When is mandatory training not mandatory?
Jennifer Taylor looks at how training was lost – and the risks this poses
Either the dictionary got it wrong and mandatory no longer means compulsory, or the NHS has its own definition. Over the last few months, NT has outlined the problems of time and funding that nurses face trying to fulfil their post-registration training needs. Surely mandatory training can’t have been cut too?
Unfortunately, cut it has been. And where it hasn’t been axed, some nurses can’t attend – because there isn’t enough backfill, because new recruits take priority, or because they are not prepared to do it in their own time.
There are no government guidelines that state what comprises mandatory training for all nurses. It’s up to employers. But, broadly speaking, it refers to resuscitation, fire safety and moving and handling.
‘Mandatory training is absolutely essential,’ says Gail Adams, Unison’s head of nursing. ‘You only have to look at the fire that engulfed the Royal Marsden to see how vital simple fire awareness and evacuation training can be.’
But Ms Adams says last year there were reports of areas where all mandatory training was being put on hold for a period of time. She believes it came down to the dire financial situation in the NHS.
But she adds: ‘It has to be a one-off. You cannot afford to become lax with mandatory training. It’s the thin end of the wedge in terms of staff confidence as well. If you’re not providing what you actually have to legally, then where does it stop?’
Budget pressures have also led trusts to give priority to certain staff. ‘If someone needs an update or a refresher, they might be put back because the trust is still trying to prioritise new staff or new appointments,’ says RCN head of policy Howard Catton.
He adds that healthcare providers have been at pains to point out that this is not a permanent measure. ‘I think they’re taking care to choose words which don’t suggest that the courses are no longer available or that they won’t be reviewing them later.’
Constraints on staffing and time are making it difficult for some nurses to attend mandatory training, according to Janet Marsden, a senior lecturer at Manchester Metropolitan University.
‘The training is there but unfortunately [trusts are] not necessarily quite as committed to allowing their staff to get away from their clinical areas to access it,’ she says. ‘Work priorities will mean you don’t get to go on your mandatory training.’
Ms Marsden gives the example of one trust she has clinical links with where each nurse should have two days of mandatory training each year. She says this study leave is being cut so managers can find the cash-releasing efficiency savings (CRES) demanded of them by their trusts.
‘Two days doesn’t sound much but, when you’ve got a huge number of staff, it adds up to an enormous number of whole-time equivalents which, these days, just aren’t in people’s budgets,’ she says.
And, while some trusts are becoming more creative in the way they provide mandatory training, for example by having learning modules that nurses can access online at the workplace, the question remains – whose time do they do it in? ‘I think people probably end up doing it in their own time,’ Ms Marsden says.
Nurses in the community do mandatory training in their own time, says Dave Munday, professional officer for Unite/CPHVA, and a nurse and health visitor himself.
‘There wouldn’t be staff backfill for those times when staff go on mandatory training,’ he says, ‘but, at the same time, if nurses don’t do the work, it doesn’t get done.
‘Staff appreciate that doing this mandatory training is important but they also appreciate that doing the job is important, so they [let it interrupt] their home life by covering both,’ he says. ‘When I was in practice, if I did training over three days, that would be three days out of my week but I would still have to do the week’s work in two days.’
It comes down to a balancing act, which involves juggling the priorities of training and work. In some cases, nurses have to pick one because it’s impossible to do both. Mr Munday explains: ‘If members are faced, for example, with going to mandatory training around infection control, or having to go to a case conference around a child protection issue, what you’ll find is that they’ll more than likely cancel the mandatory training to do the more important issue there.
‘They have to reschedule that training into another slot in their diaries, and that puts further pressure on their future workload.’
All of which, he adds, has an effect on morale, with staff being pushed to the limit in order to cover services.
Public confidence is important too, says Ms Adams, since it’s often when the worst case scenario happens – such as a hospital fire – that health workers come to the fore.
She adds that mandatory training is also about making sure nurses are conversant with the most up-to-date techniques. With resuscitation, for example, the European Resuscitation Council periodically alters its guidelines on the number of compressions to breaths. ‘If you’re out of sync with something as fundamentally simple as that, it could have an implication on you acting in accordance with the most up-to-date guidance based on research,’ she says.
Cancelling mandatory training will have a knock-on effect on future training, with trusts playing catch-up to ensure all nurses have access to the training they require.
When nurses miss out on lifting updates and carry on using a poor or out-of-date technique, both they and their patients are at risk of injury. And, as Ms Marsden points out, trusts could be liable for compensation. ‘Moving and handling training is supposed to show people how to do it properly, so that they avoid injuries. If people injure themselves and haven’t had their training, then they’ve got a really good case against the trust,’ she says.
Even more worrying than the immediate risks, according to Mr Catton, is the issue of training budgets being seen as targets for savings because the clinical implications of cutting or reducing those budgets haven’t been thought through.
But what of the future? Will mandatory training return to its compulsory status, or will it continue to be a soft target?
Ms Adams is optimistic that mandatory training could get back on track but says trusts still need to look at the bigger picture in terms of workforce planning.
‘I genuinely think that last year, in terms of [cuts to] mandatory training, was a blip,’ she says. ‘But I still don’t feel that we’re very good at workforce planning and therefore ensuring that we’re matching the knowledge and skills of our existing workforce and developing them at a pace that we need to deliver healthcare.’ N
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