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OPINION

'Education is not keeping pace with demands in clinical areas'

  • 9 Comments

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

  • 9 Comments

Readers' comments (9)

  • No, I think that Nursing education needs to be LESS responsive, and more robust and standardised. The core of it needs to be cleaned out of all the 'responsive' fluff subjects it is filled with in many places at the moment and instead replaced with a solid core of A&P, pathophysiology, regular and repeated clinical skills, etc. Provided that courses set a high standard for entry, then THIS is the way forward. The superfluous subjects which we need less of an academic background in, management, sociology, etc etc, can be added around that. Instead, at the moment (and I remember this from my own training), clinical skills and A&P etc are starting to get pushed aside in the rush to be an all inclusive degree with management, politics, communication, sociology and psychology, etc etc etc, all part of the curriculum. Because yes, society is changing, but the human body hasn't; we still need to cure people's illnesses, care for the dying and sick, treat the injured. No amount of courses in management or human geography or sociology is going to teach us how to do that. I agree that the higher echelons of our profession are a wonderful thing and the way forward, I also agree that they are at the moment disparate and poorly defined, but that will never change unless those who are climbing the ladder do not display the same - if not more - clinical skill as the medical profession they are standing beside.

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  • Nurse training should be fit for purpose, it should be based on sound foundations first of all.

    The fancy stuff can then be built upon this foundation and then extentions to this over the years via both academic and experience. But if you do not get the basics right initially, the rest will fall apart.

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  • Have newly qualified Nurses ever been 'fit for purpose'? Surely becoming an educated Registered Nurse is the first rung on a very long ladder of life time learning and adjustments. However Junior Doctors were not fit for purpose either and relied upon the skills and kindness of Senior Nurses to help and guide them.

    I am afraid I pre date 1974 by some years and also remember post op patients staying in bed for weeks. Very different skills and competencies were required then. However the basic skills and knowledge of A & P, continuously updated over the decades, have stood me in good stead. Inspirational Nurses have also guided me.

    I have in the past been a Manager and I have been a Nurse Tutor but I am at my happiest now working autonomously in General Practice. All of my knowledge, skills and judgement and education are put to the test daily and I love it.

    What saddens me though is that there is no one, other than my patients, to share this with. Whilst the emphasis today is moving more and more care into the community and primary care, we never see student nurses, newly qualified nurses or indeed medical students. It seems such a wasted educational opportunity.

    Therefore I agree, education is not keeping pace, the future is in primary care as well as with Consultant and Specialist Nurses. We give holistic care to the whole family, not just adults. Skills and knowledge of Mental health, learning disabilities, family health and child health and care of the elderly are all as equally important as adult nursing.


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  • I too agree that the curriculam designed, is only partially meeting the clinical expectations. There is a wide gap between theory & practice. Highly educated nurses are interested only in taking up, teaching profession. I think we need to integrate both education and service people. Then the future of nursing will be fruitful.

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  • Whilst the article gives some interesting perspectives it would have have greater impact if it was factually correct. Project 2000 did not begin in the 70's. that was Briggs proposals. Project 2000 did not start to be implented until the early 1990's and began in Wales.

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  • "...but I am at my happiest now working autonomously in General Practice. All of my knowledge, skills and judgement and education are put to the test daily and I love it.

    What saddens me though is that there is no one, other than my patients, to share this with. Whilst the emphasis today is moving more and more care into the community and primary care, we never see student nurses, newly qualified nurses or indeed medical students. It seems such a wasted educational opportunity."

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  • Oops, above... sorry I thought I hadn't logged in, but how I agree with the above statement. The problem is, and I say this time and time again, no one seems yet to have realised that academia in medicine hasn't necessarily produced good doctors. I mean the rhetoric is that they are often poor communicators and unfortunately, in General Practice, often the "boss" over nurses' professional development.

    I started out as a cadet in 1970 and did make the grade to SRN training but ended up compromising with SEN because my now ex husband was stationed in the RAF in a rural area. I enjoyed "bedside" nursing but left nursing because I had (too young for me) no power over my own direction to change anything.

    Years later I returned in 1995 as an SEN with a BSc Hons and another degrees worth of nursing modules that I did in my own time, at my own expense because my employers always saw me as bottom of the barrel because I had left nursing for a while.

    The thing is, I am sick and tired of being expected to work at both ends of the skills timeline. It's not that I mind lower grade work, but I so much enjoy using my initiative, questioning things I find poor practice, but the machinary just keeps making more hoops to jump through to be seen to be doing the right thing when in fact they are not.

    We now have a lot of experienced (and that doesn't always mean in doing things right) nurses with a variable array of expertise forging the boundaries as was wanted in Liberating the Talents, but now many "teachers" want to unify them all into one neat generic package.

    We need a core generic package of practical skills first and foremost, then more of an awarenness that "intelligence" is represented by more than a bunch of A levels and a Degree. There is often "something" lacking and we are going to get them in nursing unfortunately... it is happening now!

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  • I did train in the nineties and P2K was just coming in as I finished my third year. The thing is, and perhaps this was in preparation for P2K we did look at more 'academic' subjects when in college but we also had the good fortune to have lots of hands on ward experience and from day one I knew which wards we were going onto and when for the next three years. It was the 'work' that inspired further study and I went on to do a diploma and then a degree as a result. Student nurses that I talk to do want to have the chance to 'nurse' as well as to study the 'science' behind what they are doing. I thought that what we wanted was a thinking practitioner so that the person who delivers the care understands what they area doing and why. I think that is what patients want and I also think that this is the most efficient and cost effective way of working. What good does it do for someone to complete a task but be unable to explain anything to the patient and so a registered nurse has to take as much time again in explanation when this could have been done with the task. I do not agree with degree only - how many of today's most brilliant nurses would have been rejected if this had always been the case?

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  • We need to take a leaf out of the medics book and train the same way ... lots of A&P, lots of clinical knowledge and the 'touchy feely stuff' just interjected here & there. We do not need multiple hours of college time devoted to bed making and washing/dressing etc - that can be learned on placement.

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