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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

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  • 158 Comments

Readers' comments (158)

  • I am a final year student nurse and having being on various placement,I feel student nurses roles are more of hca's job. In some of the wards, all hca are on annual leave when students are on placement.Student are not given the opportunity to learn and at the end of their training are classified as being incompetent. This need to be addressed.

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  • I am really disappointed that student nurses feel they are above basic caring for their patients. What do they think there job entails? How can you do a basic assessment for patients without taking care of all tasks requred?

    I am a university trained nurse and I see this as just as an important part of my job as administering medications, advocating, completing transfusions and any other nursing task you can think of. A persons basic comfort is esssential to their mental health and well being.

    It might be interesting to see how those nurses where to feel if they were the ones in need of care and a nursing student felt they were above completing basic tasks.

    They neeed to walk before they run

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  • This article has clearly struck a cord with alot of us. I am also a third year student. I enjoy working with nursing assistants as well as nurses. I feel that they have been very helpful and informative. As far as cleaning up poo goes, you, as a nurse should be prepared to do whatever you can to CARE for your patient. We are potential patients ourselves and if my nurse considered themself to be too high up the ladder to wipe my bottom id feel inclined to throw my bedpan at them! (but of course i would not!). By providing personal care for someone helps to build a therapeutic relationship. We students cannot be good nurses unless we are able to demonstrate understanding,knowledge and experience in all aspects of care, from personal care to psychological. Wipe a bottom, listen, a few kind words.....just roll your sleeves up and get on with it.

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  • "Too posh to wash" I am a nurse from the old school. Trained many years ago but have kept up to date with nursing procedures as required by PREP and the I still care greatly for my patients. My brother was in hospital with cancer. Most wards he was on were really great, however there was one ward that showed up all the reast. My sister in law went to see him evey 3 days due to the distance from home to the hospital. Each time she visited him she had to wash him, change his soiled clothing and shave him. once he had the same pygamas on from the previous visit and they were sticking to his skin with dried faeces.
    These are BASIC NURSING CARE duties of a Nurse/Student nurse. Another patient had to help him take food and fluids, as the nurses just put in front of him and left it there. The poor guy couldn't use his hands or lift his arms, he had amyloidosis, secondary to his cancer. He did not have a working gag reflex due to the above condition so could not swallow properly. Medication was in tablet form and just left on the bedside table. He was not given a bedside swallowing test as he was not observer by nursing staff, a basic nursing procedure. What amazed me was that for the whole time he was in that ward he was never put into his bed. He slept in a chair the whole time. Another thing that really annoys me is that there were student nurses on placement. With the care standards so poor how were the student nurses going to pass their assessments? Oh yes, I nearly forgot he developed a pressure sore on his sacrum and the nurses never picked it up. How could they, he never had a bath whilst he was there. There were 5 staff on each shift, all huddled around the nursing station computer looking at pictures on face book etc. The moral of my story is to student nurses and it is this: Please if you see a patient in distress you have the right to help that person. Challenge protocol, Challenge mentors, Challenge practice and please please remember the Code of Conduct. That could be you or someone you love. I rest my case.

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  • I have read this thread with interest. I have been in nursing 25 years - 22 of them as as registered nurse. I am now a unit Sister and Clinical Nurse Specialist.
    My feeling is that much of the current debate around 'too posh to wash' is the backlash from making an inherently practical profession too academic. I'm sure there are people out there who would make very good nurses but don't get the chance.
    While I take the point that in some areas being a student CAN feel like being an HCA I'm curious to define why that is a bad thing. In the current day and age of paper mountains the skill of patient communication is being lost.
    HCA's are invaluable in often being the ones closest to the patients, seeing changes on a daily basis, being there to listen to concerns.
    I think its very sad if the students of today(not all I agree) don't see that spending time making a sick person feel clean, warm, nourished and comforted is not valid or a learning tool.
    With all the technical skills and knowledge I have I still get most satisfaction from making the individuals feel better - whether that is giving drugs, adjusting medications - or simply washing their bum - its all the same principle. We are there to care.
    I think too much focus is now on the 'paper filling' - tick the boxes and away we go. Ticking boxes teaches nothing - getting into caring for patients is what teaches nursing. I had an old style training. 6 weeks in school and then on a ward, in the numbers, same shifts as the regular staff. Yes it had its faults but the lessons I learned then still apply. Maybe I was a glorified HCA for a the first 2 years or so - but its not stopped me reaching my goals.
    I have mentored students over the last few years and seen good ones and bad ones - the common thread has always been the aim to complete the paperwork and I think its time that was reviewed - yes have learning aims but take away the 'must be filled in' philosophy and then perhaps students will start to see the value of delivering hands on care.

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  • After 22 years in the nursing profession as an auxilliary nurse and now a nursing sister you come to realise that you can tell a lot about a patients condition by observing and smelling their poo, so get in there, observe, smell, listen to the patient and LEARN!

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  • I am currently writing my assignment for mentoring learners in practice. NMC guidelinEs state that 50% of learning should be in practice. They also state that mentors should facilitate learning and act as ROLE MODELS for students. If we are too posh to wash then perhaps this is why they are too posh too wash?

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  • I think this is a hugely important issue, but its not just an issue for student nurses, in my experience (speaking to friends who are nurses) there are plenty of qualified nurses who see themselves as being above doing basic care, hygiene, feeding, and cleaning.
    This has clearly got worse with the nursing profession becoming more predominantly degree qualified, and many students thinking that with a degree they should not be cleaning up blood or faeces, but the problem predates Nursing 2000.
    Its essential that there is a senior nursing professional on duty in every ward who has responsibility for ensuring that the ward is clean, patients hygiene is looked after, and obviously that the patients medical needs are being met. There needs to be a matron / sister type figure who no junior nurse has the temerity to disappoint.
    It is imperative that hospitals are a safe place for patients to visit, and that nurses see it as their responsibility to make sure that patients do not come down with hospital acquired infections. That means all nurses and HCA need to see themselves as a team, and together ensure that they discharge their duty of care to the patients diligently.
    There needs to be an effective chain of management responsibility at the ward level, and accountability if there are lapses. There should be a whistleblowing route for the ward level staff to appeal to if the staffing level is not sufficient to provide adequate care. It is simply not good enough for hygiene and infection control to be seen as someones elses responsibility, it is everyones responsibility, and issues should be resolved as soon as it is seen, regardless of whether nurse or HCA, and professionals should be aware of and looking out for issues.
    This also applies to ensuring patients are given feeding assistance if required, and looking out for those who may need it. I am aware of an example of a friend that needed to be periodically hospitalised and restrained due to lupus who would have meals left by the bedside, with no means to reach them, and the meals would be collected later with a "not hungry dear?" comment, when there was obviously no ability for the patient to feed themselves without assistance. No assistance was given. Absolutely shocking.
    How is it possible for a caring profession to be so uncaring? To have no thought to the needs of the patient? No wonder so many relatives feel that patients would suffer or even starve if they do not attend to feed their relatives themselves. It is a shameful situation that this could ever happen.

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  • Maybe we should stop using nurses as cheap doctors, and stops using HCA's as cheap nurses.
    We need adequate number of doctors on the wards.
    We need adequate ward level nursing management and responsibility.
    The health care assistant role and title is not helpful, and encourages student nurses to feel that HCA work is not nursing work. HCA's should be a nursing grade, and noone providing patient care should have a job description without the word nurse in it. All nurses should have to start their career doing what an HCA is currently expected to.

    All nurses need to be reminded that by the middle of the nineteenth century, post-operative sepsis infection accounted for the death of almost half of the patients undergoing major surgery. A common report by surgeons was: operation successfully but the patient died. The medical and nursing professions need to relearn the lessons that Joseph Lister taught us re antiseptic technques.
    Basic care, and infection control are primary duties of the nurse, always have been, and always will need to be.
    Antibiotics have made the medical and nursing professions lazy and forget these old lessons.
    The only way we will avoid returning to the problems of the health professional of the nineteenth century is for doctors and nurses to seriously take responsibility for preventing infection at ALL times.
    Doctors and nurses should assume EVERY infection could be life threatening, and not rely on an expectation that antibiotics will solve issues created by poor care.
    It is just not good enough for the medical and nursing professions to wash their hands of the problem after the event and bemoan antibiotic resistance, when washing their hands beforehand could have prevented the infection in the first place!

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  • Im getting very annoyed at all the comments saying how shocked you are that student nurses do not want to participate in basic care.

    That is NOT the case! As a student nurse in their third year who has worked alongside many other students nurses, I know that student nurses have NO problem with participating in basic care, in fact I think alot of us would rather do that than sit in front of some paper and write in care plans.

    The problem is that MOST student nurses are used and abused as 'free' HCA's. Thats not what we are here for. I work my bottom off when im in placement and I WILL refuse to work a full 9 weeks as a HCA, I have many more skills that I need signed off than basic care. If all I did was basic care I wouldnt be alowed to qualify, so ease off the students!

    I have seen more nurses who refuse to wash and leave it to HCA's than nurses who help HCA's out. So please someone write a load of crap about how nurses, new and old, are too posh to wash and leave us students alone who have a much better idea of how wards word since we work on four different wards each year!

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