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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 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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