don't know what to do with students when they are on placement so use them as a spare HCA.

    The statement given by the student in the main article makes perfect sense to me. Students arrive on a ward armed with a list of learning objectives that need to be achieved whilst on placement and spend much of the time being used as a spare HCA. We students dont want to complain or alienate ourselves from our colleagues so we get on with it but then it starts coming towards the end of our placement and it becomes apparant that we are not going to complete our learning objectives as all we have done since arriving on placement is "clean up poo". This is when we are forced to have to focus ourselves and refuse to do some of the basic bedside care so that we can achieve what we have been sent there to do.

    In my opinion, there is a massive failing in the way Universities and placements communicate with each other. Mentor's never seem to understand the students paperwork or what they are and are not allowed to do whilst on that placement. I've arrived on placements and been allocated mentors that are annual leave for 3 weeks, i've been allocated mentors that have had no mentor training, i've been allocated mentors that are so disillusioned with the NHS that they actively encourage me to rebel and tell me that they are going to sign off all my learning objectives regardless of whether i even turn up to placement because "its all b*****ks now anyway".

    Nursing mentors need to be given formal positions where they are sent on yearly training to learn the students paperwork and what they are expected to teach their students, given protected time during the working week to spend time with their students and paid a subsidary (much in the way that social working mentors are) to provide the motivation to do the job and reward the effort they are putting in.

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  • Practice placement is called that for a reason, we are practicing for being nurses. All we have to do is do what a nurse would do within safe limits of our capabilities and learning level, the qualified nurse we are paired with will do what we cant. This practice way of learning starts with getting people up in the morning. Yes in first year you do a lot of personal care but this is necessary to get good at things (as state above) like time management, understanding the patients capabilities, on your feet assessment, familiarising yourself with the patients needs instead of asking an HCA weather they have been continent, eaten, mobilised etc. I fear students who dont practice the hands on approach will become the hands off nurses that know know who their patients really are.

    Nurses dont qualify and accept new roles like medicine admin or catherterisation they add these roles to all the ohers from giving someone a tissue to bed bathing etc

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  • The comments, made so far, are extremely reassuring to an old one like me!! They make absolute sense and demonstrate that we are still recruiting and training people who will make extremely good nurses.

    It also shows that in the last 30 years or so, we still haven't reached utopia as far as nurse education and training is concerned.

    Even in the good old days, there were student nurses who did not see basic nursing care as an importnat part of their learning experience, so we cannot criticise the students of today.

    From the comments made so far, if they do exist, then they clearly are in the minority. Darren has put the problem into a nutshell and talks good sense.

    By the way, where did this word "Poo" come from, surely we can still talk about faeces or is that not PC!!

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  • In response to one of the comments on here where a student nurse wrote "Mentors should know what they are expected to teach their students, given protected time during the working week to spend time with their students and paid a subsidary"... I just wanted to add as a registered nurse with 5 years experience now training to become a mentor/assessor that Yes in an ideal world these allowances should be made but it is very clear that they are not and it is often the students that suffer. However as a new mentor it is also very difficult to work full time whilst attending the course in our own time at Uni (for no subsidary might i add) then be expected to "teach" and mentor students as well as provide good standards of nursing care to patients on an already understaffed ward. All nurses undertake the basic aspects of nursing care and learn the more technical aspects on qualifying, but i agree also that nurses are qualifying with limited technical experience due to this. However as a mentor who is accountable for a students practice and often doesnt get time to have a break let alone provide regular teaching technical sessions it is understandable why such skills are not being facilitated. The ward environments are often too busy to give mentors and students any protected time and there is no incentive to be a mentor as it often means more stress and more responsibility where nurses are already pushed to the limit over stretched and under resourced.

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  • I recall when project 2000 started student nurses were being fed the believe by schools of nursing that they would be prescribers of care and not deliverers of care. Is this still the underlying principle?
    Problem is nurses need to have credibility and to have this they need to have good experience of basic care that they are expecting others to deliver. You won't maintain good standards on a ward when you're eventually in charge if you don't get your hands dirty once in a while. (or twice).
    Having said this I do feel that students get a raw deal when qualified staff are working under such pressure that they are expected to be everything to every body. Protected time was mentioned - we wish!!

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  • Ahhh the old debate rears its ugly head again. Nurses treating student nurses as HCA's. Having been all 3 I actually think there is a very fine line between the roles. HCA's are there to support the role of the nurse, and that includes the student nurse. Students should not feel that the role of a HCA is a scivvy or any less of an important role. I have had my fair share of students who throw the i'm supernumery card and seem to only care about paper work and drug rounds. But thats not what nursing is, it's what it has become. I can't help but feel dis-heartened when thats all my student wants to do. Imagine my joy when we get a student who takes the initiative and takes her self off to feed a patient or give assistance with hygeine or take the time to clean some dentures. yes these seem trivial tasks but when you can't manage them for yourself they are a huge task.

    I do remember my time as a student and being asked to perform these tasks but I always used the opportunity to chat to the patient to develop communication skills. It was always so much more than a bed change.

    Any student reading the above article will read it and no doubt agree with some asspect of it. I only hope that they use it to their advantage. To master basic skills and become great nurses. So as when they are qualified they can justify the allocation of any task to their student with conviction. There are already far to many nurses out there who feel that basic care isn't part of their job. It's the first building block in nursing care.

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  • it is a sad affair if student nurses feel that clearing up poo is not part of their role. There could be many health issues relating to the patient which they may miss such as melena which has serious health implications on the patient. When I was a student nurse, i prefered to have direct pateint care i therefore could document true casenotes and knew what issues each patient had. Are these student nurses going to be the new qualified staff who do not see patient care and the nutritional status of the patient as being important?? At the end of the day it is the responsibility of a qualified nurse to ensure the patients in their care are well care for and i would suggest student nurses go and read the NMC The Code! I have mentored student nurses and when they display signs of not wanting to attend to any duties they deem as being a health care assistants role I ask them why they chose nursing as a career. Another question to ask is define "Nursing", amazing the answers I get back. If people chose to go through three years of training please do it for the right reasons, it is not a glorified job, it is hard work but nursing is the holistic care of each patient not simply administering medications and sitting at a computer imputting information about patients you dont really know

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  • sorry but the first thing in nursing is basics when you get that right then you move on i have worked with many students at different stages and after the third year some deserve their diploma some have have come back to work with us and dont know a from b i have experienced this for over 20 years and nothing will change it is frightning to be looked ater in any form of care yet higher clinical support workers get got at for trying to take jobs of nurses

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  • I have decided to leave the NHS after 15 years working as a nurse, the attitude to patient care has changed so much. I trained to be a nurse, not a glorified receptionist. I miss spending time with patients under my care, whether that is to attend to their personal care, helping them with their diet and fluids, speaking to them to find out what issues and worries they have and attempting to resolve them with the help of the MDT. I no longer want to spend over 3 hours completing a stack of paperwork for one grade 2 pressure ulcer. In this day and age which comes first paperwork or patient care?
    As a mentor, I would not be saying to students "ill just sign your paperwork" do these staff not know they are accountable for the students they just sign off?
    It is frightening to see and hear what is happening in the NHS. I am a fair mentor and will encourage my students to get the most out of their placements but if the student is not up to the mark after input from the university and the clinical facilitator then they will fail the placement. It is a mentors responsibility to ensure that competent students progress, then I have to question how competent is the nurse to be mentoring student nurses?

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  • To add here - ive been qualified for 2 years so my training is very fresh in my mind still - but what people are forgetting is that a lot of students will have experience already or work as a HCSW along side or prior to their training so a lot of these 'basic' skills are already being experienced its just learning to have an analytical mind and improving your assessment skills better - students are used as support workers and there is no getting away from it. Has anyone actually ever read recently what is expected from students? their learning packages skills and competencies that they must do in order to pass the course has so much more in it than the 'basic' nursing skills and personal care - students need to be allowed to do more. I always pushed myself to work with the support workers in the first couple of weeks as this is the best way to learn the ropes and patients and what’s expected etc then I would try and be involved in the more technical things especially towards the end of placement otherwise how else are they supposed to pass???? They put in all that time and effort and can fail. There are always going to be some bad apples and everyone has met them but this does not mean we can judge all students by this – we have to allow each student the opportunities to learn all aspects and we must consider their learning needs individualistically and take into account what they can and cant do already.

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  • Maybe it's down to what they're experiencing on the wards nowadays? In the days of dinosaurs (when I was a Charge Nurse) I never expected anyone to do anything I wouldn't do. Even the most menial (not my use of the word) task needs careful attention. I used to work with the junior staff (qual & unqual) as a way of ensuring good care, keeping myself 'grounded' and as supervision.

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  • Gillian Duncan

    I'm a third year student and I have no problem with perfoming fundamental care on patients and understand its importance.

    Please stop attacking us students, I'm sick of the whole too posh to wash debate now.

    I am always willing to perform fundemental care, as this forms a basis for learning to be a good nurse. Fundemental care builds up our communication skills, nursing skills and overall ability to care, feel compassion and understand the patient perspective.

    I object to this article as not all student nurses are too posh to wash.

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  • As a third year student in my final placement, I can honestly say that I have thrown myself into all aspects of nursing care, whether that has been cleaning and washing patients or removing drains and sutures, I have ordered blood tests, administered CPR, spoken to relatives and I understand what will be expected of me when I qualify.

    I think its a shame that students are again being accused of not wanting to get their hands dirty when I have never seen this from any student I have worked with. Of course its not a pleasant task but I for one understand the importance of it. In my treatment of patients I just remember to do as I would be done by.

    I have worked with some excellent mentors, who answer my questions and set me tasks to challenge my practice and knowledge, I have loved (nearly) every minute of my training. I acknowledge that I have been very lucky as after speaking to others in my cohort this is obviously not always the case, students are used as hca's frequently and its not the work that is the problem, its the fact that as students we are there to learn all aspects of nursing care, not just one, by being used as hca's takes multiple opportunities away assist or observe other aspects of nursing care that we haven't seen before.

    As a student I have seen amazing nurses, they are inspiring and have taught me the kind of nurse I would like to become but I have also seen nurses (both experienced and newly qualified) that are lazy, rude, uncaring and at times verging on the dangerous, they have taught me how not to be a nurse.

    If people are so worried about students having gaps in their training, then they should be equally as concerned about the practice of some existing nurses. Quite clearly some experienced nurses should have left the profession a long time ago and let us students learn from those who actually do care about their profession, their patients and their students.

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  • The sensationalist manner in which the Nursing Times has chosen to highlight this research will undoubtedly attract attention and stimulate discussion. However it is also successful in missing the point completely! The majority of student nurses are concsientious and hard working during clinical placements. They are also recognise the importance of essential care for patients and are prepared to participate whenever necessary. A finding of this research appears to be that the difficulties they experience in relation to this aspect of care arises from their observations of the practices (role modelling) of their mentors. If student nurses do not see quailified nurses participating in the delivery of essential care, then how are they expected to identify it as a key requirement of their role when they qualify? This is entirely different from the over-simplified claim that 'student nurses reject basic care'.
    I suggest that the message would have been more appropriate had it been that mentors should concentrate more of their time on the delivery of essential care if they are to demonstrate its significance to learners. I acknowledge that this is very difficult in today's clinical environment - but that is another issue altogether.

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  • I am staggered that student nurses do not value the fundamentals of care. Have they ever suffered a sore bum! Do they not value what you can learn about a patient and their condition by delivering the vital basics of care. I remember as student nurse in the 1980's being very proud of the qualifications I had gained in order to enter the profession and whilst on my first placement on a medical ward attending an elderly lady who had been doubly incontinent with a nursing auxillary who asked me what qualifications I had and did I really need all those to 'wipe bums' and to this day my reply would still be yes. As I can assess plan and learn what to do to make my patient more comfortable. To this day I believe in getting the basics right and then move onto the technical stuff. I would not want anyone who is too proud or too full of their own self-importance to wipe a bum to share the same professional register with me. If you are a nurse no matter what your curent role, if a patient needs their bum wiping then you role up your sleves and get it done.

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  • This story makes me so angry. As a third year student nurse on each placement I have 61 competencies that have to be achieved and signed off by my mentor, and I am always mindful that in less than a years time I will be expected to work as a qualified nurse.

    Many students such as myself have already worked as HCAs or work with NHS Professionals to top up an abyssmal bursary. I have no problem at all with delivering personal care, what I do object to is nurses ignoring my learning needs and using me as an extra HCA, and I imagine that this is what most people interviewed in this survey will have said.

    The number of times I've had nurses tell me that I'm not allowed to administer controlled drugs or that I can't watch an NG feed being set up because there's not enough staff on the ward, etc etc etc makes me want to scream with frustration.

    Am I magically supposed to learn these skills the day I qualify, or will I have tell the sister or charge nurse on my first job that I can clean up poo, sorry, faeces, but nothing else!

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  • I am a newbie student nurse who in four weeks time will be sent on his first placement. It must be said that I am a wee bitty older than some other students and this may colour what I feel.
    I expect to spend most of my time wiping bums and cleaning tums.
    For me I see it as a learning experience, it will allow me to help patients on a most basic level, it will also allow me to practice the skills that I have been taught at uni. Communication, moving and handling, oral hygiene and nutrition, these will involve me getting up close and personal with patients.
    My own feelings are that it will also help weed out those for whom nursing maybe isn't really the career path they should be following.
    I know I have got lots of learning outcomes to achieve and lots of boxes to tick. I will do what I have to to ensure that this is done.
    At the end of the day I want to pass my placement with as good a rating as possible. I will have time enough, when I qualify, to develop a prima donna attitude, until then call me igor.

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  • I agree with the nurse who says there isn't a job he would ask someone to do that he is not prepared to do himself. I don't consider any form of basic care - or emptying bins or cleaning commodes - to be beyond me as a qualified nurse of 22 years +.But a note to the students -
    There is so much to learn from undertaking basic care that there shouldn't ever be a case for students declining to undertake it at any stage of their learning or afterwards. There is also a lot that can be learnt from all the other staff on the ward who care for that patient, from the housekeeper who spots someone coughing on a cup of tea to the physios / ot / pharmacists who form part of the ward team. Your eyes and ears teach you as much as any piece of equipment about your patients. We have been criticised recently for letting basic observational skills (I include feeding and bathing in those) slide down the list of important elements of learning. You have to know the normal very well well before spotting the abnormal becomes second nature or intuitive. All of these things come from hands on care and getting to know your patients. Can I dare to suggest that the education purported as being superior for todays gaduate nurse will impede that side of learning so badly that failing to spot a deteriorating patient will become a far more common occurance - and who suffers then?

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  • As a qualified nurse of over twenty years I am appaled that student nurses do not see the learning oppertunites in 'basic nursing care'. During a proceedure you can develop communication skills, observe any breakdown in skin conditions, observe wounds, any neumerous amount of things from after all where nursing began with these skills!! Any nurse worth there salt do not ask students to do something they would not do themselves, I am not stupid however and know this is not always the case, but when I have to do something I would rather not I look for the learning oppertunity even after all my years working in the NHS, I still have at least thirteen years service left ( Pension keeps me now) and still look for oppertunities to learn after all continual learning is what we are about!!!
    Maybe students take there attitude from previous mentors who think that's all HCA's should be doing!!!

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