Chief nurse Katherine Fenton on why education needs to be much more responsive to the changing demographics of the population
I started nursing in 1974, just before nurse training underwent a massive overhaul and the launch of Project 2000. Since then, despite many changes to the education programme, we still say nurses are not fit for purpose when they start on the ward.
We are now aiming for a graduate-entry profession on a par with our medical colleagues. Will that make the final change we need to ensure nurses are competent and fit for purpose at the point of registration in today’s world? Time will tell.
It’s easy to look back and think of the “good old days”. I was “trained” not “educated”; when I completed that training, on many occasions I had already been put in charge of the wards on which I worked. It was the norm.
I still remember my first post as staff nurse in gynaecology - it was only then I felt the weight of my new status. I did feel ready, but I didn’t know what I didn’t know. I was fully prepared in terms of practical skills as these had been drummed into me throughout my training; I knew little of evidence in practice or sociology but had a good grounding in anatomy and physiology. We did not have preceptorship programmes; we learnt how to manage from enrolled nurses. We learnt how to care. The ward sisters proved fierce but excellent role models.
‘Improvement science is essential if we are to continuously improve services and ensure we are being efficient but it does not form part of the education curriculum’
Hospitals were very different. If there was a 90-year-old patient, it was rare. Families lived close by, could visit often and were available to care when patients went home. There were patients who could help with the morning teas and evening Horlicks. The medicine trolley carried antibiotics and analgesics and not much else. Patients stayed on bed rest for weeks after a myocardial infarction; after surgery they stayed for a couple of weeks. There were empty beds.
Today it’s a different world: society has changed and the population is much more mobile; the extended family barely exists; the population is much older; mental health problems are common; and increasing numbers of patients have dementia. With new hips, knees, livers - we can rebuild you. There is little tolerance of ill health and we expect to be made better and quickly. Care and treatment is much more complex. Patients have many co-morbidities and long-term conditions, and everyone knows someone who has cancer. Hospital wards are full and much more care is delivered at home. I could go on.
Nurses have expanded their role and can do almost anything as long as they have the skills and competencies. The pinnacle of a nursing career is the role of consultant nurse and, done well, it is a fabulous one. It provides great benefits for patients yet there is no recognised path for nurses - advanced practice is yet to be properly defined.
Resources are short and we must continuously seek ways to improve quality and reduce costs but, for most nurses, research awareness and use of evidence in practice is not high on their list of competencies. Improvement science is essential if we are to continuously improve services and ensure we are being efficient but it does not form part of the education curriculum.
The education programme is not keeping pace with the demands in the clinical setting, whether that be the community or the hospital. It will have to be much more responsive to the changing demographics of the population and we have to improve on the way in which we integrate services across acute and community care.
Hopefully, the new graduate nurses will be much better prepared - but are we asking for the impossible?
Katherine Fenton is chief nurse, University College London Hospitals