Sometimes you can ask the right question and get the wrong answer.
Sometimes you can ask the right question and get the wrong answer. “What sort of care plan would you suggest for this patient?” is a reasonable question for example, and “Plans are for people who build large buildings. I take a freer, make-it-all-up-as-I-go-along approach, then see if they get better,” is the wrong answer.
Other times you can ask the wrong question and get the right answer. Wrong question: “Why are we even bothering with that grumpy woman in bed four?
No matter what we do she is still miserable and annoying”; right answer: “Here is an application form to be an estate agent and there is the door if grumpy, ill people don’t appeal.”
And in these increasingly confused times, when we appear to believe that those with disabilities and those who are poor are the enemy of the common man, and that repairing the economy is more important than repairing the society it is meant to serve, we may occasionally bump into something that manages to combine the wrong question and the wrong answer.
In asking the wrong question (“What can we do to make a student nurse’s life more difficult?”) and coming up with the wrong answer (“Let’s make them work in unsupported environments on low wages for a year just to earn the right to get on a course”), we have a festival of wrongness that will help nobody except the accountants - which appears to be the real motivator for current health policy.
The suggestion that students’ pre-course experiences are responsible for the difficulties at Mid Staffs is both distracting and insidious. There is no evidence that emerged from the Francis report to suggest students were anything other than the most caring of those in attendance. More importantly, if we want to ask questions about education - and, under the circumstances, we should surely ask questions about everything - isn’t it post-registration education we need to look at? We need to be investing in supportive, focused CPD for qualified staff. Training that keeps them fresh and engaged and makes them feel both invested in and valuable. Those budgets are being slashed and that training has never been so unavailable - yet that need has never been so pressing.
And then of course there is the elephant in the room. What if the culture of care in which new pre-student nurses finds themselves is a poor one? What if the HCAs with whom they work are tired, uncaring, rubbish, burdened, cruel, unsupported? What if the students we receive now, who usually have some experience in caring and a great desire to nurse well, are poorly shaped by their year of cheap labour? What if the habits they form are the wrong ones and we (lecturers, nurses and mentors alike) have to spend three years trying to undo them?
Is it feasible that the ability to feel compassion - and, perhaps more importantly, the ability to express it in a meaningful and helpful way - is going to be enhanced by employing a prospective student nurse as an unsupported care assistant and hoping for the best?
I started nursing in 1986 and in all the time I have been in or around it I have felt one thing has remained constant: we eat our young. We blame them when things go wrong, we punish them when we can’t do what we need to, and we make them live with the illusion that no matter how hard they work they will never be as good as us. This is just another example of that. Anyone would think we were trying to put them off. That can’t be the case, can it?
Mark Radcliffe is senior lecturer, and author of Gabriel’s Angel