Sunday, 15 November 2009

Who will do the nursing?



Much talk has taken place in recent days on plans for all nurses to be trained to degree level from 2013. I think a lot of the chatter and debate has missed the point. 'Degree level' is just a label, it doesn't mean a great deal on its own, I think the problems with nursing training are similar to the problems with medical training that have become apparent in recent years.

Good old fashioned basic nursing has become devalued as an entity in recent years, it seems that an apprenticeship in one's trade is simply no way to learn the ropes in our current politically correct times. Basic things such as feeding patients, washing patients and attending to bedpans are beneath some modern nurses. A little knowledge can be a dangerous thing, a quick superficial glance at the science behind medicine seems to have inspired quite a few nurses to bit off a bit more than they were able to chew.

I do not wish to single out nurses, the same types of problems exist with the training of doctors. The basic science has been dumbed down, the apprenticeship has been lost and the ward hours are just not there anymore. The same is the case for nursing training, the ward hours and apprenticeship has been lost at the expense of satisfying politically correct mumbo jumbo spewed forth by educationalists. The subspecialisation of educationalism is to blame for a lot, invariably idiots who were not very good at the job end up doing all the teaching despite the fact that they haven't been on the front line for years.

This loss of the apprenticeship and the reduction of basic standards is a direct result of one thing, money, the government does not want broadly trained competent workers who have learnt the ropes adequately, they want to isolate individual competencies and shift work down to people who have had way less training than in years gone by. To see this in action all one has to do is see who does most of the basic nursing on wards, it is done by 'health care assistants' who have had very minimal levels of training, they are the modern day nurses.

Nursing is no longer good enough for modern day nurses, a lot of them now go into nursing as an easy route to becoming a quasi-doctor or 'noctor'. In life you get what you pay for and less training and knowledge inevitably results in a lower quality of service for patients. Many nurse specialists who specialise in areas which are suited to their skills and training, for example stoma care nurses, district nurses or various sub speciality liaison nurses, are a great asset.

The problem comes when nurses are promoted into jobs that demand a broad based understanding of medical diagnosis and management, for example the nurse in the Walk in Centre who practises independently or the scarily 1984-esque nurse 'consultant'. Some experienced nurses can just about get away with it, some of the time, however when inexperienced nurses are given these roles the consequences can be rather disastrous as well as expensive. One example is the massive failure of nurse-run Walk in Centres to reduce referrals to other health services.

The government cares not for quality of care, all is interested in is privatising the NHS and selling it off to private corporations. Breaking the medical profession's monopoly on doctoring has been part of this corrupt privatisation process. A side effect of this has been the devaluing of proper nursing which is sad to see. There is a real need for patients to be properly nursed and in the future we'd be better off having nurses doing nursing, rather than letting anyone with a couple of weeks training take their place and moving trained nurses into jobs that are outside of their expertise and training.

32 comments:

GrumpyRN said...

Oh dear God! Can we please move away from this rubbish? This has been done to death on your colleague NHS Blog Doctors' blog. Melanie Phillips cites a document 150 years old as relevant, so real evidence based practice there then, should the medical profession go back 150 years - laudable pus, frock coats, typhoid, dysentery etc., etc.
Modern nursing is very different than portrayed by Richard Gordon and Barbara Windsor; it is high tech, high knowledge. Research shows that being nursed by educated nurses makes a huge difference to patient outcomes - as does having good nurse/patient ratios. Unfortunately, as in everything else in this country, the accountants rule and nursing numbers are cut to the bare minimum (and sometimes below) to meet some target that management or government have set. But you know all this already Ferret.
Just curious, what is "proper nursing"? Do you mean the consultant doing his ward round with all the nurses running behind him afraid to disagree, nurses expecting to bag a junior doctor in marriage and then give up nursing, Sister in her frilly hat making cups of tea for 'Sir' or matron getting what she wants rather than what is evidence based? There were always health care assistants; they used to be called auxiliaries. So please do not blame nurses for trying to improve themselves, if doctors’ training is crap, then as usual if there is any slack the nurse will pick it up.

Garth Marenghi said...

Hmmmmm.

Proper nursing means doing the basics right, obviously this is different for every subspecialty of nursing.

For the surgical nurse it includes things such as getting pre-op patients ready for theatre and making sure nothing has been forgotten, it means caring for the sick post operative patient, it means ensuring the patient is well fed and watered, their pressure areas and surgical sites are taken care of, it means nursing the patient back to fitness.

Your criticism makes it appear you have not read the piece.

I have nothing wrong with nurses improving themselves, I make specific reference to a lot of specialist nurses who are appropriately empowered in certain areas in which they have experience and expertise.

In fact your 'improvement' defence is a fairly standard one used by the lame ducks at the RCN whenever a new nursing role is questioned.

It is not just improvement when people are empowered well beyond their training and expertise.

Is it 'improvement' for a cavalier junior surgeon to start operating on his/her own before ready?

Is it 'improvement' for HCAs to be left to care for sick patients with no support as they rountinely are in the modern NHS?

Is it 'improvement' paramedics to be empowered as independent medical diagnosticians after a short course in clinical skills?

I feel very sorry for the nurses that are left to pick up the pieces from this mess, as you say they are routinely short staffed partly down to the fact that so many of their colleagues have been promoted to non-nursing roles.

However if I choose to start practicing in areas of which I am not yet ready I would expect to be up sh*t creek without a paddle if things went wrong, I know not to do this because I know that my position comes with responsibility. The problem with many of these new 'practitioner' roles is that they want all the positives of responsibility without any of the negatives.

The nurses in WICs working independently as quasi-GPs must take some responsibility for taking on roles for which they are not trained, even if they are too stupid to realise how out their depth they are, it cannot all be blamed on the government, the nursing community should take some responsibility for taking on way more than it can competently chew.

GrumpyRN said...

Proper nursing means doing the basics right, obviously this is different for every subspecialty of nursing.
 For the surgical nurse it includes things such as getting pre-op patients ready for theatre and making sure nothing has been forgotten, it means caring for the sick post operative patient, it means ensuring the patient is well fed and watered, their pressure areas and surgical sites are taken care of, it means nursing the patient back to fitness.
 >  I agree, but with education the nurse understands why
 
In fact your 'improvement' defence is a fairly standard one used by the lame ducks at the RCN whenever a new nursing role is questioned. 
>  Does not make it wrong
 
It is not just improvement when people are empowered well beyond their training and expertise. 
>  Education!!
 
Is it 'improvement' for a cavalier junior surgeon to start operating on his/her own before ready? 
>  We are discussing nurses, these are the kind of things a well educated and confident nurse would hopefully stop.
 
Is it 'improvement' for HCAs to be left to care for sick patients with no support as they routinely are in the modern NHS? 
>  I do not recognise this in any hospital I have been a patient in or worked in, this is a financial decision
 
Is it 'improvement' paramedics to be empowered as independent medical diagnosticians after a short course in clinical skills? 
>  I am assuming you mean the Emergency Care Practitioners, do not know anything about them, it is not a nursing role
 
I feel very sorry for the nurses that are left to pick up the pieces from this mess, as you say they are routinely short staffed partly down to the fact that so many of their colleagues have been promoted to non-nursing roles. 
> This is a fallacy, nurse staffing is decided by accountants not by front line nurses. If these promoted nurses went back to the bedside there would be redundancies and there would still be short staffing

However if I choose to start practicing in areas of which I am not yet ready I would expect to be up sh*t creek without a paddle if things went wrong, I know not to do this because I know that my position comes with responsibility. The problem with many of these new 'practitioner' roles is that they want all the positives of responsibility without any of the negatives. 
> Nursing is aware of its accountability and responsibility and we all make mistakes sometime

The nurses in WICs working independently as quasi-GPs must take some responsibility for taking on roles for which they are not trained, even if they are too stupid to realise how out their depth they are, it cannot all be blamed on the government, the nursing community should take some responsibility for taking on way more than it can competently chew. 
> Can't comment, we do not have them in my area but personal abuse is never a good argument.

Radiographers - degree level education, OT's - degree level education, Physios - degree level education, Nurses - even the Diploma level is too much according to your thinking.
You have to make a decision, do you want to be nursed by highly qualified well educated people or do you want someone who can perhaps scrape a few 'O' levels together (yes I'm showing my age). Always remember, “the doctor told me to do it” is no longer a valid excuse for nurses so we need to know and understand what is happening around us.
Good care begins with having sufficient educated, trained staff to do the job effectively. Not trying to do it with the minimum you can get away with – a financial decision.

Garth Marenghi said...

this is a general argument, so it's not fair to ignore the general point and then claim that this can be narrowed down to a few random things that you wish to shrink things down to!

it is also not 'personal abuse' to say that some people are working outside their areas of competence,

the WICs, the ECPs, HCAs in certain certain circumstances are all examples of people who have been put into situations for which they are not adequately trained

if you had read what I argued then you would have noticed that I was saying that nurses should be educated to a high level in the appropriate areas, it simply doesn't matter what name you put to it,

however what I am saying is that as a general point, there are too many educationalists getting involved in education and the hands on learning is becoming far too infrequent, meaning that the balance is being lost in creating a well rounded apprentice who is ready to do the job upon the completion of training, this is why the basics are not being done well in my opinion

"Good care begins with having sufficient educated, trained staff to do the job effectively. Not trying to do it with the minimum you can get away with – a financial decision."

i couldn't agree with you more on this one,

this is precisely why we should not accept people being educated way less to do the same jobs that have been done previously by far more skilled and educated people for many years before them,

this results in a lower quality of care for patients and this is precisely what the government's reforms have directly led to

greg cryns said...

you said, "what I am saying is that as a general point, there are too many educationalists getting involved in education and the hands on learning is becoming far too infrequent, meaning that the balance is being lost in creating a well rounded apprentice who is ready to do the job upon the completion of training, this is why the basics are not being done well in my opinion"

I could not agree with you more. My wife is going for her Nurse Practitioner license and she also agrees with that idea. But in her case there is no apprenticing going on.

Nice article.

the a&e charge nurse said...

Dear, oh dear, citing 'mad' Mel Phillips as an authority on nursing (see Spectator item) - isn't this a bit like linking to the Mail whenever the issue of GP pay comes up, or medical blunders in hospital?

http://www.dailymail.co.uk/news/article-432882/Gloating-GPs-delighted-lucrative-pay-deal.html

http://www.dailymail.co.uk/health/article-1221971/Boy-10-dies-meningitis-doctors-wrongly-diagnose-migraine--despite-mother-insisting-killer-disease.html

Such a disreputable link (Phillips) simply illustrates how deeply medical trades unionism runs in certain sectors of the medical community.

Grumpy (above) has already demonstrated how little insight some doctors have into what nurses are expected to do nowadays.

the a&e charge nurse said...

Incidentally, Ferret, Nurse Anne has dealt with academic standards amongst nurses in some detail - I know you are usually very resistant to research findings but the data highlighted by Anne PROVES that better education actually saves lives - I'm sure 'Mad Mel' must be furious that her piss-poor 'analysis' does not bear any kind of scrutiny?
http://militantmedicalnurse.blogspot.com/2009/04/research-into-survival-rates-of.html

Garth Marenghi said...

yep ae CN,

typically rock solid argument from you, addressing none of the points at all!

might want to do some reflective practice on that and come back to me when you actually want to make a decent point

the a&e charge nurse said...

Ferret - do you understand the difference between a hypothesis and evidence?

A HYPOTHESIS might go something like;
Nurses who do a two-week course then act in a pseudo-medical capacity are far more likely to harm patients (when compared to junior doctors, say).
The hypothesis might be bolstered by claims about the difference in educational attainment between the two respective groups, etc.

Then we have EVIDENCE.
Evidence relies on data that has been collected in a scientific way that either proves or disproves a hypothesis.
As you know personal opinions do not usually count for much once we apply scientific criteria.

So following on from the hypothesis (highlighted above) the evidence would tend to corroborate the points you are making about harm being done to patients by inadequately trained nurses?

My problem is that you seem to be relying on the likes of Mel Phillips (rather than verifiable data) to support your thesis?

I assume you have resorted to a failed Daily Mail churnalist because the later (evidence proving nurse incompetence) is in rather short supply, or, as I have suggested before, virtually non-existent?

Now why is that I wonder - perhaps we should ask Mel?

Garth Marenghi said...

that's for the patronising crap AE CN, you are certainly good at that,

less training, less quality i'm afraid

no amount of your rambling twaddle gets around that i'm afraid

do you understand a polite f*ck off?

i have heard your same old lame duck arguments over and over again, we have agreed to disagree on this so please refrain from repeating the same old tired points

if you don't like what you read then don't come here and read it

the a&e charge nurse said...
This comment has been removed by a blog administrator.
the a&e charge nurse said...
This comment has been removed by a blog administrator.
Garth Marenghi said...

anymore of the same tired comments will be deleted i'm afraid,

you have been previously warned on this

GrumpyRN said...

Dear me Garth. Being a bit touchy deleting posts that disagree with you. I can understand deleting posts that are abusive, but you started the name calling and abuse and A&E Charge Nurse was polite and if his comments are wrong then he will be picked up on them by others – it is called debate. But let me see if you will allow me to answer.

"however what I am saying is that as a general point, there are too many educationalists getting involved in education and the hands on learning is becoming far too infrequent, meaning that the balance is being lost in creating a well rounded apprentice who is ready to do the job upon the completion of training, this is why the basics are not being done well in my opinion"

> Educationalists in education - jings, who would have thought it; someone who knows something about teaching being involved in teaching.

> Hands on learning is becoming far too infrequent - not in any nursing course I am aware of, I believe that it runs about 50%, oh and by the way, this is governed by EU law. It also means that nursing students do not get the long holidays that other students get and are also used as cheap labour in ward areas.

> this is why the basics are not being done well in my opinion - no, again this is because you are trying to do it on the cheap and don't have enough staff.


"this is precisely why we should not accept people being educated way less to do the same jobs that have been done previously by far more skilled and educated people for many years before them"

> More educated – yes, but we are trying to rectify that (against appalling prejudices such as yours). More skilled - I doubt that, skills are learned; therefore given the same opportunities we will be just as good or better than the people who have gone before.

Garth Marenghi said...

educationalists are becoming more and more specialised and have frequently forgotten the reality of what they are trying to teach, that's the point i was making

also you're skills/education point is nonsensical, skills are complex things and one's innate ability combined with one's education/training/experience all come into play

complex high end skills like medical diagnosis and management need a high level of education and training to be done well

this infrequently doesn't happen in the NHS

ps AECN has been warned about repeating the same old tired arguments over and over, once of twice is fine but if he/she chooses to keep going on my blog then there will be a limit

Nikita said...

When I was a student psychy nurse in the early nineties, I do remember my tutor stating somewhat prophetically, that qualified nurses were allowing their roles to be devalued by allowing skills that were were once part of their remit, i.e, counselling, that is to me - actually listening and talking to patients, O.T., etc, to be farmed out to other professionals. They allowed this in the belief, that they - the nurses - were somehow to busy to do (or above?) these tasks. He stated that eventully, he thought, that all RMN's would have is paperwork. To a large extent, this is now true.

My first position after qualifying, was in the community in a rehab hostel. I was horrified to learn that I could not actually 'counsel' the residents as I did not have the required certificate. Anyone, who had not had a background in mental health, but had the certificate, could 'counsel' the resident - but not me! Doesn't really make sense, does it?

I cannot comment on general nursing that is hospital based, as I obviously have no experience of it. But I would suggest you read Militantmedicalnurse who is just as angry as you about the devaluation of the nursing role. She exists on a ward where qualified staff have no time to offer hands on care due to appalling staffing levels and skill mix. I do fear that degree nursing will be used as a further excuse to operate at these dangerous levels.

With regards to Melanie Phillips article. I presume she had based this on the report in the Nursing Times that research showed that a percentage of nursing students felt that basic skills were of no use to them. Although I accept that more knowledge gained in a University is bound to be helpful, ward hours and an apprenticeship is the foundation of nursing/patient relationship and is truly what nursing is about.

I fear GPs are falling into the same trap, as seeing themselves above some roles and handing them over to the practice nurse. In my own practice - that is, as a patient - the nurses role encompasses COPD clinics, diabetic clinics, wound care, depots, innoculations, annual check ups, bloods, ICP and so on, the list is endless. It is harder to see the practice nurse than it is the doctor! In view of this, I can see why some nurses are irritated by said doctors viewing their role as more lowly than theirs. It appears that they are quite happy to hand over these roles to the nurse, while receiving the fees themselves. Our dear government seems intent on deskilling GPs by further removing arears of care - but beware GPs! - you are also deskilling yourselves by handing over responsibility to practice nurses.

If I had my time again I WOULD have chosen medicine, but in my era, us silly females were directed into certain roles which I happily adopted. I entered nursing in my thirties. I am a nurse and am over the moon to be so! I love hands on care and would never ask a carer to do something I am not prepared to do myself. But in my work setting, I have the time. Hospital nurses probably do not. If a carer approachess me and asks me look at this or do you think this?, I reply that I am not a doctor, see one!

I really like your blog. You seem like a damned good egg!

Nurse Anne said...

Jesus.

Degree trained nurses are not taught to be above basic care. They get plenty in the way of hands on placements.

There is not such thing as "the modern nurse who thinks she is too posh to wash". That is a myth perpetuated by fuckheads who don't know better or cannot understand the situation. I am degree trained, have nursed for 13 years, and have worked with many new grad nurses.

I have yet to meet any highly educated nurse who thinks that he is above basic care. So I am thinking that maybe you are just a liar, or a goofball repeating statements that you don't understand.

I trained at one of the top science universities in the US. I had to have two years of uni level science and math and top grades to even be considered for their nursing program. I also had to be in the top 10% of my high school class. And even then they had over 50 applicants for every one place.

Our nursing instructors had masters degrees in nursing, doctorates in nursing and PHDs.
They taught us to be bedside nurses.

They taught us that hospitals should be rid of care assistants and highly educated nurses should do all care. They taught us that if we didn't do basic care ourselves that are patients would not be assessed properly and that would lead to total fuck ups. They taught us that nursing was a completely different science to medicine and that we were nurses not junior doctors. They hated the whole diagnose and prescribe thing like the devil hates holy water. Their degrees were in nursing, not playtime medicine.

These same instructors, despite holding master degrees and higher still did shifts at the hospital as bedside nurses. They attended our placements with us, and needed to be up to date. Therefore they stayed in touch with basic care and reality.

They taught us that if we were ever working in facility where we were taking on more than 6-8 patients at a time that we needed to get the hell out of there and find a new job. "If you are working for a hospital that makes you take 10+ patients you will have no choice but to triage and delegate all basic care to care assistants. THIS IS BAD. Never EVER work for such a hospital". These were nurses with masters degrees who were teaching us these things.

"such a hospital" is every fucking hospital in the NHS.

The new grad nurses are very well aware that people think that they are too posh to wash. When patients are having an acute excab of CCF and are short of breath these new nurses are putting people on bedpans and handing out meals rather than notifying the on call and getting orders because they are so afraid of being labelled as "too posh to wash" by visitors, health care assistants, and guys like you.

Remember you only have one nurse for a large group of patients. If she isn't getting the lasix etc for the ccf guy then NO ONE is.

You wouldn't believe the shit that is happening because many of these new grads are on a mission to prove that they are not to clever to care and all that. I have seen patients with an HB dropping faster than a hooker's knickers not get intervention and their blood etc for hours and hours because the lone RN was getting grief off of visitors and patients for not getting the bedpans out fast enough.

You people need to stop it with this bullshit (perpetuating the myth that degree nurses can't do basic care) because people are getting hurt.

Nurse Anne said...

You people need to stop it with this bullshit (perpetuating the myth that degree nurses can't do basic care) because people are getting hurt

Should have said "the myth that that won't do basic care". They all prefer doing basic care.

I don't like your link but agree about NOT using degree nurses as pseudo docs. Is that clear?

Nurse Anne said...

And forget about the practitioner thing. Never met one personally even though I know many highly educated nurses I don't know of ONE who wants to be a practitioner.

Zarathustra said...

All the hoo-hah over whether degree nurses will be less able to do basic tasks would only have validity if degree nursing students do less hands-on work than diploma ones during their training.

But they don't. Whether you're doing a diploma or a degree, student nurses spend 50% of their time out on clinical placement and 50% in universities regardless of what kind of qualification you go for.

Garth, can I pick you up on a point in your post.

The same is the case for nursing training, the ward hours and apprenticeship has been lost at the expense of satisfying politically correct mumbo jumbo spewed forth by educationalists.

Well, if 50% of nurse training is on placement doing 37.5 hour weeks and the three year course has a 45 week academic year (student nurses don't get the insanely long summer holiday afforded to other students) then a bit of back-of-a-fag packet maths reveals that a student nurse has to do 2531.25 ward hours before they're allowed to qualify.

Oh, and the margins allowed in that total for sick leave etc are ridiculously narrow. If they've been off sick more than a couple of weeks, then they have to make up the hours somwhere, or they don't qualify.

So, when you say that the ward hours have been lost, what on earth are you talking about?

Garth Marenghi said...

well from what I've seen in several NHS hospitals in the last few years the basics are not being done

pressure sores developing after routine low risk elective surgery, basic feeding and cleaning of patients

whatever the reasons for this basic nursing is not being done well and the senior nurses are well aware of it

maybe a large reason for it is the shortge of nurses on the wards, and maybe this is partly down to many nurses being enticed into jobs with more lucrative pay that do not really suit their abilities, who knows

Zarathustra said...

Who knows indeed.

Well, who knows apart from everybody who has ever read Militant Medical Nurse, because those people know.

Nurse Anne said...

Gareth if every nurse who has ever left bedside nursing to enter more lucrative jobs that don't suit their abilities offered to come back and work on the wards MANAGEMENT WOULD NOT HAVE THEM. MANAGEMENT WOULD NOT HIRE THEM.

Nurses on my ward who have been nurses for 35 years are band 5. Nurses who have been nurse for 10 months are band 5. They will not promote anyone. There is no ward structure. When they got rid of my ward system they refused to hire another or promote any of us. They won't post the job. We have no sister. The job is being shared by two of our staff nurses. They do as much as they can on top of doing their shifts. One has been a nurse since the 1970's and one since 2002. Both are on the same pay band and it's the same one that I am on.

They will not promote any of the experienced RN's to senior staff nurse or charge nurse either.

Nurse Anne said...

That should ahve read "WHEN THEY GOT RID OF MY WARD SISTER". Not ward system.

Nurse Anne said...

I was just thinking of something last night that I wanted to add.

A nurse friend of mine recently went into one of these highly paid off ward pen pusher jobs.

She has been a great staff nurse. She didn't want to leave the wards but her husband left her with 2 young children to support. First off all, ward nursing does not pay enough to support a family, especially if your ex is getting around paying child support because he has gone overseas.

The second thing you must realise is that the hours that ward nurses MUST work completely operate outside of the hours that child care providers work. WE work, days, evening, nights with no pattern. If we are days we start at 0700. Creches and childminders don't start until 8 or 8:30 AM. If I am on an evening shift I finish at 10 PM. Child care providers stop for the day at 5 or 6.

If I am nights I would have to pay someone to care for them at night (impossible) and during the day while I sleep. Our shifts are in no kind of pattern, they are completely random and we don't get enough notice of what we will be working to arrange child care. Family friendly my ass. You can't work on the wards and have shifts that start and finish when childcare is available. I can't come in early and leave early or come in late and leave late or work shorter shifts because that would often leave the ward with no trained nurse.

Many of us have no family around and I have a child with special needs that cannot just be dumped on a neighbour.

Hiring a live in nanny is no option. Even though they are less educated than nurses they are get paid more.

I am lucky. My husband earns a good salary and he is also around to take care of the children before the nursery/childminders open and shut for the day. He uses up most of his annual leave to look after kids since I rarely get enough notice of my shifts in time to get childcare booked, and most of my shifts are outside of childminders working hours. This is what allows a mother like myself to actually be able to hold down a job on the wards and avoid a 9-5 fucktwit penpusher position.

If something happened to him or he left us and stopped supporting his children as my friend's husband did I would have to quit my job effective immediately or leave my young children alone when I work. There would be no other option. No other option. I don't earn enough to support my family anyway and as they won't promote any ward nurses even if we are acting sisters......

It scares me. If something happened to my husband I would be straight into a penpusher/fucktwit with clipboard 9-5 position in order to support my family and have someone to look after my children while I worked. No other choice.

This happens a lot. Nurses are primarily women and women are the ones left holding the baby and need jobs that pay enough to support a family, pay for childcare, and allow you to work 9-5 hours. Ward nursing does not allow for this IN ANY WAY SHAPE OR FORM REGARDLESS OF THE TRUSTS FAMILY FRIENDLY POLICY BULLSHIT.

Don't blame the nurses who have left the wards for any of this. Not one nurse can be blamed for this clusterfuck of a situation.

Nurse Anne said...

And I guess that I should also make the point that many ward nurses are leaving ward nurses for lower paid jobs elsewhere, just to get out. There is, in my opinion, more of that than there are nurses going for noctering.

Fox in sox said...

hey nurse Anne, chill a bit. We appreciate you. On my ward we have sound reliable nurses, mostly fillipino or south Asian, but also a few sound English ones. On some of the wards I go to see referrals and it is positively scary. How much of this is the downward spiral where an understaffed ward develops a sickness and morale problem, which then affects recruitment...

I agree with FF though on medical educationalists, great in theory but in practice absolute Hoons. Those who can do, those who can't teach. Those who can't teach, teach teaching.

The problem is that good nursing is like good doctoring, not easily measured, yet easy to recognize when seen. It doesn't lend itself to the target and box ticking mentality so beloved by the management.

I remember your article on matrons. The problem is that the nurse tutors are likely to be drawn from this pool rather than good clinical nurses like your goodself. Medicine has the same problem, with the penpushers in the driving seat.

At least the destruction of medical competence keeps myprivate practice strong. Sadly it seems the exit for nurses seems to be emigration. When Filipinos are denied visas we are sunk.

Emily said...

What difference does it make to you how Nurses are trained? Let's look at the facts.

Nurses are now put in dangerous situations where they are caring for more than their safe load of patients. Mixing dangerous drugs that YOU ordered, that, over the pond, a pharmacist would be mixing and preparing. Now, as militant medical nurse would put it, she has a a dozen patients to take care of, and a dozen IV's to mix, drug rounds to do, things to order, care assistants to delegate tasks to carefully, whilst simultaniously making sure your patient doesn't deteriorate so her's and your ass aren't on the line. And you want a thick as shit nurse to do this? To care for your child or parent if they were in the same situation, a patient on their ward? No, you'd want an intellegent, bright and quick thinking nurse. Basic care is now a small fraction of the nursing role, which is constantly being delegated to HCA's because Nurses have 1000's of other things on their plate, to do at the end of their shift. Nurses WANT to be involved in basic care, why? So they can assess the condition of their patient. But they constantly can't. Being "too posh to wash" isn't an option, as it's part of the treatment of the patient and it's in our job description!!

I'm studying to be a Nurse and there are people on my course who are thick as shit, they have no sense of real patient care and they also cannot keep up with the frankly, elementry level of science and nursing theory we are being taught this year, our first year. Thankfully, they will probably not make it through the end of the course, since they need to be assessed at a high standard of their competancies, particually in Medications, Maths, Science, and basic and intermediate Clinical Skills. They just don't have the Brains for it. I'm doubtful if they could pull of the basic care stuff too. I'm also grateful that people like them won't have the oppurtunity whatsoever to even make it onto the course from 2013.

Having just a "degree of Common sense" or "good heart" and "caring" isn't a good enough standard anymore to be a Nurse. You need to be diligant, attentive, and clever. You would want your nurse to be aswell. Sure, there are nurses out there who have been doing it for 30 years and just as good, but the NHS is moving fast and Nursing care is changing, we can't wait another 30 years and churn out a few good "bunch" of Nurses out of the tens of thousands who did a diploma in the last few years. The standard needs to be high from now on.

Jump of your high horse and allow Nurses the development in their training they deserve. They are working under your licence, and caring for your patients, I can't seem to fathom why you would want a dullarse Nurse when the NHS is ever-changing, aswell as the role, doing that for you, when yours and the Nurses ass is on the line. Stop banging the drum about Junior doctor training aswell, it's a totally seperate issue.

Nurse Anne said...

Emily, You have to remember that these doctors are just bunch of little boys comparing willie size to see who is the bigger man. They think that educated nurses want to compete with them and take over their job, or aspects of their jobs. Yeah right. As if. No Thanks. Puke me out the door.

Eventually my husband will transferred back stateside with his job and I'll be earning more as a bedside nurse there (please god let it be California or New England and not the south again!!) than many of the docs here. Ha ha ha.

But even if we end up back in Canada it's still a better deal for me as a bedside nurse there than a nocter here.

So basically they just feel threatened. They just need a dummy and a blankie. They will probably never understand a bedside nurse's role in a million years.

What's funny is when people like Minette Marrin and Iain Dale think they know more about what kind of education a bedside nurse needs than an actual bedside nurse in acute care who has been doing the job for 12 years. That's what funny. That is how low their opinion of a nurse is...

But if you mess with their entertainment industry world view of nurses being airhead girlies who need a doctor to keep them in line and on task you are totally fucking with their serenity.

People will let every patient suffer horribly and die and run every bedside nurse out of healthcare before they let go of their Carry On view of Nurses.

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