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Nurse training needs 'urgent reform', says primary care chief inspector


Nurse training needs a “radical review” to meet the “urgent” need for clinicians with the skills to care for patients with long term conditions, the chief inspector of primary care has told Nursing Times.

Professor Steve Field, who took up his new post at the Care Quality Commission last Tuesday, said boosting the “competencies and quantities” of practice and community nurses was more urgent than training extra GPs.

The Royal College of GPs has claimed an impending shortage of doctors is a barrier to achieving the government’s aim of making general practice accessible to patients seven days a week.

Professor Field said that, while extra GPs were “undoubtedly” needed, more nurse-delivered care could help improve access and also continuity, with patients more likely to see the same health professional on different visits.

But he warned there was a lack of the appropriate skills within the current nursing workforce and that courses should include more primary care placements and have a greater focus on long term conditions.

“We need a radical review of nurse training so we have more nurses placed in primary care… very quickly. I think it’s urgent. We [need to] have enough nurses trained to support long term condition care now.”

He called on Health Education England, which is responsible for commissioning nurse education, to look at the nurse training programme.

“It strikes me there are insufficient numbers of well trained nurses to take on quickly the long term conditions load,” he told Nursing Times.

Professor Field added that in many parts of the country there was a need for practice nurses to work more closely with community nurses. “It’s completely bonkers that in many areas you’ve got practice nurses who are just about talking to the community nurses,” he said.

A spokesman for Health Education England said it would work with the Nursing and Midwifery Council and universities to ensure training was responding to the needs of “older patients with more complex needs”.

However, he suggested that a lack of continuing professional development was more of a problem than initial nurse education. He noted that much of the current workforce would be delivering the new services and there was a need for a “frank discussion” about the responsibility of employers to ensure staff were given “appropriate development opportunities”.

This view was echoed last month by Crystal Oldman, chief executive of the Queen’s Nursing Institute. She told the QNI’s annual conference that practice nurses were suffering from a “lack of investment in the development of their skills and that urgent attention is needed in the support of their professional development as specialist practitioners”.

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Readers' comments (5)

  • It seems worrying that the person reviewing the provision of nursing, in primary care, does not think that nurses require "education" rather than "training"....

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  • Most nurses I no in primary and community care would love to have more training and "education" about chronic disease management, but are unable to even manage their case loads let alone spend more time with patients with many co-morbidities.

    Most are told that there is no money for training/unable to increase hours/provide overtime etc etc and will take a couple of years to even be considered.

    Practices are full to bursting, patient demand is enormous, the continuous round of "study days" to be able to even perform certain duties are never ending and many have to do these in their spare time.

    Added to this community nurses are paid poorly, have to maintain a car themselves and receive petrol allowance that is years out of date.

    Unless a huge re-think about continuous updating and training, funding of primary and community care and lack of support generally, then I fear this is an area that will continue to fail.

    This government could not care less about nurses from whatever discipline, and therefore as our overall "employers" things will only get worse.

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  • The chief inspector has noticed that nurses need more training.

    This overworked, poorly paid nurse here noticed that a majority of nurses know their stuff, but need more updates and study days within contracted working time.
    This nurse here noticed that because there is massive understaffing, nurses who know their stuff have to give watered down care so twelve patients can stay alive instead of one with good quality care.
    The nurses are aware that the care is watered down and this makes them very sad and stressed. It actually hurts real bad, but no one is listening. This makes the nurses even more sad and stressed.
    To make a name for themselves someone who is earning much more than the underpaid nurses keeps coming up with 'new' ideas and what they think is the problem with nursing, without any talk about putting on more staff.
    This then keep the nurses is a continual state of fustration.

    Has anyone wondered why nurses are leaving, not staying, having to get nurses from abroad. Why our youths don't say they are interested in nursing.
    Will staffing be improved a little nearer an election?
    Why is nursing always used as a political toy?

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  • Training IS education. The old paths were best ie -more holistic, personalised care. Very highly trained in paperwork, assessments, instrument checks etc but what about observations. What about signs and symptoms? What about empathy and end of life care?

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  • I am very delighted to read this article on Nurse training needs 'urgent reform'.
    My career background is in Adult Nursing and I practiced as a Nurse for 3 and half years, and I did my Masters in Public Health & health Promotion. One of the reasons I went to do the Public Health & health Promotion course is because I identify that as a Nurse, we lack the experience of using an intervention like motivational interviewing (MI) to communicate with patients. During my research for my dissertation, which was about intermediate care nurses perception and understanding of health promotion and their health promotion role as a nurse, I identify some gap in nursing which make me concluded that Nurse training definitely needs to be reform.
    It is a fact that there is shortage of staff and Nurses are unable to spend enough time with patients. But if they have enough staff and time to spend with patients, how will they spend it? What skill will they use to carry out basic health promotion intervention?
    I have two scenarios as example,
    1. How do Nurses see and communicate with diabetic patient that always ask for more sugar for his/her tea or like to eat sweets and chocolates? Do they carry out any intervention with this type of patient?
    2. What do nurse do for an elderly patient in hospital due to fall and needs to go back to his/her home after treatment? Do nurses look at the causes of the falls? Is the falls caused by getting confused due to infection? Or the infection caused by lack of drinking enough water? Or why is the patient not drinking enough water in the first place?
    Research has shown the effectiveness of MI with patient and healthcare professionals to understand patients’ health behaviour, but how can Nurses know that, if is not part of their training. I have looked into many university curriculums, it is sad not to find any university doing MI and Health Behaviour as a whole course unit. Some university do it as a day lecture. But is part of the postgraduate courses for community public health nurse.
    I think all registered nurses should have a better knowledge of patients’ health behaviour and have better skills of how to communicate and empower their patients by using intervention like MI.

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