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'Nurse education is not to blame for care failings'


When exactly did nurses get too big for their boots and too important to perform “basic” nursing tasks?

That was the question posed time and time again by journalists last week after the government announced its pilot scheme to make every wannabe nurse do a year’s experience as a healthcare assistant before starting their degrees.

I don’t know any students who consider themselves above helping a patient eat or taking them to the toilet. They all know that’s part of nursing, and assisting a patient with these tasks is one of the things that motivated them to nurse.

But the government has led the media to believe that nurse education is to blame.

I agree with the notion of getting as much practical hands-on care as possible - but I am unconvinced by this scheme.

It could potentially deter applicants who are less aff uent from applying for a nursing degree, and it may distract nurses from supervising students, undermining their training and ironically reducing the quality of hands-on experience that nurses-to-be get.

It also sends out a message to the public that nursing is about a set of “basic tasks” that any untrained person can carry out. I take issue with the concept of “basic” care. Helping patients to eat or washing them and using the opportunity to observe them are fundamental aspects of nursing. They are also complex clinical tasks that require skill - as well as compassion. If people believe that such tasks are “basic” or “easy”, they will undervalue nursing even more.

On top of this, by emphasising the “basic” care, or “essential” care as we prefer to call it, the scheme suggests that clinical knowledge is not necessary for nursing.

But this plan isn’t just bad for those entering the profession, I fail to see how it will actually improve patient care.

Robert Francis QC wanted to introduce HCA regulation, something the government has steered away from. But if unregulated workers are an issue, why have more of them caring for patients?

Can trusts afford to offer placements to vast numbers of pre-student intakes, train them, supervise them, coach them and then just have them leave - only to have to repeat the process year in year out?

Why aren’t doctors and others being asked to spend time “proving” their commitment to their jobs?

This feels like a test for nurses to prove they are worthy of their jobs. The implication is that it’s needed because nursing has failed, when we all know, that’s not really what is wrong with the health service. Follow
me on Twitter @nursingtimesed


Readers' comments (23)

  • Agreed but not sure why we continue to try to address specific issues such as this when the NHS is fundamentally set up for failure. Seems to me that the danger of trying to tackle so many different angles of attack is that nursing is weakened and on the defensive. Not reassuring for the public!

    I would suggest that the priority is for the nursing profession to launch it's own PR campaign. Nurses must unite behind a simple clear positive message for the country.

    This serves two purposes: 1) nurses will have a united, powerful voice that will be listened to and 2) the process will inspire and re-energise nurses which will make it easier for them to make positive changes across the NHS.

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  • I disagree ever since nurse training was taken out of hospitals basic care and attention to those who need care has taken a back seat, I often come across 3rd year student nurses and newly qualified nurses whose basic A&P is appalling the very idea that they should know one bone from another escapes them, as for asking a 3rd year to actually lay hands on a patient no chance, I hanker for the days before project 2000 when nurses were trained to nurse and classes rarely taught more than 30 at a time and you could be sure the majority of them wanted to be a proper nurse, bring training back to schools of nursing based at hospitals and let students be taught what they need to be nurses do it now before its too late

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  • Dear John Edwards,
    I am really concerned by your allegations. if you are frequently meeting third year students who lack the education and skills you mention, it is important that you raise this with your university. if you are supervising these students then it is your responsibility NOT to sign them off as competent at the end of their placements. Any student nurse refusing to care for a patient in the way you describe should be reported to the Link Lecturer and to the Dean of Faculty/School so that action can be taken.
    If you are a registered nurse, and it is not clear from your post if you are, then you have a professional responsibility to report this.

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  • Hi June thank you for your comments, I am a registered nurse and have been for many years, I am glad you are concerned by my comments and I have repeatedly done as you say, but the problem lies with the training which now focuses on academia rather than caring its time that nurses were nurses and having a degree does not make you a good nurse, I trained in traditional training and I also have a degree all that the BSc means to me is tat I can write about nursing it doesn't tell me or anyone else that I am a better nurse because I have it, lets get back to traditional nursing please before it's too late

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  • How I agree with John Edwards. Nurse training should go back to common training and common examinations at the end of it. That way, there should be no regional differences in the quality of nurses passing the exams. Academia has a place - but why not have all nurses train as hospital-based staff with regular classes and then, once they have passed their finals; they hould have the opportunity, if they wish, to progress to degree level, That could be accomplished as post-graduate students. Too much time in academia and too much time spent on irrelevant topics detract from what is really important here - and it must be the ability to care competently for those who need it.
    I too have a Degree (and a Masters), but I know I learned more about care during my three year traditional ward-based nurse training than I ever would have in a University.
    I don't care how many times it is said that nurse training should be based in academia; there is something fundamentally lacking with nurse education now and it is way past time it was addressed.

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  • bill whitehead

    Jenni has it right of course. The strange thing, to nurse teachers such as me, is that, as is well known, student nurses are required to spend half of their time in practice settings. At Derby University, where this year we had 1600 applicants for 80 adult field places, we have been looking at the nature of the applicants to see if there is anything in the "too posh to wash" allegations. The data indicates that over 80% had care worker experience prior to starting the course and that the qualification profile was almost identical to that of the advanced diploma course that we ran prior to the BSc (Hons). About half of those getting onto the course were mature students with access certificates rather than A levels for example. The ones without care worker experience would have had experience of caring for a family member or voluntary work. This was not really a surprise to us as we have always had previous care experience as a requirement for entry to the course. We have an excellent nursing course at Derby; however, I don't believe that the University of Derby is unusual in this. See radio interview by our head of nursing on 26 March:
    Listen to Paula Crick, Head of Nursing and Health Care Practice - University of Derby - Health and Social Care, commenting on nursing announcements on BBC Radio Derby. (around 1 hour 48 minutes into programme)
    The Willis Report rightly gave nurse education a clean bill of health on this regard. Why then is there still a problem with the standard of care? Maybe it can't all be about individual nurses being uncaring brutes or nurse preparation being too academic. It would seem most sensible to look at the pressures that those nurses are under in a system that still doesn't have minimum nurse to patient ratios outside of critical care environments. I would say that if we provide nurses with the staff and resources to do the job then we can start looking at issues such as individual character. Until then it would seem most likely, to a fair minded person that any failings are mainly down to an understaffed and under resourced system of care.

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  • I am a 2nd year student nurse, just about to start my 4th placement. In none of my last three placements could I have possibly avoided providing hands on personal care to any patients, not that I'd have wanted to.We have clinical skills we have to achieve before we are signed off each placement and I suggest John Edwards that you are not fulfilling your role as a mentor if 3rd year students are avoiding providing such care whilst under your charge. I have been a care assistant for many years before starting my training, and do not believe you can teach compassion and caring through a years work as a HCA, it is part of your personality, part of you. Student nurses today apply to do their training for the same reasons as you and many others did, to help people and to make a difference. It is unfair to blame student nurses or their training for the appalling treatment patients received at Staffordshire. I believe in the Telegraph today 3 Drs are being prosecuted for their involvement, how is that anything to do with nurse training? Senior Management are blamed for important audits not being carried out, how is that anything to do with nurse training? Staffing levels were dangerously low, how is that anything to do with nurse training? Too much emphasis on financial considerations rather than patient care , again completely out of the control of student nurses! One nurse being prosecuted is a senior nurse 60 years of age for bullying nurses and disregarding their concerns, don't think she was a newly qualified nurse do you? This neglect had gone on for years, you cannot blame student nurses for it. The main concern is that 1,200 innocent people died needlessly, you cannot blame this on training or student nurses. This is not a little mistake at the hands of inexperienced nurses, this is due to a lot of senior people turning a blind eye. You don't need any sort of training, degree or otherwise to recognize essential needs of hunger and thirst and people screaming in pain, this is not down to training, it is plain and simple neglect in the hands of people that should never be in the caring profession in the first place. I know that myself and other students I have worked with are caring, compassionate and hard working and would not stand by and watch this happen to another human being, so stop using student nurses and the way we are trained as a scapegoat for other peoples downfalls, this is at a much higher level than that.

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  • not everyone in nursing is suited to the job, I've met HCAs, student nurses and qualified nurses who are pretty awful and uncaring.

    'too posh to wash' is a stupid phrase, what is 'posh'? it's being too lazy and too uncaring to wash and care for people, it's only called too posh to wash because it rhymes.

    i don't think the term 'wannabee' nurse is very respectful, why would anyone want to be a 'wannabee nurse'. For the right people it's a hard job, rubbish hours, poor pay, no thanks at the end of it, no support, backbiting and bitching, constant criticism in the media.

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  • Hi Deborah Sherman please read what I wrote properly, I thank you for being a student who cares, I DO NOT blame student nurses I point the finger at the training which at present is not fit for purpose, I don't think that for one minute that students are to blame for the problems, you seem to think that what happened at Stafford is isolated I'm sorry you are so wrong and appear quite naive, no offence meant, but I have worked for more than 20 years in the NHS and have fought this poor care throughout this time, I have been a whistleblower and stood up for patients and nurses for years and this has caused me a lot of grief including being bullied and eventually dismissed unfairly. As for being a mentor I believe I helped and encouraged every student I had and many have become good nurses others not, so please stop pleading that students are wonderful and are all going to make great nurses they won't

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  • Does no one actually understand that diploma and degree students were all taught the same in class and had the same placements?

    Banging on and on about academia is really getting boring.

    A nurse is a nurse, you very rarely meet a degree nurse that is rude about a diploma nurses qualifications yet daily degree nurses are slated.

    It really dies seem as if those that bang on about it when they have no actual idea what current training is, this I found out myself a few days ago when a colleague went into a rant about degree nurses being useless, no intuition and not like her or myself.

    And you might of guessed that in actual fact I am a degree nurse!

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