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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)

  • please don't slam SRNs and SENs and their training. it was developed for very different times and health care needs of the population and has served the service and patients extremely well throughout all the recent years of rapid and change. Nursing and healthcare as a whole is highly complex and is constantly and rapidly evolving and those who underwent this training received an excellent grounding allowing them to keep abreast of considerable change. it also served nurses highly successfully through the last world ward treating serious illness and injury.

    one needs to look at the history of nursing and how the profession has developed before telling any one group their training is deficient or older nurses are looking through rose-coloured spectacles which is an affront.

    Instead we should be praising the devoted and valuable contribution of each and every one accepted on the register no matter when and where they trained and work together and learn from each other - it is one of the most valuable resources we have.

    Any nurses who are not up to standard is the fault of the regulatory system and not of the individual who has accepted the training available at the time they needed it. Obviously if they feel this is inadequate it is their responsibility to question and challenge and offer feedback on the methods and make sure they are able to acquire the knowledge and practice they need.

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  • Anonymous | 16-Jun-2013 3:25 am

    Wind your neck in. No need to be so defensive and precious about degrees. And this is typical of the attitude about them. Someone suggested here that those who do not have degrees should stand aside and allow those with degrees to move on. I was addressing that attitude. Like I said, I don't have a problem with degrees. I have a couple myself. I really don't care what we call the nursing qualification, as long as the content adequately prepares nurses for the career. But let's look at the content. That is a problem.

    Nursing is not a business and it is not Medicine, therefore any comparison to them is meaningless. Another common mistake. Medicine is a completely different discipline, requiring a much increased academic input (it is also longer) and different role within the care of the patient. When doctors are required to carry out essential nursing care and hands on direction of the nursing care of a ward/caseload of patients, then maybe we can look at their training. Until then, stop being silly. Nursing is a unique and changing profession, which requires lifelong learning and education. You don't become a 'productive' after 6 months. I thought that we had finally got over the obsession with comparisons to med students. Apparently not.

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  • tinkerbell

    On average i have changed speciality every 4 years over 26 years. No one has ever questioned my pedigree and I can honestly say for the majority of my colleagues with whom i have worked it has not been an issue either. I am wondering if it really is an issue in the field, or just on these threads.

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  • Brewers23 | 16-Jun-2013 12:09 pm

    You are being precious about degrees. And by being so, are diminishing their value. Your arguments about business and the medical model in comparison to nursing have no value. Now if that annoys you, then that's all it does. I don't care.

    We have nurses going through 4 years of training who seem to require ongoing courses and training to become competent in the basics. That isn't good enough. Nursing is too complex to be spending so much time, energy and money teaching them skills they should already possess. Third year students unable to competently understand and complete fluid charts isn't acceptable. Post basic courses should be available for more complex skills. With regard to IVs, catherisation, venepuncture and cannulation. If you think that these should not be established essential skills, learned and assessed prior to registration, then it is not difficult to understand why so many are critical of the degree. That's a problem with curriculum. Far worse though, is that it demonstrates low aspiration for nurse education. Which is why the UK continues to slide down the global ranking in nurse education, when we were once leaders.

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  • michael stone

    I'll risk chipping in, as an idiot outsider here: I'll say what I said when he raised this 'care' issue while I was talking to a nurse at the local university open day yesterday.

    There do seem to be some - probably a small minority - of nurses now entering (and within) the profession, whose 'approach/mindset/competence' is very 'academic': patients coming across these, raise the 'modern nurses don't care' issue. MOST nurses do want to 'care' BUT many will effectively say 'we are not given the TIME to care - we are rushed off our feet'. A lecturer-nurse in Scotland commented to me that 'patients often tell me that nurses who work with end-of-life patients are 'somehow better than other nurses'' and I've been surveying this - the consensus answer, from EoL nurses, seems to be 'I believe patients and relatives/carers would hold this view/perception as the nurse is there for the patient and allows time for talking and listening so patients feel valued and listened to and their wishes and desires allowed. ... Nurses are given the time to sit and talk or listen to patients which can be rare in other areas, so they actually get to know the patient and they're relatives'.

    The goverment seems to have sidetracked the Francis report, by going on about 'do nurses care' and the 6 Cs, etc - totally avoiding 'have nurses got the time to display 'caring''.

    I've also got a 'gut feeling', that we (patients and relatives) are not entirely fair to nurses, if only at a subconcious level. I have a feeling, that 'somehow' we judge whether a nurse is 'caring' by 'how much the nurse is suffering with me': in terms of 'empathy'. This isn't very fair, at all - and I suspect we don't do that, to anything like the same extent, with doctors ?

    Clearly, nurses must be able to competently handle any 'high-tech stuff' they are required to work with, etc: and obviously being good at the academic 'things' does not stop a person from being 'empathic' as well (but I'm pretty good at the academic stuff, and I'm not very empathic - these are two quite different things).

    If individual nurses are pretty good at what they are personally required to do as part of their jobs (and that seems to be very variable, with a huge variety of tasks being called 'nursing') then that should work out just fine - but don't let the goverment/media avoid the 'are there enough of us to reveal our instinct to care' question, by repeatedly pushing the 'do nurses still care by nature' question !

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  • problem with all of these bits of paper is, apart from permitting entrance to a professional register, they all have sell by dates and become fairly meaningless thereafter!

    Fortunately most of the 'goods' have a longer shelf life before they eventually expire and may remain in reasonable condition for some time thereafter due to their post-diploma/grad. experience and regular top ups of CPD!

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  • from Anonymous | 16-Jun-2013 1:19 pm

    in other words, it is what one can do for the patients that counts as well as for colleagues and employers as a useful, valid and supportive member of a team, and not a bunch of papers which are rarely seen by anybody except those who hold them!

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  • Brewers23 | 16-Jun-2013 12:09 pm
    3 or 4 years and you couldn't catheterise when you qualified? seriously? our students learn this as well as looking after ivs. they want the chance to learn venepuncture and iv cannulation and the uni are looking at this.

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  • michael stone | 16-Jun-2013 1:10 pm

    Good points.

    However, I think the issues being discussed here are not necessarily about caring or empathy. They are about what skills and knowledge are being taught and learned in nurse education in an increasingly complex profession, which does require more academic input than before. Obviously that should not be at the expense of compassion (although I am beginning to hate how that word is being used and always in the direction of nurses). It isn't much use to you if the nurse looking after you is caring and empathetic, but unable to assess and carry out your essential needs and you suffer detriment or die as a result.

    I think that there is a middle ground. Like others, I don't care whether someone has a degree or is SRN trained. I agree that the basic training (diploma or a degree) really does need to be looked at. I have worked in different areas of the UK and the training does vary greatly. That didn't used to happen. The students are at the mercy of the training they are given. Some are well trained and educated and very capable in their 3rd year. Other hospitals I've worked in it has been a very different and disappointing picture. Placements also seem to be largely luck. Some clinical placements are great learning environments, whereas others are not. It's a bit of a lottery for the students.

    Syllabus is an issue and I have spoken to university nursing lecturers who agree. We need to ensure good content, but also consistency for our students. We should not have them spending their first months post-reg learning skills which should have been taught pre-reg. Those first few months should be spent consolidating and using what they have already learned and putting it into practise, not doing MORE courses and assessments. Otherwise, what is the 3 or 4 years they have just spent studying been all about. Nurses embark on lifelong learnin. There are plenty of courses and onward learning in front of them, but they must have the opportunity to know the basics and do them well.

    I also agree that Nursing is a specific career and doesn't lend itself well to the models of learning in other subjects. It's trying to compare apples and oranges. Not to be forgotten is the improvement in learning opportunities for more experienced nurses. This is a sadly neglected area. Most of my ongoing learning has been financed by me and carried out in my own time, but it has benefitted my patients and my workplace. More support would be good.

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  • michael stone

    Anonymous | 16-Jun-2013 2:06 pm

    'I have worked in different areas of the UK and the training does vary greatly. That didn't used to happen.'

    There seems to be a theory, that by allowing variation within the NHS, 'best practice will spread'. It doesn't necessarily work - I've seen some very dubious and downright wrong ideas spreading - but there are arguments both ways.

    The ideal, is for people to have reached the right answer, by having thought it through for themselves.

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