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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)

  • The poor student nurses, perhaps they would prefer to be work in a garage or in engineering if they want to be technical. nursing is about caring for the person. This means taking the nice learning bits with the dull smelly learning bits. Oh yes you can learn a lot from obesrving poo! Perhaps that has not been covered yet in the module!

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  • This is a debate that will continue as long as we have students. As an educator, the students face challenges to integrate classroom learning into the ward and community, as a student I have a list of skills and requirements to develop and not enough time to do it, as a staff member I want to encourage the students but the workload is growing and work time is reducing, as a manager how do I juggle all this and ensure quality care to the patients within the budget. It is the same world wide as we all continue to try to do more with less, and try to keep nursing education on the front foot when others do not see us as the professionals we are with our ever widening range of skills.

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  • Well mummy bear isn't probably going to be the most appreciated description of 'some nurses' but it is far from being entirely inaccurate.
    And i've only been a patient as a child, but it was hardly a forgotten experience.
    My patients can actually (for the most) tell what i am interested in and where my priorities lie, if they don't i tell them. This is because i work in acute care. In acute care, me keeping them alive is at the top. What they wear and whether they shave is not. Whether they are dirty of course does matter.

    The unreliability of the argument that i, or others who think this way would actually avoid or ignore or decline to assist is frivolous at best and unfounded at worst and also quite unsympathetic. Who really finds it enjoyable? Who wouldn't want to not do it if they could? All of us really, but for us, we can't, so we don't.

    I also have to say that even if previous styles of nurse training did not allow for the most effective role in patient's psychological processes, the result today would be much the same. Nurses were and are held in an ever decreasing amount of societal admiration vis-a-vis stereotypes of police, teachers, doctors, MP's, priests.

    And even so, what is the reason to 'make windows into the souls' of our patients? And why would they not want to feel better anyway?

    Is there a genuinely WORKABLE strategy to the idea that if we help the patients to feel better, they will get better?

    Are we to assume that their need for emotional support is of utmost importance or just important?
    Are they going to want a nurse who knows what's physically wrong with them or one who knows what's emotionally wrong with them? (in the context of adult nursing)

    And actually diagnosing stools was not in any of my lectures, nor the physiology of the kidneys, brain, liver, gall bladder, the major arteries and veins of the body. We had no more than a rudimentary approach to pharmacology which at no point covered how any drugs worked, nor was it ever suggested that we learn them ourselves (besides busy with 'so much more thrilling stuff'). Nor did we learn basic concepts like arm-brain time and drug excretion! We didn't learn about various ECG readings or how to doppler pulses or ABG's, INR's, various blood tests and even Basic diagnostic imaging, like perhaps how a drain might be put it, or taken out. Same for CVP lines, same for catheters.

    Yes we had to have witnessed attempts at these things in practice, but minus the theory it is up to the student to make it happen.
    Yes you all might say thats not a problem but what it allows for is a massive variability in the knowledge of qualifying nurses.
    Allowing the focus to drift further and further away from in depth clinical academia means that some nurses won't know basic things about what the role actually entails.
    A situation where new Staff Nurses will act as a effective professional outwardly but they won't know what's actually wrong in any substantial depth, or what common signs mean during certain and different illnesses. They won't know exactly how durgs work, but will be responsible for administering almost all of them and drug reactions will be a fraught, frightening and unforgettable experience as the nurse won't know what the reaction entails and what to do specifically.

    So, are we to be the mere observers and referrers of problems like cannulas and catheters and blood cultures or are we to be autonomous clinical practitioners who can solve nursing issues by clinical definition and rationale?

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  • Call me old fashioned, and one of the luck ones who trained back in the late 80's, but, BRING BACK TRADITIONAL TRAINING - more work on the wards than in a classroom. On a Ward with REAL patients, this is where you learn how to look after patients!

    Is basic nursing care, the first and foremost fundamental in caring for a patient or am I dillusional?

    Do we as Nurses need to
    1. Keep patients clean and comfortable
    2. Maintain a patients Dietary and Fluid Intake to aid recovery
    3. Make beds
    4. Keep patients pain free, comfortable and not make them anxious/afraid
    5. Provide physical and emotional support.
    6. Show a caring attitude

    Do I need to keep going on even though I will probably be called an old fogey, even at the tender age of 38, but I was a traditionally trained nurse, but am now an Advanced Emergency Nurse Practitioner/ Independent Prescriber, so have been to University post traditional training in order to raise the nursing bar.

    Perhaps the students with such dillusional ideas should ditch their nurse training so far and consider a new career perhaps as a doleite, as they appear to be going against the NMC's basic Code of Conduct and have no ideas of what being a nurse is all about. And these types of students are supposed to be going to look after us old fogeys - perhaps migration to another country is coming my way - Scarey, very Scarey!

    Paul.

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  • 'Paul - call me old fashioned'

    Oh dear, I've been hearing that old war-cry about bringing back traditional training since I was a student back in the early 90s. Give us a break. I trained as a degree student and went on to be a good, caring, motivated nurse, as did many of my fellow students. During my experience as a ward nurse I have fouind most of the problems to lie with lack of proper staffing, inappropriate skill mix - not poor training! Obviously there will always be a few who should not be following nursing as a career, but many of those will 'weeded out'
    during training. In fact, my family were caused great distress a couple of years ago when my mother received sub-standard care and bullying from one 'traditionally trained' nurse. A complaint ensued and the problem was addressed. I will continue to be proud of the excellent university nurse education I received. We had to fight harder to prove our worth because of prejudiced opinions and comments we had to deal with from some of our traditionally trained mentors. Everyone of us has something to offer nursing, regardless of where/how we were trained, and nobody should be think that they are superior because they earned their wings the good old-fashioned way.

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  • Michael Sandiford

    Sadly I think this article highlights another example of the minority runing the reputation of everyone else!
    I have encountered student nurses who feel that basic nursing care is very much below their role, and that such tasks should be performed by HCA's. Fortunately this has been a minority of students who think this! Not all students should be tarnished with the same brush! Most are more than willing to get involved with all aspects of patient care!

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  • To the anon above, as a third year student (and previous HCA) I would like to point out that perhaps the situation is being misunderstood... in my experience the majority of students are complaining about 'clearing up poo' NOT because they don't see it as their role but because they would like the opportunity to learn other skills too.

    I know I feel completely unprepared for qualification, perhaps I have been unlucky but it's only in my current management placement that I'm actually being given the opportunity to provide a full range of care, not just the aspects in which I already had experience thanks to my previous role.

    It's a frightening time, particularly in third year and I think students are having to be vocal about needing time for technical skills rather than just being an extra pair of hands 90% of the time.
    I personally was told in second year that I could not change a shift to attend a family event because the ward was short-staffed, and on the day in question I didn't even see my mentor but worked with the HCAs all day - as I did many days. This was not because my mentor didn't care, but because of the immense pressures she and the other qualified staff were consistently working under. It's a sad truth that this is how much of the NHS functions now.

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  • To the anon above, as a third year student (and previous HCA) I would like to point out that perhaps the situation is being misunderstood... in my experience the majority of students are complaining about 'clearing up poo' NOT because they don't see it as their role but because they would like the opportunity to learn other skills too.

    I know I feel completely unprepared for qualification, perhaps I have been unlucky but it's only in my current management placement that I'm actually being given the opportunity to provide a full range of care, not just the aspects in which I already had experience thanks to my previous role.

    It's a frightening time, particularly in third year and I think students are having to be vocal about needing time for technical skills rather than just being an extra pair of hands 90% of the time.
    I personally was told in second year that I could not change a shift to attend a family event because the ward was short-staffed, and on the day in question I didn't even see my mentor but worked with the HCAs all day - as I did many days. This was not because my mentor didn't care, but because of the immense pressures she and the other qualified staff were consistently working under. It's a sad truth that this is how much of the NHS functions now.

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  • I am Anonymous | 6-Nov-2009 12:50 pm.. and I apologise, I missed out a couple of pages so ignore 'to the anon above'

    Oops!

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  • I am a 1st year student nurse I have completed my 1st placement and passed it. When i first started i did not know what was expected of me. I had no previous healthcare experience and trust me when i say it was a massive shock. I was a little apprehensive to clean feaces more than patients because of the smell and i am sure you can all appreciate that.
    When my mentor realised this she spoke to me and pointed out that patient care and bedside manner is the basic and if you cannot appreciate and carry out these tasks I will not let you do anything else. I guess for me it was the shock of it all and the fact that ramadan had started and I was fasting!! I know not good!! but i decided I am going to have to get on with it and it is a part of the job with the support of all the team i became one of them and enjoyed it while it lasted.
    The point is mentors should ask their students if they have had any previous healthcare experience as if they haven't like me they won't have a clue and the image os that student may be put accross as unenthusiastic and uninterested which may not be the case and students for god'ssake get on with it I know there are some good ones out there that do and there are some who see basic care as HCA jobs but its not!! and to all HCA's I have a lot of respect for all of you as I do not know how nurses would cope if you guyz wern't around and i'm sure many people will agree with me!!

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