VOL: 97, ISSUE: 07, PAGE NO: 39
Marie Downes, RGN, is senior staff nurse/clinical demonstrator, Royal Hallamshire Hospital, SheffieldMany ward staff think that Project 2000 student training is heavily weighted in favour of theory, to the detriment of practical skills. This perception is open to question, but certain factors do retard the development of students' clinical skills.
Many ward staff think that Project 2000 student training is heavily weighted in favour of theory, to the detriment of practical skills. This perception is open to question, but certain factors do retard the development of students' clinical skills.
Nursing students' supernumerary status is part of the problem. Initially, staff interpreted this as meaning that students were there only to observe and the wards were cluttered with nursing students simply standing around. Eventually, the bored students wandered off to the library with the staff nurses' blessing.
During my training in the 1980s, the patient's permission was never asked before nursing students learned a practical skill. The student would watch the procedure, perform it themselves and then - contrary to popular belief - repeat it until competence was achieved. Only then would they be allowed to perform simple skills unsupervised.
Changing attitudes and philosophies have rightly given patients more control over their own care. But many refuse nursing students the chance to practice skills on them, even under the direct supervision of a staff nurse. This means that students miss out on a chance to administer injections and suppositories, remove stitches and catheterise patients.
The shift from skill-focused placements to observation has also sparked fears that staff could be held responsible if a student makes a mistake while under direct supervision. Again, students are denied opportunities to practice important skills.
The nurse's role now includes previously medical areas of practice, such as administering intravenous therapy. This means that staff nurses are taken away from fundamental care, leaving support workers to continue in their absence. It can also mean that nursing students spend more time working with support workers or watching staff nurses prepare intravenous antibiotics.
Experienced nurses can accommodate these activities and maintain their input into fundamental patient care. They are aware of nursing priorities and, if necessary, will tell doctors they are unable to administer intravenous drugs, for example, without compromising patient care. This is because experienced staff see such tasks as an extension or addition to their core practice and know that their primary responsibility is to the patient's nursing needs.
Unfortunately, nursing students are misled into thinking that the administration of intravenous drugs is the staff nurse's job, perhaps at the expense of basic nursing care.
Finally, clinical placements of three weeks are too short to allow an initial, intermediate and final review of the student to be made. These placements only work for the most able and enthusiastic students. If short placements are to stay I suggest that the current assessment booklet is discarded as it cannot be accurate, fair, constructive or useful.
Towards a solution?
A common theme underlying these problems is the weak link between universities and the clinical environment. Bemused clinical staff often struggle to cope with changes to P2000 training after no consultation and with little relevant information.
An understanding of the theory that underpins practice and creates a questioning, reflective practitioner is welcome. But we must improve the teaching of practical skills by collaboration between the university and the clinical area. Nurses in the clinical environment need a better understanding of the student curriculum and the tools of assessment and a closer relationship with link tutors. We need someone to teach practical skills to nursing students, while complementing this by having mentors on the ward who can link theory to practice.
To this end, the University of Sheffield's School of Nursing and Midwifery has created the role of clinical demonstrator. It aims to give students greater clinical support and entails the demonstrator being seconded from the clinical environment to work in the school of nursing.
Mentored by a registered teacher, the demonstrator works in a skills laboratory where different aspects of patient care can be simulated. This means that groups of students which are too large for practical sessions with a singular tutor can be accommodated to practise essential clinical skills.
The demonstrator also spends two or three shifts a week working with nursing students in his or her clinical area, allowing them to learn at their own pace in a supernumerary capacity. In September last year the school introduced a new curriculum for students, one aspect of which is earlier and longer clinical placements.
The demonstrator's role is still developing, but it is of benefit to students. As a demonstrator I have developed my teaching skills, and the mentors have certainly enjoyed the extra support.
The demonstrator's role could have a positive impact on students' experiences in the clinical environment and influence recruitment and retention, mainly because it is obvious that the unit supports professional development.