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Practice comment

'Student plan based on an ‘alternative’ recommendation'


The loudest “noise” in the nursing profession following the Francis report and the government response has been around the proposal that prospective student nurses should spend a year working as a healthcare assistant before starting a nursing degree

Many expert comments have demonstrated bewilderment at how this is helpful in addressing the many issues of systemic failure identified in the report. Going back to the original report, rather than relying on media interpretation, has encouraged me to reflect a little more.

The relevant recommendation in the report is number 187, which is a paragraph of five sentences. The last sentence, actually offered as an alternative to the first four, is the one that has been interpreted as the requirement and has caused so much concern.

The first four sentences of the recommendation are as follows: “There should be a national entry-level requirement that student nurses spend a minimum period of time, at least three months, working on the direct care of patients under the supervision of a registered nurse. Such experience should include direct care of patients, ideally including the elderly, and involve hands-on physical care. Satisfactory completion of this direct care experience should be a pre-condition to continuation in nurse training. Supervised work of this type as a healthcare support worker should be allowed to count as an equivalent.”

And then the final sentence states: “An alternative would be to require candidates for qualification for registration to undertake a minimum period of work in an approved healthcare support worker post involving the delivery of such care.”

It seems to me that the first three sentences refer quite clearly to student nurses and formal supervision by registered nurses. This could work as a “probationary” three months at the beginning of a degree programme - it needs to be worked through whether this would be in addition to the current three years or included in it. It is a proposal that I would be happy to consider with the NHS placement providers that I work with.

The fourth sentence I would interpret as if someone has worked as a support worker under the direct supervision of registered nurses for at least three months, then they could apply to a degree programme, without undertaking the probationary three months. This seems to me to be a not unreasonable proposal and one that should not be too difficult to work up and pilot. I wonder how many of the proposed pilot schemes are using this approach?

The final sentence, the alternative, I continue to dismiss as unhelpful and almost impossible to manage logistically and financially. I am still of the firm opinion that the alternative is mistakenly offered as a cheap option, born of misunderstanding of current roles and education partnerships and would fail to address the culture and attitude issues.

June Girvin is pro-vice chancellor and dean of faculty of health and life sciences at Oxford Brookes University.

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Readers' comments (6)

  • Does the last sentence mean, if the first 4 sentences are not met then 3 months experience in a paid HCA capacity is required prior to becoming a registered practitioner? It probably just complicates things.

    It feels similar to countries where nursing registration occurs after 4 years, where the final year feels like working as a cheaper underpaid and non-registered nurse just to consolidate practice, but as a nurse to all intents and purposes. Though some places may offer higher level qualifications if also continuing studies for another year.

    Also what happens if this is then made a requirement for all other healthcare professions? Although highly unlikely to happen in my view.

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  • AS I SAID YESTERDAY. THIS PLAN IS NOT JUST CONFINED TO NURSING. Many LETBs informed Education Providers on the 19th April that:
    "The Department of Health wish to explore and pilot pre-training placement experience for NHS commissioned students. As part of this development Health Education England would like to understand:
    How many candidates applied for a place on a paramedic, ODP and nursing programme (by field) for start in 2012/13 How many of those selected already had some care experience (e.g. as an HCA, care home support worker, other care worker?
    Health Education England would like indicative responses by the end of next week (26th April){within 5 days!!!} with full responses to follow thereafter."
    HEE are rolling out a pilot covering other professions, not just nursing.

    This is a crazy, unnecessary and expensive pilot.

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  • This seems like a reasonable plan. However, three months I think is plenty of time for the student nurses to prove their ability with hands-on care, and it is unneccessary to spend any longer than this.
    Care work is challenging and I think a good basis for the students to build their skills on.

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  • Will there be some sort of assessment going on at the same time as the prospective students are completing their time as a HCA?

    How will they be judged as suitable for nursing?

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  • Go back to a 4 year degree with 2.5 years of practical experience as our degree nurses did when the traditional non-academic course was 3 years. It has been a disaster separating education from practice, the apprenticeship was a good grounding with post-registration specialist and academic enhancement. Not sure how it will work with increasing private provision of services, "employers' may well charge universities for the experience and supervision of student!

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  • Will be interesting to see / hear how the pilot goes when moving people around acute hospitals, community care, mental health, learning disability care, intermediate care, long-term care + rehabilitation, palliative care, paediatric specialisms, to name a few.
    Then there's similar in private and voluntary settings too. (Note for some ppl, voluntary does not mean you're not paid - some are salaried, some are volunteers, all still providing a valuable and needed service)

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