Tuesday, 26 March 2013

When is a revolutionary new approach to nurse training NOT a revolutionary new approach to nurse training?

I read this article this morning and was instantly filled with the kind of rage usually reserved for other road users, or narrow-minded snobs.

As a nurse, who was a student nurse for 3 years, and since my boyfriend is currently a student nurse, I'd say it's a topic fairly close to my heart and one in which I am pretty well qualified to speak about.

That said, I allowed myself a teeny tiny rant on twitter, and a mutual rant with Chris and then I got on with my day which mostly involved a playdate with some friends at a soft play area.

I promised myself I'd come back to the issue though (and I promised the people of twitter too, but I'm never sure if they're actually paying attention, that place moves at warp-speed so I imagine it attracts a lot of people with ADHD type tendencies...Oooh shiny thing...oooh another shiny thing...oooh...sorry, what were you saying?!)

Anyway, after all the primary colours and children's laughter and gossip, I was feeling decidedly less cross by the time I sat down this evening to write the Epic Rant I'd had in mind.

Then I read the article again:  Irked.  Then my 17 month old woke up for no apparent reason and started screaming like his cot was infested with sharks: ok, slightly pissed off.  And then I made the mistake of scrolling down too far and reading a handful of comments...aaaand that's me enraged, I'm good to go...

Pull up a chair and let me tell you a story.

Once upon a time there was a girl who wanted to be a midwife.  Despite the fact there is a widely recognised shortage of midwives here in the UK the course itself is ridiculously competitive to secure a place on.  Hundreds of applicants are turned down each intake and in 2004, I was one of them.

Dissatisfied with the idea of remaining on my psychology degree one minute longer, certain I was wasting not only my own time, but everyone else's and not to mention tax-payers and my own money, I considered my options.  The idea of effectively hanging around for a year until the time came to submit another midwifery application and potentially be knocked-back again did not appeal (how strange) and I discovered there was another way I could realise my ambition, and therefore I didn't waste a minute putting in an application to undertake my nurse training instead, with the sole aim of completing the three year course and then immediately doing an 18 month conversion course to midwifery (Incidentally, I've been qualified for 5 years and I'm yet to get round to that)

Don't get me wrong, I liked the idea of nursing well enough, and I certainly didn't go into it with a "grit my teeth for 3 years" attitude, but truth be told, at that point I had no interest in actually becoming a nurse per se, but was happy to do so in order to achieve my more long term goal.

Then I became a student nurse, and I found out that a. I loved it and b. You can't fake it.  Some people may go into nursing  because of the paid tuition fees, or because they want to marry a doctor, or because they don't know what else to do and it's better than nothing, but these people will not survive the three years.  I know because I saw them, I met them, I worked alongside them, and as soon as they too realised that you can't fake it, they either dropped out or were found out, i.e. failed assignments, failed placements, failed the course.

The day I walked on to a ward for the first time as a student nurse I could have cheerfully vomited all over my beautiful new crisp white tunic, I was that nervous.  I can vividly remember my very first task being to help an elderly gentleman wash and get dressed ready for breakfast and me saying to the support worker who'd given me said task "I'm sorry, but I don't know how".  So she showed me.

Later, I was waiting outside a side room for my mentor (a qualified nurse) to come out so I could ask her a question and I heard the support worker, who was also in the room, say to my mentor "They shouldn't send them with no experience, what use are they when they don't even know how to wash a patient?"

Guess how good that made me feel.  I realised I had a choice, I could call her on it (are you KIDDING?!) I could walk off the ward and never come back (so so so so appealing at that point) or I could suck it up.

I chose to suck it up and for the next 3 years I sucked it up.  I made a point of saying to anyone who asked me to do anything "I'm happy to do it but I'll need you to show me how first" so they'd know I wasn't saying "I can't" as a way to say "I don't want to"

I washed patients, I showered patients, I bathed patients, I brushed patients teeth, real or otherwise. Another elderly gentleman on the same ward once called me over "Sister" he shouted (They would always call me "sister" no matter how much I insisted I wasn't even a real nurse "nonsense" they'd say "anyway, about my bowels") but in this case he waited for me to get close "Sister" and, swallowing his final mouthful of all-bran he popped out his false teeth, covered in just-chewed-branny-goodness and deposited them into my (ungloved) hand "Can you clean my teeth for me?"

Those who know me well don't need me to explain but those who don't: I am not squeamish about anything. You can fling blood, plasma, poop, pee, puke, eyeballs, whatever at me (but I'd prefer it if you didn't) but mouths? Mouths? With their teeth and saliva, oh my god, just stay the hell away.  Most people dislike going to the dentist, my idea of hell on this very earth is being a dentist.

Anyway, I digress.  I mean what's a girl to do?  I was a student nurse now.  I could hardly fling the bloody teeth right back at him could I? Do you know how much false teeth cost? Do you?! I took them over to the sink and gave them a bloody good clean and I took them right back over with a smile- both his and my own.

I'm not telling you this because I want props by the way, I'm not expecting a medal (although it might be nice, especially if I could trade it in for cold hard cash, nursing doesn't pay well, in case you were wondering)

I'm telling you this because I am trying to point out that this revolutionary "THIS WILL SOLVE EVERYTHING THAT'S WRONG WITH THE NHS AND STOP BAD THINGS HAPPENING EVER AGAIN" plan,  is not in fact any such fucking thing.

Student nurses already spend at least their first placement and usually their first year and sometimes the entire of the clinical element of their training doing hands-on nursing care.  I'm talking toileting, dressing, feeding, the basics.

Some don't like it, and a few of those will vocalise their distaste.  Truth be told, I myself had plenty of moments, usually involving other people's waste products where I thought "No really, what am I DOING?!" but then I'd remember: what I'm doing is providing care and dignity to someone, in the hope that it will make a difference to them, in the hope that one day, if I ever need it, someone will do the same for me.

For every student nurse who is "too posh to wash", or every qualified nurse who busies him or herself with paperwork over answering a call-bell, there'll be ten more who would just love to be more hands-on with their patients, but can't, because they have other shit to do that they CAN'T delegate, things they would be held accountable for if it wasn't done, or wasn't done right and by the right person, like administering medications, setting up IV's, updating documentation, charting observations, making referrals.  If wards were staffed adequately then it would be possible to do these things and perform direct patient care, but a lot of the time, they aren't.

On my final placement as a student nurse I worked 14 weeks on an elderly care ward, with 28 beds, all of which were full the entire time I was there, rarely did the mattress go cold in that place before another person was on it. Most of the patients were dependent in most areas of their ADL's (activities of daily living) so would need assistance with eating, drinking, washing, dressing, toileting, mobilising.  There should have been 3 qualified nurses and 3 support workers on each shift and of course any student nurses currently on placement, but then they're supernumerary (Ha! Hahahahahahahahaha! Oh I do amuse myself sometimes)

In fact I worked many many (oh so fucking many) shifts where there would be one qualified nurse, one  or two support workers, and little me. For 28 highly dependent patients that is a hell of a lot of work, and I mean, just to get the neccessary things done, just to give everyone their medication, and meals and help them to the bathroom and settle them in bed for the night.  Anything above that was out of the question.

There will always be nurses who are in the job for the wrong reasons, or who started out wanting to make a difference and quickly realised how hard that was going to be, got institutionalised and burnt out, the same goes for support workers too.  Most I worked with were fan-fucking-tastic, and truly wonderful at their jobs.  A few were not.  There are shitty people in every profession, in every job, in every part of life. But if you ask most nurses and most student nurses, they would say they want to perform direct nursing care, and talk to their patients and get to know them better and take the time to make them more comfortable, but they can't, because they're responsible for 28 human lives and if they don't delegate the basics to someone else then who the hell is going to do the drug's round?!

If Jeremy Hunt wants nurses to wash patients then he needs to staff wards adequately to allow that to happen. In reality who is going to pay a qualified nurse to do bed-baths when they could pay a health care assistant half as much to do the same, or better still, get a student nurse to do it for free?

No really, who?


Giant Disclaimer for this Giant Rant

First up, the views above are entirely my own, as you can probably tell from the liberal use of foul language.  I don't generally blog about nursing-related stuff because that wasn't why I started this thing and also I really need to keep my job.

Additionally, much of this piece rant refers to nursing in the way that the general public sees nursing, that is to say "general nursing" or to give it's 'proper' name, adult nursing.  No, not that meaning of the word "adult", god, you people disgust me.

Allow me to explain- there are four branches of nursing in the UK- Adult health, Child health, Mental Health and Learning Disabilities nursing.  Clearly what constitutes "basic nursing care" in each of these areas can sometimes mean the same thing, but often does not, as each client group tends to have health issues in areas other than that field, i.e. people with mental health issues will also have physical health issues, but what they require from the nurses caring for them is likely to be vastly different.

In this piece, I have talked about nursing in a way that relates mostly to adult nursing, and that is simply because the article I read appears to also be talking about nurses on adult wards.  It's not because I think adult nursing is in any way superior to the other branches of nursing, or because I think it is 'proper' nursing and the other branches are not. It was mainly for ease, although now this is turning into the longest disclaimer I ever wrote in my entire life so I guess that's that out the window. Ok, look my boyfriend is a mental health student nurse and although I'm trained in adult nursing, the day I qualified I started working in neonates and haven't nursed a big person since, so please don't be thinking I'm hating on you other branches or excluding you in some way because I'm not, or at least, not on purpose, ohmygod shutting up now...

1 comment:

  1. I always thought I'd love to be a nurse but I don't think I could manage it. My grandma and mum were both nurses and they were fantastic at it and the cleaning/washing/toiletting is all part of it and every student nurse who thinks it isn't is in the wrong business.
    I don't believe for a second many student nurses get into the profession thinking they'll never have to help someone with their personal care and if they do they're mad.
    I'd still be considering it myself if it wasn't for the state of the NHS. I adore the NHS but not what's happening to it :(.
    So much had changed in the 20 months between me having two children and spending 2 nights in each time and I hate to think what will happen next.
    Hats off to you for doing what you do x