You be the judge…

training primary care NHS you be the judge

The Twitter-sphere can be a brutal place. People feel free to let loose invective and criticism I doubt they would do, even in a bar-room, face to face.

The limit on the number of characters forces us into a brevity that can inadvertently give offence. The lack of an ‘irony’ emoji doesn’t help and some people are just looking for a fight.

The red-wine twilight of late evening is no time to be Tweeting!

Even in broad daylight it can get tough.

A recent national newspaper article, about nurse training, invited some correspondence that found its way onto Twitter.

It was a familiar trope; nurse training ain’t what it used to be.

The Chief Nurse pronounced the comments ‘offensive

‘ and announced she was going to ignore them.

She got us all curious… she might have done better to realise, if you really are going to say nothing, nothing means nothing.

All this was doing the rounds when, in another part of the press it emerged one in 20 places on nurse training courses are now, not filled. On top of the 40,000 vacancies and all the rest of the bad news about nursing, got me curious.

Or present training and career models can be tracked back to Agenda For Change, where banding and a career structure for nurses was defined, and Project 2000, that in the 1990’s, moved nurse training out of hosptials and an apprentice model, into universities, as students.

Everyone else was getting a degree. Why not nurses? They should be at least as well qualified as everyone else. The argument ran; nursing is getting more technical, nurses are taking on some of the repertoire of doctors. The counter argument was; we are training nurses who are too posh to wash.

From the fall-out rate of nurses in training, at one point 20% of newly qualified nurses leave in their first year, something strikes me as not right.

Do we give entrants the wrong expectations, not enough support? We believe that nursing is a vocation. What are we doing to drain it away?

University training for nurses. Mmmm… interesting. As far as I can see, there are 72 places to train for a nursing degree, in the UK. Each of them have their own entry criteria and each have their own curricula. So we get 72 qualifications that are different. Seventy two different flavours of nurse.

Does it matter? Dunno. A degree in nursing is a degree in nursing, isn’t it? I would have thought it might matter to an employer? They often tell me a new intake of degree nurses has to be re-skilled for the workplace.

What about time spent working on a ward? This is where the ‘too posh to wash’ argument begins.

The central requirement is for a nurse to have 2,300 hours of ‘placement’ on a ward, over a three year course.

The placements require the students to be supernumerary.

This is, in part, to protect students being put on rotas, hiding gaps, and being exploited.

It also means they have to be supervised… at a time when all wards are short of nurses, every one is rushed and from what I hear, the definition of ‘supervised’ gets stretched to the limits of meaning.

It can also mean a nurse could qualify with a degree but has never given an injection into a real person’s backside. Does it matter? Dunno. Ask an employer.

2,300 hours over three years. Let’s do the maths. That’s 766 hours a year, or 95 days. The rest is in the class room, with 20-25 contact hours (teaching) a week, the rest is in private study or homework. Let’s say, a 35 hour week, call it ten hours, alone.

These numbers are my back of the envelope, numbers and probably open to challenge but I think I’m in the right ball-park.

Contrast that with how nurses were once trained. On the ward and in a hospital class room.

Today nurse a apprenticeship is close to recreating that but, apprentices, like students are supernumerary and must be supervised, creating back fill costs… that’s why the scheme is foundering.

The upshot? Training looks like a muddle, becoming unpopular, students dropping out and we are nowhere near getting and keeping enough nurses.

Was there ever a golden age of nurse training, or is this it? Dunno.

You be the judge.

Have a good weekend.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.