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OPINION

Reflections on a return to practice

  • 15 Comments

As I walked back onto a ward after 25 years away, I experienced a mixture of familiarity and cold fear.

I had been out of nursing to raise a family and had just started a Return to Practice course. This was my 14-week ward placement. I felt like a first year student, and yet, at several decades their senior, I also felt much more ‘life savvy’ and worldly.

I started at square one once again: blood pressures, temperatures, pulses, and helping people in and out of bed. Thank goodness people hadn’t changed, because everything else had. Even taking a temperature was different.

What struck me early on was how much paperwork there was. When I qualified in the 80s, there was a single ‘kardex’ where all nursing care was reported and communication happened through an ongoing recording process. Now, at the end of each bed was an A4 file, with dividers sectioning-off different aspects of the patient’s care. Inside each section were 3 or 4 different pieces of paper, each recording an element of care - e.g. care of the venflon (drip attachment); care of the catheter; a fluid chart; an observations chart; an ‘integrated care pathway’; a skin and pressure area assessment chart; a drug chart; a property indemnity form; a hygiene needs chart and often, many more still. Each chart needed to be assessed at the beginning of a shift and the requirements met. Then, every nursing action had to be recorded on the chart and any untoward changes reported to senior staff. I was shocked by how long it took to record properly all that was now legally required.

Part of the night staffs’ duties were to fill each file full of the relevant paperwork for patients being admitted the next day. This could take several hours.

On one occasion, was told off by a healthcare assistant for ‘talking to the patients too much’. ‘We don’t have time to talk’, she said - ‘we just have to do what we have to do’.

I wondered what had happened to the personal touch I had been taught about all those years ago. But I’m afraid, with the brazenness of increasing age, I just carried on doing what seemed right to me: talking to patients even if I didn’t have time to cross every T in the records, staying a bit longer than I should have done in the anaesthetic room when I sensed the patient wanted a familiar face and getting a relative a cup of tea, even when it was they who should have paid for it, technically.

Being a nurse is about being a human being in a very specific and privileged role. It is about being allowed to be close to someone at their most vulnerable, afraid, and when their defences are down. It is about having the highest possible standards of professional care and personal conduct. Furthermore, it is about delivering care with compassion, sensitivity and tolerance. Mostly, from my recent experience, I would say that is often the case. But we have to watch very carefully that the drive for order, accountability and the meeting of targets does not erode the foundation and fabric of nursing altogether; that in our quest for improvements and ‘quality of care’ we leave no room for being human.

Sally Moodey recently completed a Return to Practice course, having been out of nursing practice for 25 years.

  • 15 Comments

Readers' comments (15)

  • Well done, I do hope you can keep humanising the system. It is so important to keep the spirit of good practice going but as you have found it can be difficult in a 'tick box' culture. It requires knowledge, understanding, thought, confidence and time none of which seem to be particularly valued aspects of nursing at present. Those with power in the NHS pay lip service to these qualities but the reality is too often different.

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  • Thank you for writing this article Sarah. It was very interesting, especially as I'd attended a lovely interview recently and received a letter of acceptance on a return to nursing course this week. I enjoyed learning about the changes that you found on the ward. Every area is so different now; and although I've been out of clinic nursing for 6 years I had not heard of all the files required on the ward. I look forward to my course in September with more awareness of the ward observation system and good practice of listening, observing and talking to patients because how do we know how they are feeling if we don't talk to them?

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  • Excellent article and hopefully we can improve nursing, as suggested by maintaining the human touch, without which it does not seem to be nursing at all.

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  • Similar experience for me, though I had practised in non NHS settings, a return to practice in NHS was a real eye-opener. The Course at Bangor Uni was very good and was essential in the deluge of paper work but when completed, the practical side had to be done on the wards. The hosptial was low on funds and would only employ Bank Nurses so I was filling in, on a ward that was short staffed and where help for me was limited. I knew so little about proceedures, even dressing pack were different and I found the responsibility of looking after different people every shift, daunting. Only a brief report was given and I didnt know any back-ground info. If the patient, relative or Dr asked anything about what was happening on a previous day, I couldnt answer. I did not have 6 months mentored practice-I was on my own! I just could not cope! I like to know my patients, know their history, follow them through the whole of their recovery and this was impossible. I retired, reluntantly because of this. I hope managers will give better mentorship to "Back to practice" nurses

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  • Anonymous | 9-Jul-2012 11:36 am

    what an appalling waste, and so discouraging and demotivating for you, but I can well see your point and you would probably have had to carry the can if anything went wrong. It seems that according to management and budgets things are done well and properly in some areas and not others but in some places nothing ever improves even though the know how and willingness is often there.

    When I qualified at the end of the 70s I was always optimistic, with all the talk of change, that things would improve but some things have very sadly just got worse and especially as far as good patient care and working conditions are concerned. I also felt badly let down by my profession and am now retired.

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  • Sally, Well said, I applaud your sentiments and your values. It will be up to us as RTP nurses to try to reintroduce humanity into nursing, some nurses are able to do this naturally , some need to be taught , and there is nothing better than a good role model. Like you, I have found that the quality of mentorship is variable, and like others on here have been shocked that I have been expected to work with very limited knowledge of the patients, as some of my qualified colleagues seem to do. I have frequently received "I don't know" as an answer, with no apology, or attempt to find out, or advice on how I could find out. As with everything in life , do not assume that others know more than you do, or that you can rely on them to do what they are supposed to. I realise that there are many barriers to good practice, and many staff are disillusioned, but this is nothing new, and we must use our new found motivation and positivity well, so that we can help to improve care for our patients and better support our nurses.

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  • I am at present working as an HCA in General Practice.. I qualified as SEN in the seventies. I would very much like to do a return to practice course and become a Practice Nurse, they aren't doing much more than I do but obviously reep the benefit of a larger pay packet. Where do I find out about this course?
    Keep up the wonderful work you all do.
    Many Thanks

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  • Lucky are those nurses who can retire and leave the battlefield. Others, like myself, won't be able to retire for many many years and will probably end up being retired on health grounds.
    Well done Sally for being so brave returning to nursing after 25 years and for daring to be what we are trained to be - there for our patients.

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  • Hi there,

    Please can any one give me an idea of how to start RTP course, I live in London, and have been searching universities which offer but can not get enough information, I also need to know do I have to pay towards the course.
    Thanks your advice will be appreciated.

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  • I live in SE London and I am wanting to return to nursing but having difficulties finding a hospital that would support me in return to nursing. I feel I am hitting a brick wall as I am being told by several universities unless you have a clinical placement we cannot help you. That is easier said then done and I don't work in a hospital setting. I have found most hospitals will only support pre-reg students. Can anyone advice me on what they did to secure a clinical placement?

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