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It is the education system that leads students to reject basic care

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A research article and news story about student nurses and bedside care produced a phenomenal response on Here study authors Helen Allan and Pam Smith speak out   


Our study published in Nursing Times (Allan and Smith, 2009) was accompanied by an online news story with the headline: ‘Clearing up poo will not help me learn’ – student nurses reject basic care (see Indeed our research demonstrates how the demands of learning to be a nurse in today’s climate of rapid patient throughput can produce such a reaction in students. It also illustrates the dilemma faced in providing vital bedside care to patients while remaining at the heart of nursing.   

The response to our research, which resulted in well over 100 comments from readers, demonstrates just how acutely and passionately that dilemma is felt.

Our study was undertaken as a response to the “too posh to wash” debate following the changes in nurse education that removed student nurses from the formal workforce, replacing them with HCAs. We also wanted tofind out who provided the leadership for care in a changing NHS.

Our fieldwork took place in acute wards, where registered nurses told us they faced increased pressures to meet NHS targets. Although they maintained that bedside nursing is still central to what they do, we found the pressure from targets led to “routinisation” of work and a hierarchy of tasks. Bedside personal care primarily performed by HCAs has been divided from the technical work performed by qualified nurses who administer drugs, dressings and undertake organisational work. This routinisation is not new; it existed in the 1980s when the “new nursing” challenged routinisation and hierarchy and sought to personalise care.

Given current pressures, qualified nurses are unable to deliver bedside care. This situation reinforces the perception that technical care is valued over and above bedside care as a source of learning for students’ future roles, leaving them feeling unprepared to be registered nurses.

We wish to put the record straight that our research neither attacks students nor devalues care but analyses a system that does

Our research showed that students conceptualise nursing differently to qualified staff because of an intensified division of labour between registered and non-registered nursing staff. Consequently, students often observe HCAs performing bedside care and registered nurses undertaking technical tasks. The absence of clear role models leads students to sometimes question bedside care as part of their learning and to put greater value on learning technical skills.   

Our research does not suggest that students are the problem. Rather it analyses the system that puts them in difficult positions. We make very clear that this system, rather than students, is at the heart of the problem - both in its failure to link education with practice and its placing of technical nursing over personal care in the hierarchy.

Many respondents agreed with our findings that qualified nurses do not always know what to do with students in placements. Furthermore, mentors are expected to organise patient care at the same time as supervising students and they receive neither recognition nor rewards for their efforts.

We wish to put the record straight that our research neither attacks students nor devalues care but analyses a system that does. Indeed, we have published together and separatelyon the importance of care in healthcare systems and the difficulty of caring well. Our full report of the study requested by several respondents is available here

HELEN ALLAN is senior research fellow and director; PAM SMITH is General Nursing Council professor of nurse education; both at Centre for Research in Nursing and Midwifery Education, University of Surrey.



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