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'We must get under the skin of applicants at interview'


It’s time to strengthen the recruitment process, says the RCN’s Howard Catton

I remember clearly being asked why I wanted to be a nurse at my interview back in the 1980s. Smugly, I gave my prepared and, what I thought to be, model answer, saying I wanted to care and I gave examples of caring as a volunteer and for relatives. One of the panel, whom I later knew as a formidable ward sister, lent forward and said: “Howard, we know why you want to care, but tell us how you think the people you have cared for were feeling.”

Caring is tough and complex work and so much more than the offer of a shoulder to cry on or a cup of sweet tea. While no one would want to think of themselves as uncaring that doesn’t mean everyone has the intrinsic ability to deliver nursing care. Caring and compassion need to be tested in the selection process and we should neither be embarrassed about wanting to recruit the best nor afraid to really get under the skin of applicants at interview.

“If an employer has concerns about the students coming to them from the local university, then they should get involved in the selection process”

It is simply not enough to rely on a candidate’s personal statement and references as these alone are an inadequate indicator of their resilience for the reality of nursing today. Asking a candidate what they would do if, on arriving home they found their neighbour distressed because their pet dog had died, is likely to be a better predictor of the candidate’s ability to deliver compassionate care than the pre-prepared answers on the application form.

The recruitment processes should also be strengthened by providing more opportunities for the NHS, patients and carers to get involved. If an employer has concerns about the students coming to them from the local university, then they should get involved in the selection process. Similarly, if a student’s attitudes and behaviours on a placement raise concerns they should be challenged there and then, rather than passing the buck to the next clinical area.

There is, of course, a distinction between those who quite simply are not cut out to nurse and bad behaviours that may have been picked up from poor role modelling and leadership or inadequate mentorship. Students should never be blamed for our own shortcomings, and leaders in every organisation should walk the talk and invite challenge when they don’t.

Nursing is a profession of the hands, the head and the heart and the move to a graduate-entry profession is right for patients. However, the introduction of £9,000 a year tuition fees for many other subjects could mean that nursing is an attractive route to obtaining a degree. An A* student could on paper look like an attractive candidate to an admissions tutor, but if their motivation is wrong they’ll quickly become an attrition statistic.

There’s a big leadership role here for the new education and training bodies (Health Education England and Local Education and Training Boards). They will be responsible for spending millions of tax payers’ pounds. Unfortunately many details about how these organisations will work are still vague and some early statements worryingly commit only to delivering a “sufficient” workforce, which is neither visionary nor reassuring.

The NHS Constitution, on the other hand, is a powerful, inspiring yet simple document that can and should be used now as part of recruitment processes. It eloquently sets out the principles and values of the NHS. If the NHS is the closest British people have to a religion then the constitution is its tablets of stone. At a time when many are worried about the future of the NHS and that it may become nothing more than a brand, what better way to ensure it lives and thrives than to recruit staff to it, across all grades and disciplines, who embody the values set out in the constitution?

Howard Catton is head of policy and international at the Royal College of Nursing


Readers' comments (3)

  • Howard is attempting to address a very real problem here in relation to nursing care but I’m not convinced that strengthening the recruitment process and/or using the NHS Constitution are the answers. That’s why I'm organising a discussion 'A crisis of compassion: who cares?' during the Battle of Ideas festival at London's Barbican Centre 20-21 Oct12.

    There we’ll explore how we tackle this supposed compassion deficit? Is the problem institutional, the NHS too big and bureaucratic, the private sector too interested in profit-making to care? Or is there a deeper cultural problem? Do we as a society care less about each other? Does the crisis in compassion for the elderly reflect a deeper lack of respect for wisdom and experience? What are the causes behind our seeming inability to care?

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  • To be honest the way admissions to Nursing courses are structured has no forebearance of what the graduate will be like. Nor is there a cohesive example of just what the average nurse even does within a hospital.
    This is where the disparity begins.
    Alot of Adult branch potentials think that the university will teach them about the body, diseases and the cures but this is not the case. This is for many reasons such as the tutors not actually havig that in depth knowledge themselves. Many will leave simply because they will be subjected to an awful lot of pseudo-psychological waffle at the expense of in depth anatomy, physiology and pathophysiology which can actually be used practically.
    Universities have yet to grasp that when these students end up in clinical placements they won't have any usable knowledge. Instead they will have a wildly variable amount of teaching that is entirely informal. i.e. based on what their mentor knows themselves. Thy will be told that basic nursing care will teach them something but the reality will be very different. It will be repetitive and entirely based on the perspective of whoever is working with them that day. In short, there will be no consistency.
    There is no assurance from the clinical environment or the classroom that every nurse has the same knowledge thus some will excel others will not.
    They will find their essays and assigmets to be about abstract concepts of the patient limited to narrow viewpoints about the patient almost entirely from a psychological viewpoint, not from the basis that they are there for a reason that relates to their body.
    Many of the students (especially in the diploma course) will often be insecure in their own intellect ad thus these abstract concepts that do not uniformly apply to everybody will be difficult to both rproduce and discuss, not just because they are often theoretical, but also because they lack a correspondence within the clinical setting.
    Students drop out of nursing courses for the following reasons.

    1. The courses lack in depth useable knowledge that makes the student confident in building a systems based approach to clinical care.

    2. The courses are highly controlled with lecturers spending as much time enforcing the rules and attendance as putting across useable science.

    3. Mentoring is wildly inconsistent because mentors lack the ability to teach - since they are not teachers but nurses. Their limitations become the students.

    4. There is an emphasis on trying to teach compassion via abstraction when universities ought to accept that to even be interested in nursing shows a persons commitment to caring for others.

    5. Nursing is a science but it is taught as a vocation regardless of the individual. This should not be the case as vocations are personal not professional attributes.

    6. Students are not given adequate preparation, respect or license to see and do what they ned to see, do and learn.

    7. Nursing tends towards an authoritarian style of teaching. Curiosity and personal adavancement is stamped upon to ensure a very low minimum is met. Still abstraction rules despite its lack of results.

    8. Many within the teaching sphere lack the understanding that the workplace is very very very different from when they were there. even if it was only five years ago the hospital has changed and moved on. The disparity between the classroom and the clinical area grows exponentially.

    9. Students are blamed for their percieved flaws yet are beholden to a very unfriendly style of teaching that rarely practises what it preaches.

    10. The course is exhausting. NUrses are infact the only students whose clinical training includes far too many hours and unnecessary shift patterns. The auld style of training is still thought best depsite the fact that everything else has continued to move on. Apprentice style training is the reason why we are stuck in this void yet this is not understood or accepted. There is no reason why students must mirror nurses shifts other than it is assumed that being there will somehow transfer knowledge. This is clearly not the case but yet it persists.

    11. (just to go one better)
    Nursing models such as Roper... are effectively outdated and un-edited. Nursing is more than 12 items yet the basis of nursing is defined as such. ADL's are issues that arise within nursing but they are not nursing itself. THey are a tiny fraction of it. They form just oe part of the care plan yet often they form a huge part of the nutsing assessment despite the variable relevance. No other nation relies on them so much for education.

    It is not the students. They are passive recipients of a profession that adamantly refuses to look the future and the present in the eyes and deal with the problems it faces.
    It is the methods and attitudes of educators and the elite of the profession that unknowingly ( i assume) sabotages any potential by not teaching what really needs to be learned. The students would be far better off learning hard science than abstract concepts of 'care' with its multiple user/recipient defined meaning.
    The potentials are rarely ignorant of what the job entails. What they are ignorant of is how much of the useful stuff will be entirely left to them to get to grips with.

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  • I feel the author is using his own experiences to legitimize something that is neither here nor there. Compassion is one part of a person's psyche. It is fluid like the sea. It can change from day to day, event to event, emotion to emotion.
    The question that Ward Sister asked you was no more relevant than if she asked you what your favourite piza topping was.

    In the same way a tough as nails personal trainer might get more results than someone who was much softer and gentle.
    They might not get better results but to pretend that one approach is better than the other is not science or art.

    I might not respond to 'compassion' as he sees it. I might respond better to a verbal 'kick in the pants'.

    An elderly person might respond better to being told strongly that they might lose their self care ability if they don't do it every time. Or if they self care when i am on duty but do not when another nurse allows him not to.

    Just what is compassion?
    The etymology is 'co-suffering' and perhaps 'do to others what you would have them do to you'

    The definition alone creates a myriad of awkward issues inerviewers will face in avoiding their own subjective biases whilst attempting to judge someone's suitability.

    The knowledge of how to do the job will always be a better measure of suitability rather than whether in thetotal absenceof patients (the interview) someone can display 'co-suffering'. It becomes an abstract with no real right or wrong answers in most cases.

    What is being suggested here is that someone who displays compassion in an interview is more likely to be better suited. But that is merely a confirmation bias and no real indicator of anything beyond their ability to impress you at the interview stage.

    The ability to be compassionate is wholly dependent on the situation practitioners are in. It is context based not a character device that can be used to predict the outcome of a three year experience that truly changes that student forever.

    This whole subject really needs a much more pragmatic approach.
    Compassion is a complex, experience based VIRTUE and not something that can be measured beforehand. By simplifying it so much there is the very real risk of excluding people who could achieve the exact same results. Lastly and perhaps cynically, it is easily faked, easily misunderstood and easily substituted in place of sound teaching - which is the real thing lacking in nursing.

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