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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)

  • When will this debate end? I have no problems doing personal care and was infact an NA to begin with... Now as a student nurse I'm frustrated that people feel the vast majority of students are trying to 'get out' of cleaning poo for some reason.... The issue is: alot of people are getting through the entire 3 years with no clinical skills but dont worry they can give a mean bed bath! So do we stick up for ourselves and demand more time doing things that we will be expected to know when starting as Nq'S or do we just not say anything and end up unable to do anything a Registered Nurse should be able to do at the end of 3 years... I think its a fine balance really! I just hope at some point we find the balance....

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  • I'm a third year mental health student and although I don't agree with the student in question in the article, I can't help but empathise.
    My last placement was 3 months in a home for the elderly, although there was a mental health wing with functional residents we (myself and the other student in my class) were actively encouraged to spend as little time there as possible. We couldn't help but question why, since we are specialising in mental health. After a few weeks it became apparent that the staff were more happy to use us as HCAs and in with the number as apposed to letting us complete our learning outcomes. When a first year student joined us we would often hear "there's enough of them now we can just take the morning off!" and we would find ourselves busy until after lunch, getting people up and dressed and feeding.
    Don't get me wrong, these skills are very very important and we would do them every day without question because we knew it was benefitting our learning, but when you only have 3 or 4 learning outcomes that are related to physical care but 6 that are related to medication it's hard to just continue quietly while the med trolley passes you shift after shift and you don't get to take part.
    Say this year, I have around 60 learning outcomes to accomplish over my two placements and not one of them is about physical care. It's hard to spend so much time doing the fundemental nursing tasks when you know that the NMC add just as many, if not more, outcomes regarding other things such as communication and health promotion. Although, as people have said, you can do these while doing the basic nursing tasks, how many mentors will watch you do that? Some mentors may be willing to sign students off when they haven't been seen doing the task. But not all of them.
    My mentor can't believe the amount of work we have to do now, when she qualified she said she had 4 learning outcomes during her placement and the book was about A5 sized, it's now A4 and weighs a ton. Student nurses are under a lot of pressure, and (I'm not saying it was the case this time but) maybe they do say things they don't mean sometimes. In this profession, doesn't everyone?

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  • Good grief I wouldn't want some of these nurses caring for me. Having been a patient in acute care, worrying about if I would be assisted to the toilet was damn important and all consuming. I feel it did have an impact on my general health & recovery. Being wet and left waiting for someone to come to help is humiliating and having a nurse who is blase at best or showing her/his disgust at worst, componds the feeling. Now working in acute care I've assessed people who are extremely ill with wires coming out of everywhere but their main concern is "having an accident" in the bed.

    Here's a concept; how about providing an in depth continence assessment as to why the patient is urinally or faecally incontinent and finding the cause and then providing treatment. That is not basic, requres logical thinking and problem solving and in some instances can save lives if a malignancy is found. For many elderly people they arrive in hospital because they have collapsed or fallen and for some it is because of a UTI which is treated & they are sent on their way & for others it is rushing to get to the toilet.

    So the argument was not wanting to clean up poo; well giving the patient some dignity alongside having the specialist knowledge & skills to investigate the cause of anyone's bladder or bowel dysfunction may not be sexy to the qualified nurse but it is important.

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  • I think you're right anon above. its been functioning that way for years. when i qualified i came out feeling completely unprepared as did all my student colleagues, and in a lot of ways we were, and should have been supervised a lot more than we were. however no-one should be expecting you to know or be skilled any more at qualification other than the basics. your learning curve will be huge in the first year, you'll probably discover you're better and more able than you worry you're not. always be prepared to say if you don't feel competent or someone's asking something unreasonable of you. be stubborn. my mentor said to keep pecking at people until you get what you need, i found it priceless advice.

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  • A lot of great comments here that really show the variation of experiences and placements. These posts are a microcosm of the fundamental flaws in nurse training.

    Yes, we could say that sutdents in the first year ought to get to grips with just basic nursing care. On the other hand, other posters pointed out the many sutdents are or have been NA's before, negating not the theory but a great deal of the final objective, which is to gain experience in nurse training.

    The essence of the argument is really hidden in the quagmire of problems facing our profession today.

    What students are actually trying to say is that they have heard plenty about direct nursing care and would like to know more about the things that are out of their reach as students!

    We are relying on the entirely random experiences of practice placements to instill clinical knowledge yet the in-depth theory not provided beforehand.

    Students willl spend only 50% of the time focusing on actual clinical subjects and ACTUAL anatomical and physiological knowledge remains almost entirely untested.

    Ironically the entire culture of nursing would be totally different if in any part of this country, student nurses arrived with the ability to describe say... every organ in the digestive system from mouth to bum. test them!

    I am not saying that nursing students are not clever at all (construe away!) What i am venturing is that on the whole, if you asked newly qualified nurses if they would swap their experiences for something more indepth but harder they would say yes.

    I think that if we swapped what we have now for something more aligned to the current professions we would benefit in the future. We could hide it if you want, but i don't where else to go in a climate ehere new nurses are being forced to do more with less.

    The amount of pressure you are under when the total amount of experience between the three trained of you is five years on a friday late with patients stroking out and having their irrigation disonnect and being inundated with medical patients because they don't have any beds because you managed to get nine patients out that day but four in post-op.

    You can't put in cannulas to reconnect IV's or give boluses even if you are lucky enough like me to do your Single Drugs and IV's within six months (thanks budget cuts!!)

    You can't catheterize men because somehow that knowledge is beyond your competence.

    You can't dispsense drugs and because no automatic probationary period beigns for you, the clinical right to some sort of co-agreed automony and genuine professional supervision is lost immediately.

    You can't TTO's out for the above reasons at my trust.

    You have to wait an ungodly three months to go on a two day course that of course has nothing to do with drugs at all.
    In fact it is an almost identical repetition of university lectures, just related to your trust, so they might vary 'slightly' but that's it.

    My IV course was actually 1/3 from some chemotherapy specialist who talked about chemotherapy. Which was great, but she told us we could never disconnect IV lines, not even so patients could changed their gowns. We should stop the syringe driver, or IV, or epidural etc, then at the end the woman running the thing told us more or less to ignore what we said and agreed with things we said we did already or mentionned better ways of doing things we already did, so waste of time really.

    We had to bring an ampoule from our ward plus a 10 ml syringe and 10mls of H20 for injection and a green needle. The funny thing is i'm laughing as i'm typing this so much becuase all we had to do was draw up into the syringe.

    That was it!!
    I could not believe that was it. THen we watched her set up an IV pump and to be honest i don't think you can claim that seeing an IV being pointed at and talked about from the back of a classroom of twenty is better than on the ward over 4-12 weeks.

    We can't take blood and it dosen't matter anyway beacuse we wouldn't know where to look automatically, not even the four or five best sites are included as practical knowledge.


    Why are we focusing on this kind of thing when it results in the loss of other funadamental and equally important knowledge.
    How can we pretend that students experiences and opinions are redundant in the face of our own experiences of making a success out of the training we received.

    Just because we can make it work doesn't make it the right way to go about it.
    Obviously the slant we are taking on nursing has caused widespread concerns from students and practitioners, but why not give the students a chance to explain their concerns, rather than seeing them as gripes or simply whining.

    Everybody complains where i work. And it has been the same at the four or five trusts my training and NA days taught me.
    So why are we treating their moans as toxic to out practice when they are sharing the experience with us?

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  • I am currently a 2nd year student nurse. Some placements do expect you to be an Hca. One placement I was on an Hca told me to but in a good word about the ward to the university as they needed more students to be the "Hca's unpaid scivvies" I could not believe my ears. On the same ward I was doing a morning shift I was leaving at 11am and was told that an Hca was being moved to another ward because they had a student nurse that could be an Hca for the whole shift, I explained I was only there until 11am I was told I should make sure all the washes where done before I left, it was my last day on the ward not a happy ending.
    I have been sworn at by one mentor telling me I was a bloody student and was going to make a rubbish nurse, but she would pass that placement. She made me feel bad and I lost some confidence on that placement.
    I am now on my last placement of my 2nd placement my mentor is lovely, the other staff are willing to teach me and I have missed being there while back at uni for 2 weeks, as I have learnt so much from them, I have got my confidence back. On the same ward there is a 1st year student who could not do vital sign obs or urine alsysis, as his first placement all he did was wash and dress patients, I had to teach him both.
    I was an Hca before deciding to become a nurse and still do hca bank work and love it.

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  • A lot of great comments here that really show the variation of experiences and placements. These posts are a microcosm of the fundamental flaws in nurse training.

    Yes, we could say that sutdents in the first year ought to get to grips with just basic nursing care. On the other hand, other posters pointed out the many sutdents are or have been NA's before, negating not the theory but a great deal of the final objective, which is to gain experience in nurse training.

    The essence of the argument is really hidden in the quagmire of problems facing our profession today.

    What students are actually trying to say is that they have heard plenty about direct nursing care and would like to know more about the things that are out of their reach as students!

    We are relying on the entirely random experiences of practice placements to instill clinical knowledge yet the in-depth theory not provided beforehand.

    Students willl spend only 50% of the time focusing on actual clinical subjects and ACTUAL anatomical and physiological knowledge remains almost entirely untested.

    Ironically the entire culture of nursing would be totally different if in any part of this country, student nurses arrived with the ability to describe say... every organ in the digestive system from mouth to bum. test them!

    I am not saying that nursing students are not clever at all (construe away!) What i am venturing is that on the whole, if you asked newly qualified nurses if they would swap their experiences for something more indepth but harder they would say yes.

    I think that if we swapped what we have now for something more aligned to the current professions we would benefit in the future. We could hide it if you want, but i don't where else to go in a climate ehere new nurses are being forced to do more with less.

    The amount of pressure you are under when the total amount of experience between the three trained of you is five years on a friday late with patients stroking out and having their irrigation disonnect and being inundated with medical patients because they don't have any beds because you managed to get nine patients out that day but four in post-op.

    You can't put in cannulas to reconnect IV's or give boluses even if you are lucky enough like me to do your Single Drugs and IV's within six months (thanks budget cuts!!)

    You can't catheterize men because somehow that knowledge is beyond your competence.

    You can't dispsense drugs and because no automatic probationary period beigns for you, the clinical right to some sort of co-agreed automony and genuine professional supervision is lost immediately.

    You can't TTO's out for the above reasons at my trust.

    You have to wait an ungodly three months to go on a two day course that of course has nothing to do with drugs at all.
    In fact it is an almost identical repetition of university lectures, just related to your trust, so they might vary 'slightly' but that's it.

    My IV course was actually 1/3 from some chemotherapy specialist who talked about chemotherapy. Which was great, but she told us we could never disconnect IV lines, not even so patients could changed their gowns. We should stop the syringe driver, or IV, or epidural etc, then at the end the woman running the thing told us more or less to ignore what we said and agreed with things we said we did already or mentionned better ways of doing things we already did, so waste of time really.

    We had to bring an ampoule from our ward plus a 10 ml syringe and 10mls of H20 for injection and a green needle. The funny thing is i'm laughing as i'm typing this so much becuase all we had to do was draw up into the syringe.

    That was it!!
    I could not believe that was it. THen we watched her set up an IV pump and to be honest i don't think you can claim that seeing an IV being pointed at and talked about from the back of a classroom of twenty is better than on the ward over 4-12 weeks.

    We can't take blood and it dosen't matter anyway beacuse we wouldn't know where to look automatically, not even the four or five best sites are included as practical knowledge.


    Why are we focusing on this kind of thing when it results in the loss of other funadamental and equally important knowledge.
    How can we pretend that students experiences and opinions are redundant in the face of our own experiences of making a success out of the training we received.

    Just because we can make it work doesn't make it the right way to go about it.
    Obviously the slant we are taking on nursing has caused widespread concerns from students and practitioners, but why not give the students a chance to explain their concerns, rather than seeing them as gripes or simply whining.

    Everybody complains where i work. And it has been the same at the four or five trusts my training and NA days taught me.
    So why are we treating their moans as toxic to out practice when they are sharing the experience with us?

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  • I have just started my very first placement, I was so excited and could not wait to get on the ward and see how everything was done. Well I have been sadly disappointed; my mentor had no enthusiasm, she was negative about many aspects of the ward and said she never even wanted to work on the ward that she is on. I was so upset by this and felt my bubble had been burst.

    I also have alot of years experience as a carer and support worker, and feel I am definately a caring and professional individual. I have noticed many things on the ward that are clearly unacceptable. I'm praying that my next placement will be more positive one.

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  • As a qualified nurse of one year, I remember my training very clearly, prior to this I was a HCA. For those Students who think they are "too posh to wash" you have a lot in life to learn. Most importantly - nursing is about caring for those who cannot carry out activities of daily living for what ever reason, but remember one thing each and every client you care for is someone's mother, father, child, brother, sister or even grandparent. How would you feel a member of your family was hospitalised and were looked after by a "too posh to wash" student nurse. I learnt a great deal by means of basic nursing care - spotting the early warning signs springs to mind. Prevention is better than cure and the satisfaction I gained by providing this care. You will find that you are able to spot immediately a client's deterioration whether it is a pressure sore, mouth ulcer, constipation. In respect of cleaning commodes, if you clean them then you are preventing the cross contamination of MRSA, C-Diff and other infections - of which can be documented in your CAP Document. Just think - eliminating Hospital Accquired Infecton, wouldn't that be great to document! During quiet times I would clean all the commodes and bowls at least once a day and I don't mean a quick wipe over either - it was always using the correct substance. In respect of commodes I used to wipe before every use and clean after use aswell as providing the client to facility to wash their hands afterwards -this way I believed I was doing my duty to prevent as far as proacticable cross-contamination.
    Infact the basic things means a lot in the long run. To be honest I would rather carry out these tasks than delegate this to a student nurse because then I will know how intact my client's skin is and how he/she is feeling, I will then be able to ascertain throughout my shift whether my client(s) are getting better or worse. Good luck to all you fellow students - but remember nursing is not just about drugs, IV's and management it is about the well-being of your client(s) knowing you have given each and everyone 100 per cent care.

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  • at placement yesterday i brought up this debate. The staff nurse i was working with pointed out to me that the way in which nurse education was going, lent itself to attracting managers not nurses, which i feel is the crux of the 'too posh to wash' debate.

    to all the 'mummy bears' hey i love you, with out your guidance i would never have been the HCA i became. thank you.

    to jjjhaz, i agree with you in parts, you sound as if 'the fear' has you in its grasp, by this i mean the realisation that your training was pants, and now you have all this responcibility on your shoulders and not the knowledge to be able to fully help your patients.... spare a thought for the F1 you work with, what ever stress you have is 20x worse for them.

    i worked for 2 and a half years in a busy MAU, so i understand the value of knowing about blood tests and ECGs etc. BUT YOURE A NURSE not a doctor, its valuable information to know, but you arent priscribing treatment, you are delivering it. why not try to channel your obvious passion for the job in to advocating for your patient instead of worrying about what you dont know yet. That knowledge will come, it did for me. Im sorry if that seems like a personal attack it isnt im sure you are a brilliant nurse.

    Interestingly i find myself at the end of my first year training expecting to fail because i cant write an essay for love nor money. ironically i've passed all my skills tests and am on course to pass my placements. so even if im NOT too posh to wash, ill probably be on the check out at tesco's next year with all the other losers! god bless modern nurse training eh!?

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