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Francis Report - NT Response

Recommendations on student nurse training


The Francis report suggests changes to pre-registration training to improve skills and to ensure students have the requisite attributes


Much of the care at the Mid-Staffordshire Foundation Trust was below an acceptable standard due to a lack of staff, but Robert Francis QC also attributes some of the failings to nursing staff not being skilled enough to provide the care required.

The evidence collected by the inquiry shows several examples of poor care putting patients at risk and delaying recovery; this was the result of some of the nurses not having the skills to cope (Francis, 2013).

To combat this, Mr Francis has suggested changes in nurse education to create a more compassionate workforce that is able to provide the care required.


Student nurse selection criteria

The report stresses a need to recruit onto nursing courses only those who possess “the appropriate values, attitudes and behaviours”. Mr Francis said that student nurses need to be intelligent, caring and possess an intrinsic desire to help others.

To ensure that nurses are motivated to maximise the welfare of others, Mr Francis suggests that one of the minimum requirements to study nursing should be three months’ experience of working in direct patient care, under the supervision of a qualified nurse. He argues that this will ensure only students who are committed to becoming good nurses and who possess the necessary qualities will be given the opportunity to train.

In addition, this recommendation would give potential student nurses an insight into what is involved before they start a nursing course. Mr Francis said that “even in a well-run organisation, the stark differences between nursing as they imagined it to be and the reality will challenge their ability to maintain their motivation”.

But the government’s response published last week suggests pilot schemes should be rolled out to make students work for a year as a healthcare assistant before receiving funding for a nursing degree.

He also suggested that, before starting their training, potential student nurses undertake an aptitude test designed to ensure they are willing to undertake hands-on care and are capable of doing this, and are not just interested in the more technical aspects of nursing. The thinking behind this test is not to assess knowledge but to check that prospective students have the caring and compassionate qualities to be a good nurse.

Changes to nurse training

Reassuringly, the report acknowledges that the existing education system does not make nurses incapable of providing personal care.

However, the evidence collected by the inquiry included examples of poor basic care and the conclusion was drawn that the current model of training does not focus enough on the impact of culture on caring.

The report highlights the need for student nurses to be provided with more training on practical elements of nursing, such as lifting and personal care, and for this to be governed by national standards. It stressed that these are skilled tasks that require an appropriate level of training to ensure nurses are competent in them.

Currently, student nurses are expected to learn these skills while on placement. However, as students undertake different placements, the amount and type of practical training they receive vary considerably. Mr Francis recommends that all student nurses, regardless of where they train, are taught practical nursing skills to a consistently high standard.

The report recommends that students all take the same exams and achieve the same qualification at the end of the course. Exams should include practical elements of care in addition to testing knowledge. The aim of making all student nurses take the same exams is to reduce differences in the standard of education provided by different institutions, and to prevent anyone who is not capable of providing compassionate and safe care from working as a nurse.


Mr Francis has advised that there should be a greater focus on nurse training, education and professional development. The report recommends that more emphasis should to put on the practical requirements of delivering compassionate care, in addition to the theory.

The first step to achieving this is by recruiting student nurses who already possess compassionate qualities and the potential to be caring, practical nurses.

This, along with including more practical elements in nursing courses, is intended to produce workforce of skilled, caring nurses who can change the culture of the health service.

Fran Entwistle is assistant practice and web editor at Nursing Times.


Readers' comments (8)

  • Mr Francis recommended that students work as HCAs for a minimum of 3 months before training. This is sensible. So, why is the government considering a pilot scheme of 12 months?
    The government should ensure that workplaces are adequately staffed, mentors are well trained, time is protected for teaching students in a way that they can understand and bullying/harassment is eradicated.
    This would provide the environment for providing compassionate care.

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  • If staffing levels were adequate there would not be a problem. Staffing levels are now at an all time danderous level.

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  • My wife is a Nurse who trained in the 1970's when the training was practical and job-related. She also qualified by taking National exams. Since then my wife has gone onto obtain a Degree, a Masters and a job related qualification in Travel Medicine, all taken in her own time to enhance her abilities. Too much emphasis is placed on degree qualification which is obtained onsite, with non medical related training included.

    My experience, of student nurses in hospitals latterly, leaves me with a dread at their lack of practical ability, the writing of reflections if they cannot or will not do a job and their lack of understanding of patients needs. They are there to 'nurse' (refer to Florence Nightingale) the patients not to be 'managers'.

    My final disbelief is that there is no National Professional exam to decide if they are good enough to be called a RGN. I am a Chartered Accountant, trained in the 70's, but my profession, as well as law, surveying and architecture still has a professional exam and lengthy job-related training.

    Wake up - train for the job, not the degree......

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  • Re: Anonymous | 3-Apr-2013 12:47 pm

    There is emphasis on monitoring throughout the whole 3 years with rather than on a final exam at the end.

    As a current student nurse, whilst we do not have a final national professional exam, we do have several exams spread through out the 3 years of training. As a first year I have 2 exams this year, 1 at the end of the first semester and another at the end of the second semester, I also have assignments related to the theory behind practice.

    When in practice we are working 37.5hrs per week with a minimum of 40% of this time spent working along side our mentors so we do get lengthy job related training.

    My course is 50% Practice based and 50% theory. If you do not pass your practice you fail, if you do not pass your theory you fail and that goes for the exams too. It doesn't matter whether you pass one and not the other, you have to pass both theory and Practice to be able to progress to the next stage.

    With exams that must be passed and targets that must be met throughout the course I believe it is now easier to pick up on anyone not suited to nursing and not good enough to be called RGN before they reach the end of the 3 years, thus saving the government from spending 3 years worth of money on training someone unsuitable.

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  • Re Anonymous | 3-Apr-2013 12:47 pm

    I spent most of my 2 years as a carer in the community looking after patients personal needs, now as a student nurse I do personal care all day along as well as supervised drug rounds, paperwork etc. I think I have a pretty good understanding of patients personal needs thankyou!

    And I agree with the comment above. We have plenty of exams and there are plenty of opportunities along the degree to weed out those not suited to nursing.

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  • Bring back the SEN's The were the best carers.

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  • Why, if there are ample early opportunities to pick out nurses who are unsuited to the profession, are we seeing so many examples of bad care? Many of the cases highlighted are not because of poor staffing levels; (I think the public do understand and sympathise with that circumstance) - but rather the more shocking aspect of nurses simply not caring - and not only that, but making it obvious they don't. One only has to read the Francis report to see how many examples of this are quoted. That is what the public find shocking. And this is why as a profession, we have lost public sympathy and understanding.

    There may be plenty of exams in the Degree courses; but there is no National standard, as each university sets its own. Neither is there any National standard content of practical work - which may vary vastly from nurse to nurse (also see Francis Report). There should be a National standard content of both practical work and of examination.

    I note the comments in favour of traditional training all come from the Nurses who have now experienced the results (in nursing terms), of both type of training. The comments in favour of current training all seem to come from students who emphasise how hard they are working for their Registration.

    The three year Registration of yesteryear also ensured nurses were monitored; (ward reports and Clinical Teacher feedback) and there were exams during every period 'in school' Final exams were both practical (with external examiners) and theory - and just as now, both had to be passed in order to gain the qualification. Where did the idea originate that the three year course was an easier option?

    I concur totally with the comment about SEN's. How do potentially good nurses, without the academic ability (or the desire), to complete a degree, gain a qualification now? Patients are the ones who have really lost out, on the phasing out of these qualified bedside nurses

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  • Re Anonymous | 5-Apr-2013 11:35 am

    But are all these examples of bad care from degree nurses? I'm not quite sure what you're getting at as the degree has only been recently brought in. Sorry for the misunderstanding. Surely all bad practice cannot be blamed on those newly qualified? I have heard of cases of bad care way before the Staffordshire inquiry - back in the 70s my mother witnessed bad care when in hospital having her appendix out. None of the systems seem to totally get rid of poor care :-(

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