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Nurse rejections over numeracy and literacy skills highlighted in report


A report analysing the NHS workforce has highlighted how one London trust rejected between 40% and 60% of band 5 nurse applicants because they did not meet the organisation’s standards for numeracy, literacy or compassion.

The report, by the Health Foundation think-tank, said the situation at Central and North West London NHS Foundation Trust was an example of anxieties surrounding the variability of nurse education across the country.

“At some of our most recent assessment centres we have yielded a 75% pass rate, but it is still very variable both within the organisation and across London”

Andy Mattin 

It noted there were questions about whether the oversight provided by the Nursing and Midwifery Council and local education and training boards (LETBs) – made up of representatives from local NHS providers – was sufficient to ensure consistent standards among graduates.

Those behind the report – called Fit for purpose? Workforce policy in the English NHS – said it was unclear whether the London trust’s situation was representative of what was happening at other organisations.

However, it called for “further thought” from nursing schools, the NMC and national workforce planning body Health Education England, which oversees LETBs, about “how best to assure themselves that nursing graduates are consistently meeting the high standards of care expected”.

Central and North West London’s executive director of nursing and quality Andy Mattin said the organisation’s pass rates were improving, but there was still more to be done to increase graduate skill levels.

Central and North West London Foundation Trust

Trust rejects nurses over numeracy and literacy skills

Andy Mattin

He said recent figures showed newly qualified applicants met the required standards in up to 75% of cases.

Mr Mattin noted higher numbers of rejected band 5 applicants in the past were usually down to problems with numeracy and literacy rather than standards for compassion, which are assessed at interview by using a “values based recruitment” approach.

He said: “Overall we have seen generalised improvement in [nurse] assessment centre performance for numeracy and literacy. At some of our most recent assessment centres we have yielded a 75% pass rate, but it is still very variable both within the organisation and across London.”

“We are especially seeing some very strong performance from postgraduate diploma students,” he added.

Mr Mattin said the variation in nurse pass rates seen between different provider organisations in London was being tackled in part by developing a standardised assessment tool as part of a programme called Capital Nurse, which is also looking to introduce guaranteed jobs for graduates in the city.

Recent interim evidence from an NMC-commissioned review of nurse pre-registration standards said they were too complex and result in perceived variation of knowledge and skills among registrants.

The NMC last week agreed to a £2m programme to revise pre-registration education standards for nurses that will take place in 2016-17.

Students are expected to begin the revamped university courses from September 2019.



Readers' comments (20)

  • michael stone

    It is worrying if nurses are not capable of fairly basic maths, and I'm not sure how 'compassion' can easily be assessed.

    I was contacted out-of-the-blue by someone who was really disturbed by how her parent had died in a London hospital - I wrote up my understanding of her complaints/position at:

    But, I was subsequently told in very clear terms, that I had missed a major part of her concerns, so I had to subsequently add a further piece:

    The lady who contacted me previously, has recently been in contact again, and it seems I failed to understand a problem she had with NHS staff from abroad who were working in the hospital. She has a strong issue with nurses (and doctors) processed as acceptable by the NHS, and working with acute and dying cases within days/weeks of having arrived at Gatwick airport, their first time in the country (coming from Africa and Asia) and NOT having ENGLISH as their mother tongue: with insufficient English culture and language to meet patient's needs, and whose English language skills and 'culture' inhibit adequate communication with patients and relatives. I admit that I might have under-weighted that concern, even if I had picked up on it, because even clinicians who have lived in England for their entire lives, are often 'not at all open and honest when patients are dying' (and that IS an issue I bang on about). Her own words are better than mine, so the following are extracted directly from some e-mails she has recently sent to me, and I have excluded most of her 'stronger comments' about 'the NHS' by only selecting these extracts, although her expression of the way her mum's death affected her, makes it very clear how disastrous this type of NHS experience is for the bereaved (and the 'you' who did not understand, is me - these are parts of her e-mails, which it make it very clear that the consequences of the type of behaviour she experienced, are truly damaging for bereaved relatives [something I can understand from my own personal experience]):

    ' It is even more upsetting that you did not fully understand my issue. But the LCP is ended but that is only a name of a morphine practice, used in our case on a person who did not have mental capacity to CONSENT/OBJECT and the name, drug and dose was hidden for 6 months after the death. The issue is sickening me and better, if not accurately interpreted, to leave alone. ... This shocking DIRECT EXPERIENCE will be with me forever. ... Enough is enough! Many have lost their faith in NHS. ... Hope you get somewhere with my precise and correct info. I have personally tailed off as time has gone by but the scar is irreparable and the faith in NHS AND Any proper GOVERNMENT DESTROYED COMPLETELY.'

    I hope I have explained the above adequately.

    This is extracted from one of her e-mails:

    'My issue was not only bad or zero communication from 95% of non British staff and locum doctors, working understaffed behind locked doors, it was mainly the issue that the words LCP or morphine were not used and that what was done was hidden. It took an unusual agonising battle of wit, endurance and tenacity to uncover that a DNR and LCP had been used -and deliberately hidden from us until 6 months after my mothers death during which time the formally absent head of dept had time to alter the medical records to allow their release.'

    And this is extracted from another of her e-mails:

    ''I wonder, under the new light and emphasis of lack of investigating immigration/importing doctors and nurses, unchecked, how indeed my account stands today, especially if the mother tongue or culture is of so little moral value and so opposite from ours here in England.

    How 'exactly' are the rules and laws enforced regarding the ethics that we do/do not enforce?

    I am still not enough Internet savy to but have noted a year somewhat late that no mention was made by you of the LANGUAGE AND CULTURE DEFICIT regarding the central London case my mother suffered. If approx 90% of the staff were imported staff, all recent, within months, who and how, in the NHS system was checking the language and culture lack of communication while the heads of department and CEO were either absent or refusing to respond - for weeks and months?

    That was the 'real' issue that caused the death of my mother and for some peculiar politically correct (PC) reason, it is not allowed to be 'spoken' about openly and transparently. An Asian consultant issued the DNR, a not yet employed Serbian issued the sudden dose and the so-called rare visit nurses had just arrived weeks before from Africa, via Gatwick - all within my mothers' 6 nights and with no clear intention and not one iota of the mention of morphine or Liverpool Carepath Plan.''

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  • I notice a significant difference in my ability to concentrate depending on whether there is natural lighting, or white lighting with minimal natural lighting. This was true also at university: rooms that were re-modelled away from a style similar to classrooms of their day, and moved towards light, shiny desks, with LED lighting, and furnishings that generally gave a shine and a bounce, were quite different and difficult to learn in.

    This is not trivial. The physical environment is quite a different place to work, study, shop, and live in compared to previous decades. I do think there is an impact upon concentration and the ability to process information. We do not yet have enough data - or studies that compare the effects of certain factor - to assess what changes, for the worst, have been made, and how small changes can be made. For myself, if I sat any exam in a white room with uncovered lighting, I would struggle. If I did the same exam in my old school hall (as it was), I should be fine. If you don't have a problem, you would be less sensitive the idea that, even so, some changes might improve your concentration.

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  • I have known nurses whose basic arithmetic was so bad I would have taken my own discharge if they came at me with a pot of meds

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  • If the NMC really want to improve care it needs to demand arithmetic skills of all nurses(revalidation is a diversion from real issues). How do students qualify to apply for posts in the first place if their maths is Is it them sitting exams and presenting work

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  • This is nothing new. As a newly qualified staff nurse many years ago, one of my patients required IV potassium supplement. By the time I had returned from the clinic room with the IV bag, the locum Dr ,who could barely speak English, had given the potassium via bolus injection. Needless to say, the patient went into cardiac arrest from which he did not recover. Nothing happened other than he was not there the next day. We had Nigerian and Malaysian nurses whose spoken English was incomprehensible. Now I work with Filipino nurses who speak in their own language to each other, confuse gender (mixing up he and she) and generally contribute to a culture of poor communication. Say anything and you are considered to be racist. Time to get out of nursing.

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  • I must be missing something as I find Michael Stone's comments neither racist nor offensive. I am not his biggest fan but does he not have the right to comment where he feels appropriate? His comments from the 1st April appear largely based on someone else's emails and experience.

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  • michael stone

    Anonymous2 April, 2016 8:30 am

    I do have a doctorate, although my university department used the D.Phil abbreviation. And I comment as a patient/relative.

    As for this 'racist' thread: I was explaining what somebody who contacted me, was saying - not 'my story' but 'her story'. She was clearly 'very affected and disturbed' by that death, and to be fair her e-mails to me were bordering on incoherent: she wouldn't explain her story by writing it up in her own words, and posting it herself; she wanted me to 'do something to make things better so her [type of] experience was not something other relatives would be damaged by'; and she sent me some very confusing, and at times incoherent, e-mails which I tried to 'dig the meaning out of'.

    There were times, when I though she 'seemed racist' and she was certainly more offensive in some of her e-mails, than I have been willing to post online anywhere. BUT in fact, I think she is really disturbed, distressed and angry - I don't this this 'cultural differences' thing was racism, I think her point was that 'cultural differences can lead to serious misunderstandings, which then leads to awful and unsatisfactory communication between some clinicians and families'.

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  • michael stone

    correction to above:

    I don't believe this this 'cultural differences' thing was racism

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  • michael stone

    The link to the distressed lady's story does work, if you cut and paste it.

    But - and I'm irritated to be accused of racism - the details as I originally posted them, were (the rest of my original post was an analysis of 'the rules for communication'):

    Recently I received an out-of-the-blue e-mail, from someone who believes that 'the NHS set out to kill my loved-one, and to cover it up'. The e-mail started with: 'Is it possible to talk to Mike Stone? emailing and Internet is not appropriate and not manageable for elderly relative of a LCP victim.'

    Her 'elderly, frail and somewhat debilitated, and mentally incapable' parent (my phrase there, not hers) had been admitted to hospital after a choking incident, and within about a week was dead. During that week, the parent was made 'not for resuscitation' (DNACPR) and placed on the Liverpool Care Pathway (LCP - something intended to bring good and compassionate behaviour to the final few days of a patient's life in hospitals, where staff are not end-of-life experts: now being scrapped, following the Neuberger review last year), and also moved to a single room.

    The family - despite repeatedly asking the nurses and doctors - were not told 'what was happening' in any depth at all: the relatives were not told about the DNACPR, or about the LCP, and they were not told what drugs were being given, or why. Etc.

    Basically, the communication between the doctors and nurses and the family, was ABYSMAL - despite the family eventually being present for most of the time.

    Consequently, the family see 'our loved-one was moved to a single room, so that s/he would die out of sight' - it is considered good practice to put dying patients in single rooms if possible, so that the patient and family have got more privacy and peace and quiet. BUT IF YOU ARE NOT TOLD YOUR LOVED ONE IS DYING ... (then how do you know that ?).

    Similarly, nurses and junior doctors, tended to not answer questions, perhaps pointing the family at a more senior doctor - but this senior doctor, usually wasn't available. I know that the NHS regards the discussion of things like DNACPR and LCP as 'sensitive', and tends to try and leave those discussions in the hands of senior staff. BUT IF THOSE SENIOR STAFF ARE NOT AVAILABLE WHEN YOU ASK THE QUESTION ...(then this looks like 'evasion', and that evasion could indicate a 'cover-up').

    I'm sure this happens more than is acknowledged: an elderly, frail and perhaps mentally-incapable patient is admitted to hospital because of a bad infection, a fall, a choking incident, etc, and the family expect that within a week or two their loved-one will be back at home, in much the same situation as before the admission - instead, the patient is dead within a week or two, the family do not understand how their loved one went from 'not exactly very well, but definitely not dying' to dead, and because the hospital staff were not openly and fully talking to the relatives, the relatives perceive 'bad behaviour, non-caring behaviour, cover ups and even murder'.

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  • I can guess from which 'university' many of these nurses qualified! Why any NMC registered nurse should fail numeracy or literacy assessments is totally beyond me!

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