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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)

  • Since when has cleaning a patient and making him or her comfortable, assessing their ability to move, assessing their skin condition and other needs been a job solely of the HCA and not that of a staff nurse? ALL students need to start at the bottom (no pun intended) and build a good base of nursing skills before they can consolidate and move on. After all, no mentor in their right mind would initiate a first year student straight into drug rounds etc. Students need to be prepared to 'muck in' with the rest of us and learn bit by bit starting with the basics.

    I really dispute this student's alleged statement that she couldnt learn anything from cleaning a patient there is so very MUCH to learn as a student, and certainly to provide holistic excellence in care. Students need to be prepared for carrying out basic tasks as qualified nurses, the HCAs are there to provide assistance not be the sole providers of hands on care.

    I also hate the impression given that HCAs perform 'menial tasks'. As a ward manager I value the work that all my HCAs do and encourage them as far as possible to undergo further training to make their roles as rewarding as they wish them to be. HCAs are an invaluable resource to any team and certainly to the patients and any student should be proud to learn from them. And of course, every ward has a ward manager, maybe these students who grumble about cleaning up 'poo' should take their concerns directly to the ward manager. I am sure they would very quickly be put in their place.

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  • I am a third year nursing student. I have found that as I have been given the opportunity to take on more responsibilities (to further my knowledge and skills for when I qualify) I have less time with patients. But this DOES NOT mean I am reluctant to provide basic hands on care, which, if I'm honest, is what a patient appreciates the most. When I am working with my mentors I do manage my time and instead of doing everything my mentor does we will share the responsibilities. For example - my mentor will do the drugs round in the morning herself and I will do the lunch time drugs with her. This gives me the opportunity to spend the quality time with my patient's - which everyone enjoys.

    One thing I will see to student nurses, mentors, or whoever is affected by the this article is that hands on care is still one of the MOST important part of nursing. Not only is it something that is necessary but it also provides an alternative to carrying out other interventions. For example finding out someone's social status, how someone manages in their own home, and finding out facts from a patient that only come once a trusting relationship is formed between the professional and the patient.

    If student nurses are think that there are some things that won't help them learn they shouldn't be doing this type of job. Nothing is below anyone and everything is a learning opportunity in nursing!!

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  • I have been within the nursing profession for the past 20 years as nurse midwife and health visitor. During that time I have seen many changes none more detrimental than the way we train our student nurses, nurses who will "care" for our loved ones. In making nursing more accademic we have lost the art of nursing.

    Basic nursing is the very foundation that stabalises our career one which we have underminded by viewing certain tasks as beneath us.

    Many students today will be shocked to learn that when I started my RGN training CSW or auxillaries as they were called then were minimal with usually only 1 per shift.

    As a student I was expected to do such tasks as make a bed, empty bed pans, mop up blood etc but in doing those tasks I learnt the art of communication, observation the very essence of nursing.

    Student nurses of today may be in a rush to carry out the drug round but if all they do is dish out drugs where is the synthesis of observation and communication to provide an informed knowlegde of that patient in order to safely administer medication.

    There is nothing more satisfying that stepping back from a bed knowing that its occupant is in a clean bed, is themselves clean, comfortable and pain free.

    I would ask student nurses to ask themselves why they were attracted to nursing? If it was to care for people then one wonders why the art of caring is considered to be beneath you?

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  • From a mentors perspective, we have students who come to their area of placement and just want to get through it as easy as possible, they dont want hands on, but want to get their proficiencies signed as quickley as possible.as one male student told me "when i qualify i,m never going to bath or wipe a pts a... ever again". I try to encouarage my students the importence of basic hands on nursing as it is as important to monitor and evaluate the patients condition, such as fluid input/output, bowel movements and skin integrity, this is not rocket science but basic skills that can be a valuable source of information. i work along side my students 100% of their time and what i do they do, there is nothing i would ask a student to do that i would not do myself, i am a hard taskmaster and do not sign proficiencies without them being earned, the evaluations recieved have been one of thank yous for teaching them whilst working along side them as an equal, and explaining the procedures and highlighting how basic hands on nursing can be so informative and important in assessing and evaluating the patient. i incorparate this whilst doing other patient care and then the student realises how relavent this information can be. i would like to think that they take this information with them through out their career, and when they are qualified to remember how important basic care can be.

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  • "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."

    I'd just like to clarify that my suggestion was that nursing mentors go on annual training and not all ward nurses, as this would be unrealistic. I suggest this because as a student I find it frustrating when I arrive at a placement and my mentor cant highlight what learning opportunities are available to me because they dont understand my learning objectives, (part of this blame must go on the universities who while at the same time as advocating the use of jargon-free language in healthcare seem to write our learning objectives in a language that would confuse a babel fish), and because they dont know what i am and am not allowed to do on placement.

    The fact that most mentors seem confused about the students paperwork does mean that some students who are less inclined to roll up their sleeves and wipe a bum, can manipulate a mentor into believing that they are not expected to perform this task past the first year, which as many people here assert, really should not be the case. We students don't always understand what is expected of us either as the university just dumps the paperwork on us and sends us on our merry way, misguidedly assuming that the mentors on placement know what is expected of us.

    I've recently spoken to a mentor who told me that her mentor update training consisted of a 3 hour session where she was asked a single question about what she thought her responsiblities as a mentor were. She, herself, mentioned that the training was woefully inadequate and she learnt nothing from it.

    It is for these reasons that I suggest mentors should go on adequate annual training so that their is no confusion over what students can and cant do and what is expected of them whilst on placement, this should help weed out the work-shy students and support those students who want the best learning experiences from their training so that they can become confident, informed nurses. This is why I believe the issues in nurse training fall mainly down to the lack of communication between the universities and the practice placements.

    I also acknowledge the suggestion that students be more self-directed but this is often more easily said than done, and in my experience is often suggested by mentors that dont have the time to sit down with you and answer your questions(though no inference is meant). It is very difficult to be self-directed when you dont know what your learning opportunities are and in some cases neither does your mentor. Your proactive approach in providing your students with a list of learning opportunities is sadly not taken by all placements, but I for one would strongly advocate for it.

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  • I have left a better paid job financially to train as as nurse. I am loving it.
    While i accept that cleaning poo is not the most pleasant of tasks to do, i still believe it is an essential part of completing the nursing jick pussle.
    What is disheartening as a student nurse, is when the qualified nurse donot see this as part of their job. Once students nurse see qualified nurses happily cleaning bumps and dirtying their hands, we students will be only too happy to do as them. Show us how to clean poo and dirty our hands. Stop being so selective in your roles and help give student nurses a holistic approach towards patient care.

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  • As an old ex-nurse I can only say to the students of today 'get real' nursing to me is all about care, clearing up poo is part of the standard care that should be provided by all levels of nurses. If you dont feel that this is part of your training then, sorry, but you are in the wrong profession.

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  • Although there is a substantial issue with students being treated as ancillary members of staff which has been going on as long as there have been students, there is also the issue of the student and mentor working together to develop their clinical education. Students who feel that their education has been overly focused on one aspect of development should speak to their mentors, not simply fly of the handle in a very unprofessional manner ranting about how sick they are of the too posh to wash debate. I was sickened by the tone and nature of some of the responses, especially in light of how these students were crying out "I am good enough!". It made me cringe to read how unprofessionally some of the comments had been made.

    The basic elements of care is one of the biggest areas of concern for patients; a student may be anxious to learn all the technical and exciting aspects of nursing, but the reality is that if you want your mentor and the other nurses to have time to teach you, you have to help them make sure patients' needs are met. The patients' needs come before yours, and to have an attitude about providing that care will only raise concerns amongst the nursing staff about your suitability for nursing, limiting any other learning opportunities and threatening your successful completion of the placement.

    If you want to expand your learning opportunities, then bring a plan into your placement with some ideas about how to expand your understanding and learning, have a basic understanding of that clinical area and what it can provide, work on developing a god relationship with your mentor, and work within the workload of the ward, but additionally you need to accept the limitations of learning in an area where peoples' lives and care, not your education, is the priority.

    Maybe you don't need to wash another patient because you know how, but maybe you are being asked to wash because the nurse is seeing if you will assess their skin, their movement, their ability to help you care for them; maybe the nurse is looking to see if you will critique the care plan, guide HCAs to improve their care... or maybe, just maybe, that patient needs you and the nurse has asked a student to care for the patient because that patient needs the extra time and TLC a student can give. If you can't see that there is more to washing a patient than slopping on soap and rinsing it off, then the mentor is right to have you keep doing it until you do catch on to the bigger picture- because its in that realisation that you find nursing.

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  • its about time nurse educators look at the style of training.
    How can a "nurse" look after her patient properly if she refuses or can't do the fundamentals of total patient care. total patient care does not revolve around technical machinary or drug rounds these are just parts of the care. If a nurse wants to do the more technical stuff then may be they should re-consider there career and become a medical rep or pharmacist.
    Most of what is learnt about a patient is when you are washing, dressing and tending to their ADLs this is the big problem with to days nurses they don't spend enough time doing these things.

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  • This article is unfair for most student nurses and it fails to show the whole picture. It distorted what students try to say. Indeed it’s very important to perform basic tasks such as washing (which is not always basic). There are a lot of things you can learn during a wash- patients’ personality, their views, you can observe skin integrity and so on. But being a third year student nurse I’m frustrated to think that this is the most wards can offer me to learn for 3 yrs. I’ve seen nurses getting on with tasks and then saying ‘’why I’m a doing this when we have a student? Could you go and clean bed X, get the commode for bed Y, make the beds in bay Z’’. I stress time and time again that these tasks are very important for the patients’ well being and I’m willing to help- but not when it’s out of laziness. After all it’s like saying that students need to have these skill but once you qualify you’ll delegate it to someone else. The presence of a HCA or a student does not dismiss the nurse from helping patients’ with their ADL’s. If my knowledge of medication is very basic I’d like to think that during placement is a great opportunity to learn. I’m not qualifying as a HCA so why as a student should I only be limited to learn skills from HCA. But then if we say that we already know how to wash and we’d like to ‘learn’ something new- we are said to be ‘rejecting essential elements of bedside care’.

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