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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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  • Students do see the learning opportunities in basic nursing care, we understand about learning to observe and communicate with patients, to begin to learn what is noraml and signs that something isn't right but we also see the opportunities in other nursing care.

    Newly qualified nurses are not only expected to undertake basic nursing care, we are expected to manage our own patients, complete admissions and discharges, undertake patient specific practices AND basic nursing care.

    Its a matter of balance, student nurses are expected to undertake the same roles as an experienced nurse (with the exception of enhanced practices of course), how are we supposed to feel competent in all aspects of care this involves if all we have been allowed to do is basic nursing care.

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  • As a newly qualified nurse who has recently been told by the ward sister 'don't do washes and toileting, thats the HCA's job' i really feel that student nurses need to be prepared for the fact that they will often be too busy to perform these tasks, and that in their third year especially they need to be doing the other things (drugs, IV's, and all the mountains of paperwork) instead of washing and toiletting. I hate the fact that i don't get to assess my patients through washing them and spending time with them, it means i don't know about their skin and level of mobility. However, i simply do not have the time on an extremely busy emergency assessment unit to perform these tasks and had I not had great placements in my third year as a student which allowed me to practise the more technical skills i would have had some sort of breakdown by now. I have absolutely no problem with washing patients etc and in fact wish i could do more of it, but the plain fact is that nurses don't do so much of these things anymore. Therefore its useless to use students as HCAs and not train them to do what they need to do on the ward when they qualify - drugs, time management, liasing with dr's etc. The students used as HCA's will not be up to scratch when they qualify - they need to be prepared to wash when needed but accept the fact that mostly they will be doing other things. As someone who is having a hard time getting used to the new role and finding it very stressful, i can't imagine what it would be like if i hadn't been as well prepared for it. We're not too posh to wash, we're just too busy!

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  • I am a hca ive been one for 12 years I have to say student nurses do not like to do hands on care they have got worse over the years ( not all ) when they become nurses they think they are too good to do hands on care too good to wash is right. I sometimes wonder why they have become nurses.

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  • Again I find the Nursing faternity in turmoil over Nurse education - Students must learn basic care before progressing to highly skilled and technical issues.
    What is missing here is the fact the each student is unique and has thier own learning objectives - and mentors who whilst doing thier JOB also have to accomodate these - as with all people some willingly take this on board and some dont - As a senior Nurse manager I see students who can happily change a blocked infusion pump but still dont notice the bed needs strightening to prevent skin damage - I had a Newly Q Nurse recently who could not understand Odematus and celluitus in a 90 yrs Old - who said I am mental health trained not general!
    As long as students remain outside the health care arena - they will only learn what the Universities have on the TICK box of learning outcomes.
    1st Year should provide basic care skills as a foundation to the next 2 years learning higher skills - but hey 1st years students in Intesive care and 3rd yrs in care homes?
    Not good learning in my view - what is needed is dedicated mentors through out the clinical areas for these students

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  • When I first read this article I was utterly shocked with the attitude of Student Nurses. After giving it some thought however, and recalling my days a SN, I fully understand and appreciate why they are so disheartened.

    I can clearly remember working my backside off on placements, providing basic care to patients, sweat pouring off me; getting paid a pittance whilst seeing REGISTERED staff sitting at desks chatting with colleagues, drinking tea and getting paid good money to do so. I used to feel that I was sometimes used as a HCA and was given little opportunity to learn or develop other important nursing skills. I used to feel infuriated that registered staff abused my position and the purpose of my placement.

    At the end of your Nurse training, when you receive that little bit of cheap card (that you pay a fortune for each year) from the NMC, you are then in a RESPONSIBLE and ACCOUNTABLE position. You should feel confident that your skills are good in all areas listed in your competences, not just basic care.

    Schools of Nursing need to come up with a better ways to ensure Students get the experience and skills they require to become well rounded professionals. Mentors need to lead by example to set good standards, attitudes and encourage and motivate students. If a student is to be seen to be providing basic care, then so should you be. You should also remember that the student may be working for your organisation one day and you will be EXPECTING them to know what they are doing.

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  • There is no ideal situation during one's training, as there will always be a ward that is too busy or one that provides good learning. There will always be both good and bad mentors. However, if the student feels he/she has an issue, it should be discussed with the ward manager or their practice tutor - don't just whinge about it, that will only get you labelled as having an attitude. Ihave been qualified 18 months having worked as a HCA prior to training but throughout and to this day, I still wash and clean my patients. This gives me the chance to talk to them and create a patient/carer relationship, which helps me to find out what needs they have. It is also an opportunity for patient assessment - which includes looking at any output from the patient (I assume students (as do RGNs) don't only check urine for colour/quantity/consistency etc). This is called holistic nursing care and is what RGN's are expected to carry out for their patients. I remember my student days 18 months ago very clearly and am now a mentor myself. I am always looking for opportunities for students to learn and would not ask them to do anything I wouldn't. So to those students who feel it's not fair to ask them do do basics, please don't generalise about mentors, it is not fair to them either. In addition, when I take a student, I am signing for the skills and learning objectives but also assessing wether he/she is suitable for qualifiying as a nurse. How can I sign them off if I have not observed them as willing to undertake the basics of the job? I have worked on a busy 3 ward unit and am now specialising, and all the nurses I have worked with will wash and "clean up poo" so why shouldn't students within reason.

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  • It is a shame that this subject comes up time and again and that a few students can cause such a debate. I have been nursing for over 30 years and there is always someone who will not do the basics when necessary. People come in to nursing to look after patients and if there are only 2-3 nurses on the ward and someone needs cleaning/bathing then that should be done as soon as possible using all skills verbal and practical. I will never forget the student who said to me 20 years ago after a patient vomited. I don't do vomit in front of the patient. Need I say more!!!!!
    To the nurse who is leaving the NHS after 15 years. Its a total shame that good hard working people feel that is the only way is to go but I do not blame you. The government and senior management really has to be ashamed at how things are in the NHS and if I had not only 4+ years to go before retirement I would too.
    To all who read this we are here to CARE and HELP those that are vulnerable in whatever capacity.

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  • As a newly qualified staff nurse I feel this is no longer the case. The course I undertook was altered so that in first year, student nurses could focus on all the aspects of basic care and get to grips with them.

    On the other hand and it can also be attributed to the staff on the wards as well. With so many Universities now offering Nursing courses it is hard for staff to keep up with which students know what as there is no uniform standard.

    I remember as a student having to explain on every placement what skills we could and couldn't do. However if these findings are what is happening in the world, shouldn't all Universities let the nursing students get to grips with basic nursing care and nothing else so that this is not the case?!

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  • * However if these findings are what is happening in the world, shouldn't all Universities let the nursing students get to grips with basic nursing care and nothing else in their first year so that this is not the case?!

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  • I have been fortunate enough to work with very caring student nurses and have witnessed not so kind qualified nurse behaviour at various times in my nursing career. I feel sorry for the student nurses. Being supernumary is not much fun. I was teaching 3rd year student nurses recently and discovered there are so many practical skills that they are not allowed to do until they qualify. For example, taking blood, checking drugs, things that I had done during my training over 30 years ago. Is it any wonder that newly qualified nurses take at least another year to become confident enough to run a ward let alone become a ward sister 3 years later, which is what is happening in some hospitals. The training is full of too much paperwork and not enough practical skills. When will the NMC and the universities realise this fact?

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  • I am a 2nd year student nurse. I decided to be a nurse because I am a very much a people person. I want to be with people, help and care for people. I love the basic care elements of nursing, so much so that it worries me that I will not be able to spend so much time with patients once I qualify. After spending a lot of time reading most of the replies I tend to agree and disagree with points from each response. I dont feel as a student that I have been completely treated as a HCA. I do worry sometimes when I am on a ward that if I spend the whole 6 week placement doing fundamental care, how will I complete my learning objectives or gain experience in medications and drug calculations and care planning. I want to qualify in 2 years time and be proficient not only in basic care where I know that I will be using my observation skills to recognise the deteriorating patient; but also in care planning, medications, liasing with doctors etc etc I will be fully accountable and I want to feel that I know my role and I can carry out all aspects of nursing care confidently and proficiently. There has to be a balance and I think that it is important for healthcare professionals to step back and see eachothers point of view. Yes as a HCA it can look like a student nurse doesnt want to wash bums but does the HCA understand just what the student has to learn and show proficiency in to qualify?, as a student it can look like you are being used as an extra pair of hands (this is not entirely the fault of the nurse I must add, but the budgets and understaffing which seem to be a terrible problem), and nurses, how are they supposed to mentor students with limited time so as not to take essential time away from the patients they already have limited time with, and the amount of paperwork which has to be completed before they finish their shifts. The students of today will be be qualified and working on the wards in no time at all and it is essential they they are competent in all areas of nursing care. I believe the argument is that there is no balance and the fear of the student is that the day he/she starts work as a qualified nurse she will not feel competent enough to do so. I feel that is what students want to get across; we want to be with patients, we want to look after their skin, their breathing, their circulatioin, their nutrition, monitor their vital signs, notice deterioration, know what to do if their condition worstens, administer medications, understand adverse effect and contra-indications to medications....... I hope I have got my point across... I just hope that when I qualify I am confident and proficient in what I do and that I have been taught well as I am eager to learn and I will spend as much time as I can with my patients as that is why I want to be a nurse.

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  • Oh, dear. What a sad reflection on modern nursing. I am rather shocked at the lack of insight from some of the commentees! (Although gladdened by the comments of others who are more in tune with caring for sick and vulnerable people in the real world of healthcare!) The comment about not learning from 'clearing up poo' seems to be an enigma as many learning opportunities spring instantly to my mind... why does the patient need to have assistance with their bowels, are they too weak, paralysed, unconscious? Are are they constipated, have diarrhoea or neurological problem causing incontinence? How embarrassed might the patient feel so how emotionally could a nurse support and comfort them. If their 'poo' was not cleared up what implications could there be with pressure sores, other soreness or infection? How could we best manage it, what might be given, used to improve the bowel movement for the person in the future? I could go on with dozens of other ways a student nurse should be able to apply their theoretical knowledge to practical care. As for suggestion (in another comment), that ward nurses should have annual training in what the students are learning so they can teach them on the ward I think that this is also very short sighted and unreasonable. Student nurses need to apply what they learn at University and apply it to the real world of nursing. I would suggest that it is the the other way around. Universities should have closer contact and experience with what is needed to teach the students to become ward and community nurses and derive a curriculum to that end. Likewise, whatever happened to self directed learning? As a CNS I have prepared a sheet of information on our unit and learning opportunities for students on our ward to do with Head and Neck cancer. It has contact details of MDT members to contact to shadow and even what day of the week things such as surgery, clinics etc are held. I have to remind many of them about using their time to learn and few of them even though handed the opportunities do not do anything! It is always a breath of fresh air when we have a keen and competent student who does take every opportunity to absorb as much as possible. Even though I was an 'actual member of the workforce' when I trained, I took opportunities and was allowed, (by the far fewer trained staff), to go to see tests and scans, was tested on drugs on drug rounds, watch operations and observed communication skills as well as nursing procedures until I was competent to do them myself. Now students are supernumary surely there is even more time to be able to go and see these things?? Wake up students and wake up Nurse educators. A great piece of research by the way, highlighting that our worries about the state of nursing now and it's future are not just 'old' nurses wingeing and could have some reality.

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  • I work in a small community hospital as an HCA.
    Reading this comment, it does help to explain why we are seeing the odd few newly qualified staff-nurses arriving on the wards unable/unwilling to comfortably perform basic care skills, answer call-bells, complete personal hygeine, be involved in fluid + food intake and delivery etc, which is a major part of daily ward-care.
    Perhaps we've been fortunate where I work, but I can only say that on the whole, most of the students I have worked alongside with, have been 'hands-on', and willing to gain the confidence in their basic nursing skills. Perhaps though, they have been 'complaining' about this behind our backs?!
    On the whole, most of our trained staff realise the importance of 'mucking in' with these jobs- as they should do, and don't just see their role as 'paperwork, Dr's rounds, drug rounds and spending their time in the office, or on the phone'.
    I would say to the student who does have a problem with it, that they DO need to ask themselves if they are on the right training course? As this IS a major part of a nurse's role as I understand it?....or should be!
    Could this be more to do with a lack of information given to them about the role of a nurse in the classroom I wonder?
    I agree with previous comments about how important these basic tasks are to diagnose and evaluate, to recognise deteriation, and communicate with our 'customer'. Without this being properly addressed, it leaves the NHS wide open for complaints in lack of 'duty of care' does it not?

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  • I am a third year student nurse. Basic care is part of the nursing role. We are there to care for and look after our patients. If we don't do this, is it not neglect?! I love the basic care in nursing because you can spend time with patients on an individual basis. You get to chat to the patients and do something nice for them. It makes the world of difference to them to have someone take the time to make them feel 'normal'. As nurses, we are accountable for our actions and if we don't spend that time with the patients, how we can we do our job properly? If we don't do the basic care, how can we tell that pressure areas are intact, for example. Nurses do the documentation and fill in the assessment tools. It has to be looked at from the perspective of the patients. Healthcare assistants do an amazing job. My best placements have been where my mentors get stuck in and help out with everything. Love it or hate it, it's part of nursing care and should stay that way!

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  • I cleaned poo for years prior to, during and post Nurse training ...... It got me to a band 7 where I now have tons of responsibility and paperwork. I actually missed my days of cleaning poo so much that I work part time as a HCA in a Care Home even although I'm a band 7 Mental Health Practitioner. It's fantastic having patient contact again and I thoroughly enjoy the shifts that I do.

    Dont knock the poo students coz one day you might actually miss it!!!!!

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  • I am a third year student coming to the end of my training and also work as a HCA. I have never had a problem with providing basic care and i enjoy it I like the time spent with the patient not only is it important to check for things such as pressure sores but it is a great oppurtunity to get to know the patient. I have met one or two students during my training that don't think it's their role to do it but the majority of us get on with it and don't complain as it is an important part of nursing care and we are there to care for patients, i think it should be remembered that not all students are the same and we shouldn't all be tarnished with the same brush.

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  • Any fool can learn to do a drug round or set up an IV - its just a (fairly simple task in the grand scheme of the running modern hospital).
    It takes a 'real nurse' to be able to deliver basic care skillfully and make a real difference.

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  • After 21 years in the NHS I find the difference in student nurse traing huge. I cannot believe that students who are about to qualify cannot easily do a manual BP. I have seen students who are uncomfortable and poorly prepared when attemting to bedbath a patient. I feel that albeit academia is a large part of a progressing profession, the basics are being left out. Patients do not care if we have degrees ect, all they want is to be clean and comfortable. Being uncomfortable with performing these essential skills and being to posh to wash gets the wonderful profession we undertake bad press. I love having students but feel in their 3rd year that I should be teaching them management and assessment NOT how to perform basic nursing care. I have seen this in some newly qualified staff also. I don't blame the students, it's the culture of a university life and learning in so called 'skills labs'. You cannot learn to give individulised holistic care unless you are dealing with people not dummies in labs. Nursing is truly the best job in the world but you only get out what you put in. 21 years later I am still 'cleaning up poo'.So what? it's a small part to play and means everything to the patient !!!

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  • I am a third year student on my final placement. I feel that yes, in the first year the majority of my role as a student was 'cleaning up poo' and dragging the obs machine wherever i went! however i agree that students must learn the fundamentals of nursing before advancing to other tasks.

    The sad fact is that washing, dressing and toileting patients is really the only time nurses have to spend with them. This then allows you to ask questions and observe the patients closely. Has anyone noticed that some HCAs know more about patients than some nurses? This is why i think that nurses and HCAs should form a good team, and no they are not skivvys!

    I now nearly qualified and am allowed to do the work of an RGN- within reason, and yes i now do meds, fluids, paperwork, and plan patient care but i still help with ADLs and take the dreaded obs machine on its rounds!

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  • As a ward sister I still bedbath my poorly patients, get commodes for those who are unable to get to the toilets, stand and feed patients who are unable to feed themselves. No I don't work on a care of the elderly ward, just the opposite but patients with cancer of the GI tract, those with alcohol related problems a lot of whom are younger than 50. So if the students haven't learnt how to do these basic skills how can they document a legat document. As I tell my students think of what you see when bedbathing things like skin integrity, obvious wgt loss, pressure area care, the list is endless

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  • Since when has cleaning a patient and making him or her comfortable, assessing their ability to move, assessing their skin condition and other needs been a job solely of the HCA and not that of a staff nurse? ALL students need to start at the bottom (no pun intended) and build a good base of nursing skills before they can consolidate and move on. After all, no mentor in their right mind would initiate a first year student straight into drug rounds etc. Students need to be prepared to 'muck in' with the rest of us and learn bit by bit starting with the basics.

    I really dispute this student's alleged statement that she couldnt learn anything from cleaning a patient there is so very MUCH to learn as a student, and certainly to provide holistic excellence in care. Students need to be prepared for carrying out basic tasks as qualified nurses, the HCAs are there to provide assistance not be the sole providers of hands on care.

    I also hate the impression given that HCAs perform 'menial tasks'. As a ward manager I value the work that all my HCAs do and encourage them as far as possible to undergo further training to make their roles as rewarding as they wish them to be. HCAs are an invaluable resource to any team and certainly to the patients and any student should be proud to learn from them. And of course, every ward has a ward manager, maybe these students who grumble about cleaning up 'poo' should take their concerns directly to the ward manager. I am sure they would very quickly be put in their place.

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  • I am a third year nursing student. I have found that as I have been given the opportunity to take on more responsibilities (to further my knowledge and skills for when I qualify) I have less time with patients. But this DOES NOT mean I am reluctant to provide basic hands on care, which, if I'm honest, is what a patient appreciates the most. When I am working with my mentors I do manage my time and instead of doing everything my mentor does we will share the responsibilities. For example - my mentor will do the drugs round in the morning herself and I will do the lunch time drugs with her. This gives me the opportunity to spend the quality time with my patient's - which everyone enjoys.

    One thing I will see to student nurses, mentors, or whoever is affected by the this article is that hands on care is still one of the MOST important part of nursing. Not only is it something that is necessary but it also provides an alternative to carrying out other interventions. For example finding out someone's social status, how someone manages in their own home, and finding out facts from a patient that only come once a trusting relationship is formed between the professional and the patient.

    If student nurses are think that there are some things that won't help them learn they shouldn't be doing this type of job. Nothing is below anyone and everything is a learning opportunity in nursing!!

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  • I have been within the nursing profession for the past 20 years as nurse midwife and health visitor. During that time I have seen many changes none more detrimental than the way we train our student nurses, nurses who will "care" for our loved ones. In making nursing more accademic we have lost the art of nursing.

    Basic nursing is the very foundation that stabalises our career one which we have underminded by viewing certain tasks as beneath us.

    Many students today will be shocked to learn that when I started my RGN training CSW or auxillaries as they were called then were minimal with usually only 1 per shift.

    As a student I was expected to do such tasks as make a bed, empty bed pans, mop up blood etc but in doing those tasks I learnt the art of communication, observation the very essence of nursing.

    Student nurses of today may be in a rush to carry out the drug round but if all they do is dish out drugs where is the synthesis of observation and communication to provide an informed knowlegde of that patient in order to safely administer medication.

    There is nothing more satisfying that stepping back from a bed knowing that its occupant is in a clean bed, is themselves clean, comfortable and pain free.

    I would ask student nurses to ask themselves why they were attracted to nursing? If it was to care for people then one wonders why the art of caring is considered to be beneath you?

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  • From a mentors perspective, we have students who come to their area of placement and just want to get through it as easy as possible, they dont want hands on, but want to get their proficiencies signed as quickley as possible.as one male student told me "when i qualify i,m never going to bath or wipe a pts a... ever again". I try to encouarage my students the importence of basic hands on nursing as it is as important to monitor and evaluate the patients condition, such as fluid input/output, bowel movements and skin integrity, this is not rocket science but basic skills that can be a valuable source of information. i work along side my students 100% of their time and what i do they do, there is nothing i would ask a student to do that i would not do myself, i am a hard taskmaster and do not sign proficiencies without them being earned, the evaluations recieved have been one of thank yous for teaching them whilst working along side them as an equal, and explaining the procedures and highlighting how basic hands on nursing can be so informative and important in assessing and evaluating the patient. i incorparate this whilst doing other patient care and then the student realises how relavent this information can be. i would like to think that they take this information with them through out their career, and when they are qualified to remember how important basic care can be.

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  • "As for suggestion (in another comment), that ward nurses should have annual training in what the students are learning so they can teach them on the ward I think that this is also very short sighted and unreasonable."

    I'd just like to clarify that my suggestion was that nursing mentors go on annual training and not all ward nurses, as this would be unrealistic. I suggest this because as a student I find it frustrating when I arrive at a placement and my mentor cant highlight what learning opportunities are available to me because they dont understand my learning objectives, (part of this blame must go on the universities who while at the same time as advocating the use of jargon-free language in healthcare seem to write our learning objectives in a language that would confuse a babel fish), and because they dont know what i am and am not allowed to do on placement.

    The fact that most mentors seem confused about the students paperwork does mean that some students who are less inclined to roll up their sleeves and wipe a bum, can manipulate a mentor into believing that they are not expected to perform this task past the first year, which as many people here assert, really should not be the case. We students don't always understand what is expected of us either as the university just dumps the paperwork on us and sends us on our merry way, misguidedly assuming that the mentors on placement know what is expected of us.

    I've recently spoken to a mentor who told me that her mentor update training consisted of a 3 hour session where she was asked a single question about what she thought her responsiblities as a mentor were. She, herself, mentioned that the training was woefully inadequate and she learnt nothing from it.

    It is for these reasons that I suggest mentors should go on adequate annual training so that their is no confusion over what students can and cant do and what is expected of them whilst on placement, this should help weed out the work-shy students and support those students who want the best learning experiences from their training so that they can become confident, informed nurses. This is why I believe the issues in nurse training fall mainly down to the lack of communication between the universities and the practice placements.

    I also acknowledge the suggestion that students be more self-directed but this is often more easily said than done, and in my experience is often suggested by mentors that dont have the time to sit down with you and answer your questions(though no inference is meant). It is very difficult to be self-directed when you dont know what your learning opportunities are and in some cases neither does your mentor. Your proactive approach in providing your students with a list of learning opportunities is sadly not taken by all placements, but I for one would strongly advocate for it.

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  • I have left a better paid job financially to train as as nurse. I am loving it.
    While i accept that cleaning poo is not the most pleasant of tasks to do, i still believe it is an essential part of completing the nursing jick pussle.
    What is disheartening as a student nurse, is when the qualified nurse donot see this as part of their job. Once students nurse see qualified nurses happily cleaning bumps and dirtying their hands, we students will be only too happy to do as them. Show us how to clean poo and dirty our hands. Stop being so selective in your roles and help give student nurses a holistic approach towards patient care.

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  • As an old ex-nurse I can only say to the students of today 'get real' nursing to me is all about care, clearing up poo is part of the standard care that should be provided by all levels of nurses. If you dont feel that this is part of your training then, sorry, but you are in the wrong profession.

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  • Although there is a substantial issue with students being treated as ancillary members of staff which has been going on as long as there have been students, there is also the issue of the student and mentor working together to develop their clinical education. Students who feel that their education has been overly focused on one aspect of development should speak to their mentors, not simply fly of the handle in a very unprofessional manner ranting about how sick they are of the too posh to wash debate. I was sickened by the tone and nature of some of the responses, especially in light of how these students were crying out "I am good enough!". It made me cringe to read how unprofessionally some of the comments had been made.

    The basic elements of care is one of the biggest areas of concern for patients; a student may be anxious to learn all the technical and exciting aspects of nursing, but the reality is that if you want your mentor and the other nurses to have time to teach you, you have to help them make sure patients' needs are met. The patients' needs come before yours, and to have an attitude about providing that care will only raise concerns amongst the nursing staff about your suitability for nursing, limiting any other learning opportunities and threatening your successful completion of the placement.

    If you want to expand your learning opportunities, then bring a plan into your placement with some ideas about how to expand your understanding and learning, have a basic understanding of that clinical area and what it can provide, work on developing a god relationship with your mentor, and work within the workload of the ward, but additionally you need to accept the limitations of learning in an area where peoples' lives and care, not your education, is the priority.

    Maybe you don't need to wash another patient because you know how, but maybe you are being asked to wash because the nurse is seeing if you will assess their skin, their movement, their ability to help you care for them; maybe the nurse is looking to see if you will critique the care plan, guide HCAs to improve their care... or maybe, just maybe, that patient needs you and the nurse has asked a student to care for the patient because that patient needs the extra time and TLC a student can give. If you can't see that there is more to washing a patient than slopping on soap and rinsing it off, then the mentor is right to have you keep doing it until you do catch on to the bigger picture- because its in that realisation that you find nursing.

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  • its about time nurse educators look at the style of training.
    How can a "nurse" look after her patient properly if she refuses or can't do the fundamentals of total patient care. total patient care does not revolve around technical machinary or drug rounds these are just parts of the care. If a nurse wants to do the more technical stuff then may be they should re-consider there career and become a medical rep or pharmacist.
    Most of what is learnt about a patient is when you are washing, dressing and tending to their ADLs this is the big problem with to days nurses they don't spend enough time doing these things.

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  • This article is unfair for most student nurses and it fails to show the whole picture. It distorted what students try to say. Indeed it’s very important to perform basic tasks such as washing (which is not always basic). There are a lot of things you can learn during a wash- patients’ personality, their views, you can observe skin integrity and so on. But being a third year student nurse I’m frustrated to think that this is the most wards can offer me to learn for 3 yrs. I’ve seen nurses getting on with tasks and then saying ‘’why I’m a doing this when we have a student? Could you go and clean bed X, get the commode for bed Y, make the beds in bay Z’’. I stress time and time again that these tasks are very important for the patients’ well being and I’m willing to help- but not when it’s out of laziness. After all it’s like saying that students need to have these skill but once you qualify you’ll delegate it to someone else. The presence of a HCA or a student does not dismiss the nurse from helping patients’ with their ADL’s. If my knowledge of medication is very basic I’d like to think that during placement is a great opportunity to learn. I’m not qualifying as a HCA so why as a student should I only be limited to learn skills from HCA. But then if we say that we already know how to wash and we’d like to ‘learn’ something new- we are said to be ‘rejecting essential elements of bedside care’.

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