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New recruits lack basic skills says trust nursing director

  • 28 Comments

The nursing director of one of the largest trusts in England has called into question education standards around basic nursing care.

Heart of England Foundation Trust director of nursing Mandie Sunderland particularly questioned the ability of newly qualified nurses to produce and understand care plans.

Speaking at the Nursing Times Delivering High Quality Nursing Care conference this month, she told delegates that new nurses were often not familiar with the “fundamental issues of care”.

“We’ve got a real problem as a profession. We’ve got a whole generation of nursing that doesn’t understand care planning,” she said during a presentation on assuring the quality of nursing care.

“We need to look at whether we’ve got the [pre-registration training] model wrong,” she added.

Ms Sunderland highlighted the example of newly qualifieds failing to understand the care pathway for pressure ulcers and, as a result, not calling for the tissue viability team when appropriate.

In order to address the problem, she called on delegates to respond to the NMC consultation on pre-registration training – the second phase of which will take place between January and April 2010 and will include new draft standards for nurse education.

  • 28 Comments

Readers' comments (28)

  • No one seems to talk about the art of nursing anymore , a skill learnt in the practice setting and school of nursing. I did a basic 'apprentice style training' and consolidated this with a couple of years as a staff nurse , again a role involving socialisation, appreciation and understaning of professional discipline required to be an effective nurse. This includes consideration and respect for all members of the ward staff not just academic competition or simply learning a technique because that is part of the learning objectives or a box ticking culture ( which seems to occur with some nurses). I worry that some nurse are signed off on the practice side who are patently not
    functioning at an acceptable standard and actually are a risk. Some do not appear to have absorbed any of the professional discipline that would have been a basic requirement in the former training, compassion, and anticipating patients needs . The training today demonstrates lots of assertiveness ( which is OK at the right time, other wise just sounds, rude! )but no listening skills. I have since gone on to graduate with a degree in healthcare but feel that it gave a greater depth and understaning to my basic training, and certainly widened horizons . I still feel that so much can be learnt about a patients' conditiion(unobtrusively of course) from a basic bed bath done to a professional standard, ie checking mucosa of eyes for possible anaemia , detecting depression from the patient's conversation, checking wound drains, blood loss or signs of infection on dressings, pain etc . I feel that students are being taught to run before they can walk without that all important practical understanding and professional approach/knowledge of nursing care. Care plans work when there is apractical understanding of the information required in them!

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  • one comment i feel is needed here.

    care plans are legal documents and if the nurse writes the patients needs in a care plan they have to be carried out.

    Also their wants are regarded as secondary

    So long as their needs are met.

    i may be wrong on this as i left nursing in

    2008,things may have changed.

    .

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  • Ditto every word fom Martin Gray.

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  • As a student now coming up to my final year of training, I am dissapointed at the continual blame bounced back and forth.

    It is true there are many students who stand on the sidelines preferring to use their status as supernummery to avoid hard graft however there are also a vast amount of mentors that use students as HCA's, and do not actually take the time to teach the student anything, whilst basic care is fundermental and I personally love the time I spend doing so, a student can not gain the competance to be a staff nurse if they spend most of their time performing basic care and not encountering the other roles that will be expected of them, added to this there are HCA's who seem to dissapear when bells ring or observations need to be done leaving the student to perform these tasks alone, as well as those that stand around talking whilst a student makes a bay of beds, all of these issues need addressing if we are to improve.

    With regard to care planning, my university has done an excellent job in teaching these skillls and I was able to implement them during a recent placement, managing 6 patients single handed.

    Students need to be responsable for their own guided learning, and not expect to be taught everything but please mentors do give us the chance to do things too!

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  • This is hardly news is it, it's been going on for years and will only get worse. Take training away from the universities and give it back to hospitals and schools of nursing

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  • So Mandie Sunderland doesn’t think newly qualified nurses can produce or understand care plans? The obvious question is exactly how would Mandie know? Maybe she is one of those Dir of Nursing who would have us believe she visits the wards every fortnight?

    I wonder if Mandie considered how badly her comments reflect on the nurses she leads at the Heart of England FT before getting all animated on a conference stage? As one respondent has already pointed out nurse education is split 50:50 theory and practice, so if the newly qualified haven’t got the requisit skills it’s as much down to the quality of clincal practice and supervision that students are exposed to as it is about what’s going on in universities. Furthermore most nurses aren’t stupid, if they have problems understanding the care planning process it’s probably because it’s unnecessarily complex and fragmented. I wonder if Mandie knows how many different assessment tools her staff nurses are expected to use? Instead of simply blaming the educational model, maybe she should reflect on what she and her corporate colleagues have done to make the work of those at the sharp end a little easier.

    If Mandie is really worried about the fitness for purpose of new RNs (rather than grabing a headline in the NT) I’m sure she’ll have taken her concerns up with the education commissioner at the SHA as well as the relevant university Dean and the Teaching and Learning Committee, a seat on which either she or her nominee would as a key stakeholder have by right.

    Finally, it would also have been nice if NT had done a little background on this story rather than simply lighting the blue touch paper and walking off…

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  • As a recently qualified staff nurse I feel it appropriate to comment on this issue. I was taught the roper, logan and tierney model of nursing at university, howeve during academic sessions we were never taught to accurately plan care. Many students have a tendancy to blame mentors for their lack of knowledge and skills, I know I have done this myself however I was justified in my blame as it was not only my mentor byt all staff in the clinical area and this was not rel;ated to my ability to complete care plans cause my written documentation was indeed the only thing those staff felt I was adequate at carrying out. However from my first year I learned to accuratley plan care on an individual patient basis.
    On every single one of my placements I accurately planned care with or without the assistance of my mentor. However even as a student there were occassions where there just wasn't time to update care plans because seeing to the critically ill pateints was more important and if felp like a pointless waste of paper as no other members of staff appeared to fill in care plans at all and if they did it was done incorrectly or the didn't bother to discontinue them when the patient no longer required that particular intervention. But at the end of the day care plans are legal documents and must be filled in order to provide basic patient care and not be seen as a neglectful nurse!

    I agree that nurses should not have to be educated to degree level because if you look at the NHS as it stands right now, many of the best nurses do not and those who do don't neccessarily participate in direct patient care which is the reason the majority of people pursue a career in nursing in the first place!

    I have worked alongside excellent students and qualified nurses of all levels who not only provide first rate direct patient care but are also brilliant at the documentation. However I have also worked with students and qualified nurses that do not do any hands on patient care and do not know how to do do basic tasks like write down observations from a monitor or admit a patient, or even to draw the curtains if a patient is upset! And none of this is the mentors fault or the universities fault, it is simply because the student doesn't apply themselves the way they should or participate in the care they are required to, to meet their competencies.

    In my opinon nursing should return to apprentice style training in the hospital wards and those nurses who wish to pursue nurse management or nurse educator careers can go and complete the relevant academic course to fufil their ambitions. I also thing that having recently ceased being a student that student should take responsibility for their own learning and not blame their lack of knowledge or skills on everyone other than themselves.

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  • As a recently qualified staff nurse I feel it is appropriate to comment on this issue. I was taught the roper, logan and tierney model of nursing at university, however during academic sessions we were never taught to accurately plan care. Many students have a tendancy to blame mentors for their lack of knowledge and skills, I know I have done this myself however I was justified in my blame as it was not only my mentor but all staff in the clinical area and this was not related to my ability to complete care plans as my written documentation was indeed the only thing those staff felt I was adequate at carrying out and I take responsibility for my lack of enthusiasm in that particular placement due to my lack of skills in certain area which was my fault and no one elses. However from my first year I learned to accuratley plan care on an individual patient basis.
    On every single one of my placements I accurately planned care with or without the assistance of my mentor. However even as a student there were occassions where there just wasn't time to update care plans because seeing to the critically ill pateints was more important and it felt like a pointless waste of paper as no other members of staff appeared to fill in care plans at all and if they did it was done incorrectly or they didn't bother to discontinue them when the patient no longer required that particular intervention. But at the end of the day care plans are legal documents and must be filled in order to provide basic patient care and not be seen as a neglectful nurse!

    I agree that nurses should not have to be educated to degree level because if you look at the NHS as it stands right now, many of the best nurses do not possess degrees in nursing or healthcare and those who do don't neccessarily participate in direct patient care which is the reason the majority of people pursue a career in nursing in the first place!

    I have worked alongside excellent students and qualified nurses of all levels who not only provide first rate direct patient care but are also fantastic at the documentation. However I have also worked with students and qualified nurses that do not do any hands on patient care and do not know how to do do basic tasks like write down observations from a monitor or admit a patient, or even to draw the curtains if a patient is upset! And none of this is the mentors fault or the universities fault, it is simply because the student doesn't apply themselves the way they should or participate in the care they are required to, to meet their competencies.

    In my opinon nursing should return to apprentice style training in the hospital wards and those nurses who wish to pursue nurse management or nurse educator careers can go and complete the relevant academic course to fufil their ambitions. I also think that having recently ceased being a student that students should take responsibility for their own learning and not blame their lack of knowledge or skills on anyone other than themselves.

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  • rovergirl6@hotmail.com

    surely basic care could be taught in the first academic year,And as the education continues through the three years , each and every year more and more of the education to fulfil the role of a qualified.accountable nurse can be taught. remember the qualified nurse on the ward is not only accountable for their own actions they are responsible for any and all actions of their subordinates.

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  • Malcolm Chalk BA, RN

    Looks like another case of an old school nurse having a go at the better academically trained nurses this country now produces - sour grapes perhaps?

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