Tuesday, 24 November 2009

Last post on Nurse Degrees....for awhile anyway

We're all sick of arguing with nutters like Iain Dale and others who worked in a hospital once....so they say...... and weren't even bright enough to realise that they weren't actually any thing like a Nurse.

But I am posting this next piece because I think the author sums it all up quite nicely. This was written by a colleague of mine.

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I'm about a week behind the curve on this one, but I've been browsing through all the blog reactions to the news that all nurses will study for a degree from 2013, and alternately laughing and crying.

This is a desperately unfashionable thing to say, but I actually think it's a good thing. I trained in Wales, where nurse training is already all-degree. The news is only bringing England into line with Scotland and Wales. Contrary to what a lot of commentators are suggesting, doing a degree doesn't mean you spend less time on the wards while studying - whether you do a degree or a diploma, a student nurse has to spend over 2500 hours out on clinical placements before they can qualify.

Here's what Iain Dale (described as "insightful, informative and entertaining" by the Observer) has to say about it, in his insightful and informative way.


I once spent a year working as a nurse. There, that surprised you didn't it? Admittedly it was in Germany and was in a private clinic specialising in spinal injuries, but it was still nursing. I had no qualifications, no training and certainly no degree (it was my gap year).


So, Iain, you weren't a nurse at all. You were a care assistant. Don't get me wrong, I'm not knocking care assistants; many of them are brilliant, but they're not staff nurses.


So when I heard this morning that the NHS was now going to insist on a degree before nurses could train, I was dumbfounded. Not all nurses are academically gifted and would want to do a degree. Does a degree in astronomy make a nurse better able to do his or job, than four years hands on training?
Nooo, Iain, they have to do a degree in nursing, not astronomy!

Then there's this guy, who despite being a doctor, still doesn't seem to understand how nurse training works.


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.


But the ward hours and apprenticeship haven't been lost. I'm a degree-educated nurse, and I still had to do my 2500 hours on placements before I could qualify. I spent a hell of a lot of time running around wards doing hands-on nursing to get my degree.

Then I read Melanie Phillips article in the Spectator. Yadda yadda nurses don't want to nurse yadda yadda Florence Nightingale yadda yadda nursing is a vocation not a profession yadda yadda ...then I had to stop before my brain exploded onto my PC monitor. Though I understand this is a fairly usual reaction to reading a Mel Phillips article.

Right now there are many problems with providing nursing care, just to list a few:

- criminally low ratios of nurses to patients on NHS wards. I've heard of some wards where 2 nurses and 2 healthcare assistants were left looking after 35 seriously ill patients.

- more form-filling being forced on nurses in an increasingly lawsuit-happy culture - see also teachers, police officers and social workers

- advances in medicine making the job more technical. Florence Nightingale wasn't running around dealing with IVs, catheters, tracheostomies, all the while mixing potentially lethal medications

- an ageing population making the patients on the wards older and sicker, thus needing more care to keep them alive.


But what is not the problem is that nurses are getting too uppity because they've got degrees. All this is inverse intellectual snobbery that says that clever people can't be good nurses. My experience is that clever people often make for outstanding nurses. They think on their feet, they can problem-solve, they look at new ways to do this, they keep their knowledge and skills updated. All of these things are good qualities in a nurse.

As for the media stereotype of nurses who are too busy daydreaming about their next sociology paper to notice the patient's call bell ringing....they may well exist, but I haven't met any of them. What I have met repeatedly though is nurses who were rubbish at their job because they were ignorant, unimaginative and thick as a plank.

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Outstanding.

Melanie Phillips article here. Melanie, your ignorance is shocking. That goes for you too Iain Dale.

18 comments:

the a&e charge nurse said...

I have thought about this sort of stuff for some time now - and while I am tempted to contribute a long post I am always thwarted because I cannot make these issues any clearer than you have, Anne.

Just a quick thought, if supposedly 'clever' political commentators, or indeed medical colleagues don't get it (and clearly they don't) - then I hold out little hope for a general public regularly fed ill informed opinion pieces in the likes of the Fail and even the Spectator.

I heard the other day that at any given time over 25% of the NHS hospital population is demented (I assume this stat refers to patients, not staff).

Think about that for a moment - do Dale & Co have any idea how labour intensive such work is?
Increasingly these commentators sound like politicians far removed from the coal face.

Oh, how I would love to stick Dale, or Phillips, in a nursing uniform and put them through a month of nights on an acute admissions ward - such thoughts do cheer me up.

Nurse Anne said...

On my ward it is more like 85% demented as there are no more care of the elderly wards. Acute medicine takes acute medicine patients age 17 years old on upwards and also care of elderly. The last time I had a 17 year old overdose patient she hid in the bathroom and cried because of all the screaming shouting demented, wandering, peeing on the floor geriatric patients that outnumber the staff 10 to 1. I had to start her parvolex in the bathroom as she refused to come out.

And I don't know just what the hell it is that people expect us to do with demented patients peeing on the floor and screaming "mama, mama, mama" at the top of their lungs all night. There is nothing you can do whatsover to stop the wandering, the screaming, the peeing on the floor or on other patients beds.

Try to interfere with anything that a demented patient is doing will get you spat on and punched. And less than 5 minutes later they will forget that they just had the toilet and try to get up and fall, even though they don't actually have to go and you have already shown them how to use the call light 40 times.

Even short stay surgery that is supposed to be for fit healthy young people having that little hernia repaired is often 25% demented patients due to lack of medical beds. But those nurses can cope better than we can because they have better ratios and their regular short stay patients are not as sick.

Zarathustra said...

Opinions on nurse training are like haemorrhoids. Sooner or later every arsehole develops one.

I think I may steal these links for a moan of my own.

Antigonos said...

Except that until now the NHS did not require degrees IN NURSING. A degree, any degree, was regarded as preferable. My best friend has been the Principal Nursing Officer [or Matron, or Director of Nursing, whatever you Brits call it now] in three major hospitals connected with Universities in the UK, and her degrees [both BA and MA] are in ENGLISH.

The American BSN is almost entirely based on theory and lecture classes, and most new graduates are hopeless on the wards until they get some experience under their belts.

I work largely with degree-holding nurses. I have no degree, studied midwifery in the UK after obtaining registered nurse status in the US, and I can tell you that my level of education is equal to the degree holders, because of continuing education and refresher courses.

In my experience, degree holders like to talk about nursing, but, as the Matron of Queen Charlotte's Hospital once told me "they don't know how to make the patient comfortable". They also wind up, in disproportionate numbers, in either nursing education or administration. Bedside nursing IS a nursing specialty, but I am far from convinced that degrees improve the quality of nursing.

Zarathustra said...

@Antigonos

The American BSN is almost entirely based on theory and lecture classes, and most new graduates are hopeless on the wards until they get some experience under their belts.

I don't know much about American nursing degrees, but this certainly isn't true of British ones.

As the author of this piece rightly points out, to get a nursing degree in the UK you have to do over 2500 hours of clinical placement time.

the a&e charge nurse said...

'In my experience, degree holders like to talk about nursing, but, as the Matron of Queen Charlotte's Hospital once told me "they don't know how to make the patient comfortable".

These stereotypes are almost on a par with medical stereotypes about madwives, sorry midwives.
http://nhsblogdoc.blogspot.com/2009/05/pain-relief-in-labour-ignoring-evidence.html

Anonymous said...

@antigonos

nursing degree at Cardiff - yes their students are on the wards

http://www.cardiff.ac.uk/sonms/degreeprogrammes/undergraduate/index.html

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

Anitgonos

I did a degree in the States and we spent plenty of time on the wards...as much as the students from the old diploma schools. We also worked on the wards as cadet types outside of schooling and clinical hours.

Hopeless my butt. We were no worse than the diploma and associates degree grads. If any new grads are hopeless it is probably because they are working is an insane, underesourced environment that forces nurses to bite off more than they can chew.

The diploma in the UK is very close to the degree program anyway. Nurses (and by using the term nurse I mean RN) here train on either a 3 year diploma or 3 year degree, both at Uni.

The fact is that even before 2013 in this country anyone who can legally call themselves an RN is a well educated person who had to get through a training program that your average uni student would not survive.

Why isn't the media talking about just how exactly one RN to 10,15 or25 patients can possibly cope?

Or in the case of the ward below mine..one RN to 35 patients. Jesus Christ, Mother Theresa,Florence Nightengale, Clair Raynor and others who trained eons ago wouldn't be able to cope with that either. They would fall flat on their faces and fail.

That is the issue and that is what the media should be focusing on.

Nurse Anne said...

Zarathustra, feel free to steal anything you wish.

Nurse Anne said...
This comment has been removed by the author.
Nurse Anne said...

Anitgonos, when are you people going to realise that the real problem is that the few nurses on the wards don't have time to exhale properly let alone make someone comfortable.

Everything they do is half assed and has to be accomplished in less than 30 seconds or not done at all as they are SO FREAKING RUSHED.

That is the problem, and that is the whole problem.

Research shows that a degree makes a good nurse but no one can be a good nurse if they are responsible for too large a patient load with no resources and back up.

Why can't we allow the nurse to have some time uninterrupted to read her patients notes so she knows how to help them.

Why can't I have two consecutive minutes uninterrupted to spend with each patient? I am not exaggerating, this is how it really is.

Why won't they have someone answering the ward phone. I have to run and answer the phone literally every two minutes. If I don't answer it, no one will, and the callers complain to management about the nurses not bothering to answer the phone. How can I take care of patients and make them comfortable when I'm literally running to the phone every two minutes?

Dr Aust said...

Nurse Anne wrote:

"..the real problem is that the few nurses on the wards don't have time to exhale properly let alone make someone comfortable.

Everything they do is half assed and has to be accomplished in less than 30 seconds or not done at all as they are SO FREAKING RUSHED.

That is the problem, and that is the whole problem."


I was interested to read this, as it corresponds almost exactly to what my (former internal medicine) doctor better half used to say drove her out of hospital medicine. She had this same sort of "always too rushed to do it right" experience as a renal SHO, acting renal registrar, general medicine SHO and general medicine registrar.

Eventually she just said "F**k It" and opted for a non-acute speciality.

Of course, one has the strong impression that the managerial response to this, and to the EWTD stuff, was to "upskill" nurses and dump a lot of the stuff on them.

Whoever is doing the work, you would think that the basic message, that not having enough people of the right skill level doing the job is unworkable, would have got through to the bosses.

Or perhaps it has, but they don't care.

PS Arrived via Dr Grumble's blog. I'm a long-time teacher of preclinical medical students. These last few years I have been teaching B.Nursing students too.

Matt said...

Why don't people listen? People have little understanding of what student nurses actually undertake for their training. The NMC require a minimum of 2300 hours of clinical time - time on the wards etc for a student nurse to register. People seem to think that students will spend all their time in classrooms learning about different care models or sociological theories. The unions need to do something and educate the public as to what nurses are expected to do these days. Just being caring will not cut it. I wouldnt like to be sent to theatre to have a nurse working in the anaesthetics room who was just caring, or a scrub nurse who is holiding a retractor into a thoracotomy on me to know how to hold my hand and empathise with me. I want a nurse who has the knowledge and the critical analysis skills to know what they are doing is best informed practice and are willing to argue for me if they think another professionals treatment of me is not the best I should be getting. As I have said before, too many people are looking at nursing in the past through rose tinted glasses.

Elio said...

Ian Dale has a blog
www.iandale.blogspot.com/

Nursing Student said...

Nurse Anne,

thanks for backing my comment up on ferretfuckers blogpost, what is it with tightarse doctors and their constant picking at Nurse education? They'll need one, someday...

Anyway, I've got a blog and I'm basically banging the drum because I'm a Nursing Student and I suppose I must be desperate, if you wanna check it out (it's crap at the mo) then click through my profile.

Emily x

Nurse Anne said...

It's okay Emily.

Ferret is actually pretty cool 99% of the time. Doctors just think we want to do their jobs and they get really defensive.

Like your blog. Will have to link it on here.

Saad Amir said...

Your post has been very nice and informative for the peoples.The role of nurse has been very important in hospitals.
Thanks.....
regards, saad from
Education