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


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


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

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Readers' comments (158)

  • student nurses please remember-the patient is the reason you are there doing what you do.
    I am a staff nurse who prefers to be hands on when I am allowed the time to do so.
    All the so -called menial tasks help us to develop an understanding and trusting relationship with our patients.
    Giving care to a patient ,whatever that care may be is a priveledge to the nurse and the time spent with your patient should be cherished and use it as part of your knowledge and experience base.
    Degree or no degree not all nurses will be able to achieve higher manager status ,it's a mistake to think that post -qualification all that is required of you is to dole out medication and give orders to what you see as the less skilled members of the team.
    You have many skills to aquire and improve on and they won't all be glamorous.

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  • as a second year nursing student I am utterly shocked that other nursing are not willing to carry out basic nursing care. As I see it basic nursing care is a fundemental part of being a nurse, it's gives you oppotunity to get to know your patients and assest their needs. I have been on placements when qualified nurses have told me that it's the HCA's job to wash patients, not nurses. I totally disagree!! Washing patients is an important part of nursing to me. I feel that if you're 'too posh to wash' then you are in the wrong job.

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  • I have mentored student nurses over the yeas and never once had one who refused or backed off from carryling out personal care, including cleaning up faeces (sorry but my toddlers used to say 'poo'!) I found them eager to learn and help in all ways so that they could get the best from their placements. What does concern me me is the constant carping and moaning from people ready to find fault with students. I still think there is a lot of envy towards them from people who were traditionally trained and think the 'good old-fashioned way' is best. I think it's a great step forward to be able to enhance our knowledge by studying at degree level. The clinical experience will still be available and will be meaningful to students with good mentoring from positive role models. As a degree student myself back in the 90s, I can remember being told that we wouldn't want to get our hands dirty. I thought it was insulting then and I do now. I think our students deserve more support and less criticism.

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  • Hi 4:25 Anon, I just wish there were more mentors like us. I have had the same memories and reflections regarding students who always roll their sleeves up and get stuck in. On a ward where there are often 12 older patients with varying mental health problems and most with poor memory: nurses must work together to get the tasks done. Most mental health for the older person wards are very much hands on. Many times I have gone on duty for a 12 hour shift and there have only been 3 members of staff rostered on duty, 2 qualified nurses , 1 health care assistant and a student who is not counted in the numbers. I normally take the student and they work closely with me. We talk with our patients as we assist them to wash dress and have their nourishment. We can then reflect on what went on prior, during and after the event we carried out. We can also discuss side-effects of medication and medications used in the care of the older person. This give the student the chance to question the reasons for proceding in a particular way. We use the Bondy method of student learning and I feel that the method gives the student an amount of autonomy. In so doing gives them pride in their work. So whoever started this submission look closely at the way you teach your student, as there are ways to make a student change the way they think and it is up to you to make sure that you don't give the wrong impression and sit back on your rear end and let the trusty caring health care worker do all the hard work.

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  • I remember my time as a student which was only 1998-2001. I was a mature entrant at 38yrs of age to nursing with no previous experience in nursing after having my family but had decided to pursue a dream I had from teens to become a nurse.

    Throughout my placements I remember being used as an extra pair of hands on the wards, essentially I enjoyed the whole hands on approach from simply holding a fightened patients hand, nursing dying patients to 'cleaning up poo/vomit etc'.
    My only regret from being a student was that I did not stand up for myself early on in the placements so felt woefully lacking in meeting the objectives I had been set for my course.
    My very first placement was on a general medical ward and my 'mentor' put me to work with 2 HCAs who she said would report back to her on my progress and she could sign my competancies. Working with HCAs gave me a good grounding in basic care however as she was busy with her own objective she was not often around and hardly worked with me at all throughout placement putting me so to speak with HCAs to gain hands on knowledge, the problem came 2 weeks before end of the 6 week placement when I asked her to sign off some of my competancies and she refused stating she had not worked with me, this left me annoyed and feeling quite distressed and I pointed out that she had put me to work with HCAs, after returning to university and discussing with my tutor what I should do next I had to return to the placement and ask another nurse to mentor me for my remaining 2 weeks in order to meet the objectives set acheive my competancies.
    I found my 1st experience all quite stressful so I was determined not to be so reserved on my following placements and although still felt 'used as an extra' to some degree for much of my 3 years in training I did not suffer a repeat of that experience but still by the end of my course I felt unsure and ill prepared to enter the real world as a fully qualified nurse so when job hunting I joined another trust on a rotational programme spending a 6 month placement in each of 4 main clinical areas -medicine, surgery, critical care and clinical investigtions in order to have the opportunity to build up the skills I felt I had been denied during training because I was not pushy enough, I was very lucky to have very supportive mentors in that inital baptism into nursing.

    Based on my early experience I feel its essential that students go into placements prepared with an action plan and I am supportive of students taking the lead and setting out learning objectives both basic and technical and agreeing review dates at the initial meeting with mentor, that way it becomes apparent from the outset that you are prepared to 'muck in' but not prepared to be mucked about.

    I am in my 9th year since qualifying and now have a range of skills which I have built in that time I work as part of a team of assessment in a clinic now and manage my own caseload on a daily basis.
    The nature of the work can mean it can be quite a pressurised envionment at times, however by reducing my hours to 32hrs/week over 4 days which helps with family committments of which there are unsociable hours (but on the downside no enhancements either) so I only earn a basic band 5 salary, but that was the choice I made to gain a reasonable work/life balance
    I am currently on my 2nd attempt to complete a clinical skills course (my 1st attempt 3yrs ago was not completed due to staffing problems) to enhance my practice further and from there who knows what opportunities will follow.

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  • We in Australia (Vic) also warned about being used as opposed to being taught and being able to practise in a clinical setting. We were advised to take part in all aspects of nursing including personal care but to ensure our learning objectives were met. For those students who think there is no skill in wiping the bottom of a possibly large immovable patient cleanly, quickly, efficiently and gently, you should probably take yourself elsewhere like maybe medicine at uni, or better still become a mother and wipe some other bottoms. Then you will learn. Wiping bottoms is probably the most fundamental thing a nurse COULD do.

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  • Whilst the nursing profession continues not to cherish and uphold the key principles of nursing care where fundamental care teach nurses to learn about the person, this debate will continue.

    Whilst the nursing profession in the UK continues to avoid the education to registration of a generalist nurse first (such as the previous SRN, RGN (bearing in mind that the UK is probably the only country in the world left that does not have a generalist nurse) this debate will continue.

    Whilst we have an ineffective regulatory body that continues to misinform and lead poorly and not lead in its defence of compassionate and highly principled nursing care this debate will continue. Not so long ago the NMC crumbled to the outcry on its decision to strike Margaret Heywood off the register. It was an ill informed and lamentable decision to stike her off rather than discipline her (as she had breached her code of conduct - but for the right reasons) and it was the general public that recognised her value by voting her patient champion of the year.

    Whilst we have a professional association which has debated and messed about with its remit for the "Art and Science of Nursing" and driven hard on its agenda for its union responsibilities the debate will continue. When will the RCN recognise that defending bullying nurses and 'doing deals' on nurse/patient ratios with senior nurses who are also members of the RCN is a serious conflict of interest. The RCN is there to uphold the profession of nursing - for its scientific approach and for its values in providing compassionate care.

    Whilst nurses still aspire to do what doctors do - the debate will continue. So nurses label themselves within the medical model of health by using diseases to label themselves - the Diabetic Nurse, the Parkinson's disease nurse, the enteral feed nurse, the transfusion nurse and many many more. Or they label themselves as a treament nurse - such as an Endoscopy Nurse!

    Let's have a debate about this rather than blame all student nurses for the 'too posh to wash' syndrome. There are some wonderful caring students (and other registered nurses) and healthcare assistants out there who despair of the state that the nursing profession has got itself into over the past 20 years.

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  • Communication!!!!!! Come on students, this is the key to nursing care. Im a student nurse and im proud of doing hands on...........Why?...........Basic care nursing is the key to communication, to get to know that patient, likes + dislikes, the patients background, get to know family, the illness etc. This is the time to get all your information about the patient (and trust) so you can write it in the care notes.DFont tell me that you posh student are writting in the patients notes when you havent even done hands-on with the patient???? Sorry I think that you shouldnt be in nursing care then. This job isnt for you!

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  • Well clearly alot of people who are posting haven't read the whole thing and are just doing the whole 'breathily aghast act'.

    Such hypocrisy from these nurses.

    I've yet to meet a nurse of any age who leads with basic care as a fundamental in practice. Their theories might include it but i've yet to meet any nurse at any point who did more basic care than 'the important actual things'.

    So whilst you can whine on about how vital basic care is, nobody cares because you yourselves aren't doint it. And for god's sake why not? We've got NA's! Why should i have to drop what i'm doing every SINGLE time?

    Where's the reality in what you're saying?

    Have any of you ever had a stand up row with a student refusing to wipe a bum? Or is it really they were actually doing something genuine and you took them away from it as you saw that activity as ultimately expendable?

    Let's face it:- Students aren't wanted as effectively they are a ball and chain if you or they aren't any good. Plus, there's no renumeration of this free labour so where's the motivation.

    You have to be prepared to strike a balance for them. Yes doing basic care is important but the hospital already employs people to do the very same job. What they actually don't provide plenty of is trained nurses and this is the gap students should occupy, not the shortage of people able to do basic care.

    If basic care isn't well thought if it shouldn't be the students who are immediately pilloried if they suggest that experiencing your job is more important than the job of the NA.

    Students should be supervising and delgating to students by the late second or third year with the RN sitting on top. That is the ideal model.

    Let's get real and understand that most mentors have no formula or objective plan. It's based on face valur relationships and how the mentor judges the student.

    There's almost nothing exempliary about the paperwork that suggests the course could be at degree level due to it's vague, overwordy and empty action plans and competencies which never relate to anything truly clinically based!

    At the end of the day if students frighten you with their displeasure for the dirty work then that actually doesn't make them a bad person and won't make them abandon people either, so why get personal and try to counterclaim that personalities and not practical remedies are the answer?

    It also means that you shouldn't be their mentor and you might as well throw in the towel then and there. You are only a hindrance to modern students especially the confident, learned ones who want to push forward than remain in the current quagmire.

    My students do half my job and i expect them to impress me but not out-do me and they do. They make decisions that i agree or veto, i give them freedom to see and learn things but also times when we work together.
    I expect them to be present at every drug round, they give all the subcuts, they have to do all their own dressings and paperwork, take at least half of their own phone calls, they have to be present if a doctor wants to talk about one of their patients, they have to hand them over, if they're third year they have to do all their own IV prep before i give them with them.
    Most of you aren't offering the total immersion experience, that's a big part of the problem.
    So you see, it's what you can offer.

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  • I think that this article is an unfair example of a student nurse.I am a second year student aged 20 and I admit i do go out and get drunk,but learning is my priority.
    I enjoy providing personal care for individuals whether i am on duty as a student on a NA,but when on duty as a student I always remember that personal care is one skill area and that I other skills i need to be competant at by the end of the year.I learn a lot from assisting individuals with intermate activitys and is it is often the way i bild a rapport with them.I do think everyone needs to remember that there are the other clincal skill that we need to be competant at as weel.

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