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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)

  • isn't it rather a pointless and useless debate trying to decide who is better trained than whom? there will never be general agreement and what does it achieve and how does it inform or improve patient care? don't we need to stick to the here and now and see what our patients need and how we can best deliver it to them?

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  • "I am angered and frustrated by the view that having a degree automatically precludes you from showing compassion."

    i am angered and frustrated by the assumption that because i qualified in 1985 i no longer am good enough to be a nurse, and dont know what i'm doing. There are excellent graduate nurses, and some truly dreadful ones, as there are from when i qualified. these problems dont help us as a profession.

    Education does not guarantee compassion and sadly it doesnt guarantee competence, i have worked recently with several third year degree students who did not know how to fill out a fluid chart......

    maybe the problem is that as a profession our leaders have run so fast towards proving we can be "educated to degree level" that the public perceives this as we dont care anymore. And for nurses like me..well we are perceived as backward and incompetent purely because we trained to do a job and do it well

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  • karen hills | 15-Jun-2013 12:51 pm

    it is quite useful though having the likes of us oldies around to do the things nobody else can or are not trained in!

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  • It is all about content. Not whether or not it is a degree.

    Let's face it, you can get degrees for Adventure Tourism and Knitwear Design nowadays. I'm happy for nurses to be trained to degree standard as long as the course content prepares them well for their lives as nurses. Someone commented that nurses spend 50% of their time on clinical placement as if that were a positive thing. Well, it is not enough! That's where to start.

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  • tinkerbell

    My real training started once i qualified. Up to that point my training consisted pretty much of it being a DIY course as far as the academic input, I learned much more from my clinical placements.

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  • tinkerbell | 15-Jun-2013 7:01 pm

    does that mean you are SHOUTING for against the case for 'the complexity of nursing'?

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  • tinkerbell | 15-Jun-2013 7:01 pm
    Anonymous | 15-Jun-2013 3:56 pm

    "My real training started once i qualified."

    I so agree, but I was fortunate enough (and I know that it was luck) to have solid building blocks on which to develop my knowledge. Every student nurse deserves that, yet too many of them speak of the 'DIY' approach you describe. I am sad to say that I have had the same experiences as Karen Hills, in terms of lack of basic knowledge in some students. Not their fault. I have spoken to the uni tutors and practice education facilitators at our hospital, but no one seems to be terribly motivated to address the issue. Another real problem is the constantly changing and increasingly meaningless (in relation to outcomes) paperwork which accompany every student. The students themselves hardly understand it.

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  • tinkerbell

    Anonymous | 15-Jun-2013 8:39 pm
    see that litle spikey pink haired thing, top left corner, that's you that is.

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  • tinkerbell | 15-Jun-2013 9:35 pm

    I am flattered,but I thought that was you.
    I seem to have a day of typing errors. it was meant to read 'for or against'. I am not imrpressed with myself! Maybe it is all this complexity that is getting to me!

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  • I have several years experience of working in a totally different environment and would like to add my 2p worth. First of all the comment by anonymous 15/6 at 3:56 shows a typical arrogance regarding degrees in non academic subjects such as Adventure tourism and knitwear design, these are not new subjects to be taught at degree level; in the 70's ( the halcyon days of SRN/SEN) the Polytechnic I attended offered degrees in Fashion Textile design, shoe design and Fine Art alongside Computer Science, Physics, maths, Chemistry, English Literature and Law. Now that this polytechnic is a university it has added nursing and midwifery to its portfolio. On the continent people have to spend a minimum of two years training to become official tourist guides.
    The other point that I would like to make is that NO degree makes a person immediately competent in the work place, they still need training up. A law degree is insufficient to be a solicitor, there are professional qualifications to obtain that take another two years, likewise accountants. When working in industry it was estimated that it took a minimum of 6 months for a new graduate to become genuinely productive. I would ask that you don't suggest that the nursing profession is different because we deal with people's lives, a software engineer may be working on safety critical systems, for example some of the equipment that we use such as defibrillators or ECG machines, or it maybe the engine management system in a car or aircraft.
    If 50% of the nursing course in clinical practice, then the amount of time our medical colleagues spend in clinical practice is insufficient as well. A physician spends a long time in on the job training post graduating and registering, with a well defined path through it. Perhaps this is where nurse training or attitudes need to change, perhaps there is a case for adopting the medical model of training. Of course people will then complain that nurses are expected to do the job straight away, but if it is as complex as we claim then that cannot happen and it is very unfair to say otherwise, also those suggesting that the old SRN/SEN training was superior are looking at it through the eyes of someone with many years experience ( gained whilst working) and not as a newbie.
    Just to finish, in my training we had some sessions working alongside medical students visiting patients in their own homes, during my session I deliberately let the medical students take the lead, after they had finished I asked the patient further questions that were relevant from both the nursing and medical perspective, afterwards one of the medical students commented that they hadn't thought to ask the questions that I had, despite their relevance to the medical history. This was at the start of my third year and it was the medical students first encounter with a patient in their second year.

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