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'Let’s shout about the complexity of nursing'


Will people ever really understand what nursing actually is and that it’s a lot more complex than wandering around, asking if someone wants a cup of tea or their pillows plumped?

Last week health secretary Jeremy Hunt addressed delegates at the NHS Confederation in Liverpool and said he had visited several hospitals as part of the government’s plan to get health ministers more in touch with the front line of healthcare provision. He mentioned working as a housekeeper, doing photocopying, acting as a porter, assisting on a GP telephone line and washing down beds. He also said he had done hourly nursing rounds at Salford but said “no clinical roles were involved in this”.

What is intentional rounding, if it is not clinical?

One would have thought that with intentional rounding being the government’s seemingly biggest focus in nursing that the health secretary would be fully conversant with what it actually is.

But again, it seems that nursing is seen as a set of compassionate tasks - and not a role that requires clinical prowess.

There are people in very senior positions in the NHS who seem to think that compassionate care and clinical tasks are divorced from each other

The health secretary is not alone. There are several people in very senior positions in the NHS who seem to think that compassionate care and clinical tasks are divorced from each other.

Nothing can be further from the truth - those tasks such as helping a patient with their meals or washing can provide a wealth of clinical insight. And those clinical tasks - such as administering pain relief promptly - must be accomplished with compassion.

Worse than that, we still have people in the NHS who believe there is no need for nurses to have degrees or any form of education. Some look back with rose-tinted spectacles on their halcyon days of training and believe anyone who puts the letters “SEN” or “SRN” on their CVs are superior to those who can put “BSc” after their names. I’m not suggesting you need a degree to be a fantastic nurse, but I am angered and frustrated by the view that having a degree automatically precludes you from showing compassion.

Nursing is complex. It requires intelligence, knowledge and wisdom to know how to help a patient get better, and compassion, insight and experience to know how to make a patient feel better.

That nurses have increased their portfolios to take on more clinical responsibilities is better for the patient and the profession. Patients are seen quicker by a clinically competent and compassionate professional. So let’s start telling people what nursing really is, and let’s make sure that they hear us.

Jenni Middleton, editor Follow me on Twitter @nursingtimesed


Readers' comments (40)

  • anybody who believes nursing is not complex, and is becoming increasingly so, is news to me after over 30 years in the profession!

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  • nursing is well known to be one of the hardest and most stressful jobs which exists due to its complexity and wide range of responsibilities, which is why it can only successfully be managed by nurses who the only ones to fully understand the wide ranging roles which are seen in almost no, or very few, other jobs. it seems however that only nurses are capable of acknowledging this, (possibly because of fears of the seemingly infinite resources it requires to fund it and remunerate the professionals adequately). However this complexity and problems this can cause is also recognised by psychologists and occupational health experts.

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  • 20 years in nursing has certainly been a challenging journey. I now witness care professionals with less compassion, understanding and a lack professionalism. Students nurses and post graduate newly qualified turning up on shift with jewellery and false nails and managers turning a blind eye . We're has respect for policies and procedures gone??? As for the NHS sick leave , it's a joke nurses staying off sick and and getting paid to stay off !! Lower the sick pay and the length of sick leave that will get nurses to think twice about taking advantage and leaving their colleagues to struggle and wards short staffed

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  • Anonymous | 12-Jun-2013 8:11 pm

    I think the assertion that those nurses who were trained pre-degree are looking "back with rose-tinted spectacles on their halcyon days of training" very much affirms Martyn Taylor's view. I don't happen to think that this is very balanced article.

    I trained in the eighties, subsequently gained my nursing degree and then masters. I set off as an 18 year old on a learning journey which continues to this day. I don't believe for one minute that degree trained nurses are too posh to wash or that we should return to the old-style of training. Neither do I hold with the patronising view of a previous poster who stated, "It's time we said to the degree-less, we are not invalidating your contributions, but it is well past time to move ahead..." . Not all my fellow students formally studied for degrees, but many achieved very senior roles and have been forces for positive change. There are problems with current student nurse education and training, (which are not the fault of the students) and these really do need to be addressed.

    We are all products of the training and education we receive and the experience and ongoing learning we gain. None of that, whether 'degree-less' or not, should be de-valued. I very much agree with your point that "backing each other and respecting each other" is paramount. We have bigger problems that we should be facing together.

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  • Once again student nurse education is an easy target. Let not forgot students spend 50% of their time in clinical practice and "we" the Registered Nurse sign them off to say they are fit to practice some level of ownership and accountability here ???

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  • Anonymous | 14-Jun-2013 12:33 pm

    Once again, someone has got the wrong end of the stick. Address the CURRICULUM. It is not adequate. That is not the fault of the students OR the Registered Nurses who sign off that they have completed the prescribed outcomes.

    This is not a new discussion but, as usual, someone gets the hump and turns it into something it isn't. Stop taking offence and let's put in place a curriculum and training schedule that provides student nurses with the skill, education, training to nurse in the coming years, and above all the ability to challenge. Maybe we will have fewer mid staffs!!!

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  • Anonymous | 14-Jun-2013 1:09 pm
    i so agree. i think that the single biggest skill we can impart to our students is the ability to challenge. there are so many nurses in the nhs workforce, yet we have such a small voice. maybe because we are trained to follow instructions instead of asking questions and leading change?

    Anonymous | 14-Jun-2013 12:33 pm
    yes, students spend 50% of their time in clinical situations. do you think that is enough? an increasing number of educators and clinical nurses do not believe that it is. there needs to be change. too many of my students spend too much time 'researching' things that they should have been taught. so the 50% of time not spent in clinical practice is not always being put to the best use.

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  • Re Anonymous 11th June. As a full time Community Matron with a Clinical and Leadership role who trained as a SRN 36 years ago then went on to do Diploma, BSc Hons and then Masters Degrees as my career developed I certainly feel these academic qualifications have added to my ability to care for patients yet work within a modern business minded NHS and try to keep the role of the Nurse distinct in providing 24 hour patient care in a holistic manner at the forefront of patient care. I still feel it does not matter the qualification, the Nurse needs a caring and professional attitude to their work where patient care is uppermost. I Mentor many students and find the missing link in the training is a lack of knowledge of anatomy and physiology and the disease process and how that impacts on the individual, especially in regard to long term conditions. To me these are the building blocks which form the basis of having an understanding of the patient and family and the impact of often long term illness around which holistic assessment can be built.
    I see too many services driven by targets, numbers of visits etc where task allocation has reared its ugly head in the new NHS instead of holistic, complete patient centered care. I need all my skills to be able to work with patients with all illnesses yet be proactive in working with Managers with a business background in developing services our Commissioners will pay for. Otherwise services will be provided by companies more interested in numbers and profit than patient care!

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  • I am an SRN, RSCN and an SCM, and I am proud to put those after my name. There is no escaping the fact that newly qualified nurses today are in no way as capable as I and my colleagues at the time of qualifying of catheterising patients, changing IV fluid bags, understand the principles of 'basic' post-op care. We were taught how to make a person feel as comfortable and pain free as possible. Unfortunately, over the years I have been admitted as a patient into the main local hospitals, which are regional units for many specialisms. The standard of care i received and I observed being delivered was overall abysmal in most cases. Third year nurses who have never administered an injection, run through IV fluid into a giving set and been able to hold or initiate a conversation with patients generally is common place.
    My last admission was in January of this year for a knee replacement, the care I received was outstanding, the staff from Sister to HCA were kind, caring, competent, compassionate and professional. It was breathtaking to see how hard these staff worked to ensure that the patients under their care were cared for. Most of the qualified staff were trained in the SRN days; the Ward Manager and Sister were also trained as SRN's and it showed. It was obvious to us patients who the 'degree-ed' staff were. On the day I was being discharged (I was a patient for three weeks) I was told that management had decided that the ward was over-staffed, they staffing level was going to be cut my 4 qualified staff and 3 unqualified staff.
    I work as Clinical Trainer, delivering course to nurses and carers in the private sector. Their practice is heavily regulated and inspected on an annual basis regularly and then by unannounced inspections as thought necessary. This does not happen in my LHB, or I would imagine in any other LHB. Whilst my daughter was a patient in a local hospital, she and I had to ask repeatedly for staff to wash their hands before they did various tasks, in my training as an SRN I never had to be asked I just did, as did my colleagues at the time. When I asked how staff were trained and assessed in good hand hygiene, I was told that once a month a member of staff (who was appointed as a 'hand washing champion') spent a certain amount of time observing if staff were employing and practicing good hand hygiene; and they had documents to prove that all staff did so! If this is how nursing staff on a ward feel they are keeping up good standards; then take me back to the SRN days, Nightingale wards and hand washing as it should be done.

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  • And then the fight started..........

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