To agree with David Cameron

[McNewPants2013]

m.bbc.co.uk/news/health-22209634

I think it is a good way to ensure that the patients get good quality nurses.

A year as a HCP before commencing a degree in nursing sound a brilliant policy.

In the words of the RCN, a really stupid idea

Invest some money into the NHS to allow ward managers to increase staff ratios and employ more of the really good, compassionate staff nurses who are are already trained to a high standard and who can provide holistic care , including washing, toileting, feeding etc without getting caught up in the mountain of shitty paperwork.

I trained as a psychiatric nurse quite a while ago (I later went into teaching and other roles with the early years) - anyway after I got my place to do nursing I had 6 months on my hands before the course started and got a job as a nursing assistant before my training started. It didn't really make any difference one way or the other as the training involved 3 month stints on different wards anyway.
If there is a problem with the general, practical, and emotional care offered to patients (for example, in my experience, on the post-natal wards) then this needs to be addressed as part of a review of nursing and review of training. It won't be solved (in as far as it needs to be) by a quick, gimmicky idea like this.

It's a stupid idea and won't work. Midwives and nurses don't need to be taught the basics before being allowed to do the course, that's what the bloody course is for. Once qualified it matters not a jot whether you've worked as an hca or not, if you're the only qualified member of staff on duty you can't do everything.

'if you're the only qualified member of staff on duty you can't do everything.'

This ^^^^^^^^^^^

"they know better than anyone about anything after all"

It does seem that that's their thinking doesn't it Amandine.

Like Ms Truss goes to France on her hols and comes back saying they manage their nurseries with far fewer staff and the children are much quieter and better behaved, so let's do it like that here hey Dave - and save a few bucks whilst we're at it !

(disclaimer - I've no idea how she got the French idea in her head, maybe it was a proper tax funded research trip i don't know )

And sorry for the jaunt onto another thread - it's also on discussions of the day BTW

And Gove appears to know more than teachers about educating our children too

Am going to sound pedantic now and haven't read the whole thread thoroughly (so apologies if this has been mentioned) but there is a difference between a HCP (Registered Health Care Professional) and a HCA (Health care Assistant).

The government wants potential nurses to spend time as a HCA, not a HCP.

I have worked 22 years in the NHS and have met the most amazingly talented nurses. They may not have time to hold peoples hands as much these days but I have never seen a bunch of people work so hard or so efficiently. Multi task? They invented it!

See I do agree a little though that the hand holding is important too.
When I did my nurse training (in psychy) during the 3 months I did on a general ward I felt there was no time to stop, including to stop and talk with the patients. I just didn't feel that they were getting the best out of me with their non-stop ultra efficiency approach to things. Perhaps it's better now with the first 18 mths as shared training across the different nursing disciplines ?

Dave & Jeremy appear not to have done their homework again as all nursing degrees already consist of a 50-50 split between academic work and placement on wards or a variety of healthcare providers (community nursing, continence teams etc), so nurses already get approx 2 years experience of practical hands-on care as part of their training. My daughter is a nurse, and watching her try to work a tough f/t job (with shifts) while writing assignments and revising for exams at the same time was awful... Nursing degrees also run for 44 weeks a year, not 36-38 like other degrees, so it really does take a lot of hard work to graduate with a good degree.

I spent the whole morning today interviewing people for places on a nursing degree. Virtually all of them already had some experience of working in a health care environment, be it paid as an HCA or voluntary work. Scameron's idea is pants and completely superfluous. The whole point of the interview is to assess motivation, attitude and commitment to the role. Places on nursing degrees are very oversubscribed these days and the universities can really cream off the best, there's no need to make everyone do a year as an HCA first, there aren't sufficient positions and you potentially could end up with a shortage of applicants for the degree (because they haven't been able to gain the prerequisite experience), potentially leading to universities being forced to take anyone regardless of attitude just to ensure they fill their quotas, which would take nursing back 20 years and will be com

Completely counterproductive in terms of driving up compassion. Agree that this is cheap underhand trick to cut costs and undermine nursing by a bunch of amateurs who are creating policies based on very little substantiated evidence. They are like a bunch of children in a Lego shop!

Seems to me a cheap PR trick to get people talking about 'the good old days when nurses really cared' instead of wondering why the government isn't implementing the actual recommendations from the Stafford review. There were almost 300 recommendations in that review, so if the review team had thought nurses needed more basic experience they had plenty of opportunity to say so. However I see that the government are leaving the response to the review to individual trusts, so effectively completely passing the buck.

What training do you get to be a Member of Parliament and spout unresearched, unviable shite?

I qualified in 1992.
there was a shortage of nursing jobs at the time, not so much a shortage of caring nurses.
The nurses we have nowadays are still caring. Still empathetic.
But there is a limit to what 2 qualified nurses on a shift can do. No matter how caring they are.
These days, with shorter doctor working hours & more HCAs to make up the numbers (and save money) the extended roles of the nurses mean that there is less time for actual nursing.

Most nurses are brilliant. You do of course, as in every profession, get the ones who really should be doing a different job.
But I am now an Intensive Care trained nurse, and there is no way in hell I would go back to ward nursing, because at least in ICU the skill mix is still 1 nurse to 1 ventilated patient/level 3 patient.
The skill mix on the wards is dangerous.
And if our ministers (who seem to know everything) took some time to read the research, of which there is plenty, nurse to patient ratios are directly related to patient mortality and length of hospital stay.

This really is one the most stupid ideas this government has come up with.
In most wards I've trained or worked on a good proportion of the long served staff are care assistants. These are the people from whom student nurses learn how to care for their patients. There are only so many jobs so if you bring in a massive pool of prospective student nurses the numbers longstanding HCAs are going to plummet.
Some of the HCAs who trained me had been doing the job longer than most of us students had been alive and had a fund of knowledge going back decades. Even now I've been qualified for 7 years I'm still learning stuff from guys like this. This will all be lost if they're flooded out of the job market by people whose motivation is to do 1 year and move onto their training.
Then, when something out of the ordinary daily run of things pops up there's a much lower chance that someone will have had first hand experience of it and we'll all have to learn it out of a book - which is what I thought that wazzock Dave was trying to avoid.

An idea: Why not ascribe every patient a points value according to their medical condition, degree of ability to self care, complexity of other needs etc etc- and set up a nurse:number of points per shift ratio? So more complex cases accrue more points. Hey Dave? How about that?

Oh, hang on! That might go some way towards addressing the actual problem rather that 'populist knee jerk' spouting.

Stafford wasn't, when push comes to shove, caused by those nasty nurses (though yes, the RCN should have taken their members concerns on board)- it was caused by a management that thought they were doing exactly what their brief stated: 'deliver the 'health care' under this budget at whatever other cost'.

FWIW, you know what? If I were a patient, I wouldn't necessarily want my bedbath being done by a reasonably well-paid, degree trained professional. I think I'd see that as a waste of resources. I'd like it to be done by a properly trained HCA, one with experience, commitment and a desire to do that job not just as a step to 'something higher'.

There used to be a system with Auxiliary nurses, Enrolled nurses and Registered nurses; 3 tiers with the ability to move up through them if you demonstrated aptitude, but it was deemed that 'the public' didn't want those 'lower level' nurses looking after them; degrees became the only way to go professionally (my own HCP had to go 'degree' because it was made quite clear to us by the government that we wouldn't be a) treated as 'professionals' without it, and b), nor would be get the pay rises of other HCP groups who'd 'gone degree'- so we did) and guess what? Yes, you are likely to get some people entering these HCPs who consider that a degree absolves them of bedbathing and toileting every day; but you'll also get a valid argument that should 'we' be paying these people this sort of money to do highly necessary but not-particularly-skilled jobs?

My manager goes ape if she sees us portering patients around the hospital. She rightly states that we don't get paid from £12 ph to do a job someone on minimum wage could do (however, we point out that if the Trust employed enough porters we wouldn't need to do that job in order to fetch patients ourselves so we can do our £12ph + job!).

There is now a gulf in the middle of nursing care: degree trained nurses above; sometimes only minimally trained 'helpers' at the bottom. Nothing in between.

Final point- I wonder if you might see a nose-dive in nursing applications if they brought this system in? And why not insist pre-medical students do this too? Oh, hang on, that'd be because many dyed in the wool Tories have DC who are aiming for medical school straight out of their private school. Wouldn't want their futures patronised, would we?

Erebus, your points system is a work of genius.
Also you manager is right but sadly there seems to be an attitude that if a task in the hospital can't be done by any other group the nurses can do it. I once went from cleaning diarrhoea from the floor and walls of a toilet (because the cleaners weren't allowed to touch body fluids) to taking and interpreting an ECG because the junior doctors didn't have enough working hours to do it.

Some of the best doctors I've ever worked with were HCAs first, it really does them a lot of favours.

The problem with bringing in legislation re minimum staffing levels is that it requires someone to monitor it to ensure that it's being adhered to. And that person will need paying, which then takes more money from the pot so less money for staff actually doing the work. If there was the money there to pay for the staff, I don't think there would be a problem. personally I think we should go back to the old system where clinical staff were responsible for staffing levels. The problem with non clinical staff doing it is that they don't have to work in the ward which is chronically understaffed, they don't go home at the end of the day worrying because there just weren't enough hours in the day to give mr x a bed bath, or that mrs y hadn't eaten again because there was no one available to feed her, or that someone had been sitting in their own shit for 4 hours and now had a sore, or that someone has missed their iv meds because no one had time to administer them! All of the above situations occur daily in pretty much every ward in every hospital in the country.
Nurses are perfectly capable of giving adequate care, they have been trained to do it, they just don't have time to do it because there arent enough of them! Please let's not have more legislation, it won't solve anything, what we need is more money to pay more clinical staff to do the actual thing that the hospital is there for, to diagnose medical problems, treat them, and care for the patient whilst they are being treated!

This all makes me very sad. I went into nursing because I wanted to care for people who were at a vulnerable time in their lives. I absolutely LOVED my job. The wards were staffed well (ish) and I had time to give to my patients. I can remember that between the early and late shift there was a switchover time of about 90 mins when double the number of nurses were on the ward. That was the time I could do extra things like go and give an elderly lady or man a foot bath and massage their feet (you can tell an awful lot about someone's health my looking at their feet), it also meant I could talk with them, find out how they were feeling, if they felt their care was being managed properly and address any concerns.
All that went out of the window with the Tory Govt of the 80s and 90s and the Labour Govt did NOTHING to address it when they came to power either. In short, our Governments of both persuasions have let patients down. I am not convinced that what Shiny Dave is suggesting will address anything.
As a student nurse I worked as part of the ward staff numbers and learnt by working alongside a qualified nurse or experienced HCA. I a assessed on asepsis, drug administration, my interaction with patients, my understanding of illness and disease and how nutrition impacted upon health. But no, we have to have degrees (fine), we have to become managers of wards with HCAs and virtually no other qualified staff (utterly unacceptable for both qualified staff and HCAs). How can a nurse keep her eye on the ball when he/she never gets near the patient?

Instinctively I now distrust politicians and Dave is stupid to ignore what the RCN are saying.

Sounds like he wants free labour! I think Shiney Dave hasn't a brain in his enormous head.

But let's say it goes ahead, well then, I agree with the previous poster who said that doctors would need this too.
Most nurses I've met have been lovely, and competent, the doctors have been offensive, high handed, and unbelievably arrogant.

I don't believe this is about degrees - I did a four year Bachelor of Nursing, and a large proportion of time was ward based, learning the job from the experienced nurses/HCAs.

Nursing has changed - we do so many more medical jobs now, which ironically is supposed to enhance the patient's experience. It means that the nurse caring for you can administer all your medication instead of waiting for a Dr to come an do it, ECGs can be done and problems flagged up immediately etc. this doesn't mean that basic care is ignored or deemed unimportant. But, if you cut the number of nurses on shift, then those roles will take priority for the qualified member of staff, leaving the less qualified doing the more basic aspects.

It's completely rubbish - so much can be gained from doing the bed bath, sitting and chatting whilst obs are recorded...

I will say this again - poor, uncaring nurses should be complained about. If they have got so burnt out that they don't care anymore, then move on.

Better patient-nurse ratios will improve things dramatically. But you know? It's going to cost some money. Better nursing care would reduce length of hospital stay, therefore money saved. who knew?

Q: "The problem with bringing in legislation re minimum staffing levels is that it requires someone to monitor it to ensure that it's being adhered to. And that person will need paying, which then takes more money from the pot so less money for staff actually doing the work. If there was the money there to pay for the staff, I don't think there would be a problem."

Actually, the thing is, in our modern age- and this isn't just in health care, it's in every other aspect of state life, it is an absolute imperative to be able to prove you need the staff/the money/the new curriculum/the benefit etc. Just saying you do, or saying 'well, it's obvious, isn't it?' -won't do. You need the evidence. Evidence based practice. Then you have to show that you're 'doing it'. That's 'accountability', so, yes, it does need someone to see that the staff:patient ratio is 'adhered to'.

It, sadly, can be shown that once you take accountability away, there can be a tendency to let things slip. "Oh, ward H4 is a trained staff member down today, but I don't want to dip into that cash to pay for a bank nurse, so they'll just have to make do. Oh- they've been short all week? Who's counting?". If the management knew that in the same way they get fined if an A&E stay exceeds 4 hours, or the MRSA rate goes over a set level, they'd get fined for running wards with say 'x' points worth of patient on it with too few staff to meet those needs, they'd sort it. FWIW I think the MRSA rate and 4 hour thing in A&E are stupid. They are a crude weapon which can only lead to the sort of creativity ' that can cause Staffords to happen.

To do away with all that, to let hospitals, or schools run themselves completely autonomously would take an act of governmental will we're unlikely to see again in our life-time (note Academies are supposed to do that but they aren't free of the endless testing and numbers game of state education, are they?- and they aren't really about freedom, are they? they're about privatisation.). If all the staff on a ward from the head nurse down to the cleaners and porters belonged to that ward, with only the trainees moving between work areas, you might see a greater team spirit; instead, everyone who can be contracted is, because taken as a whole, it's cheaper. You won't see the same cleaner or porter twice. Your nurse may not have 'done' your speciality before (or even know her way to say Pharmacy having been drafted in from elsewhere that morning). You won't see her again, either.

I'm sure I heard on the radio that the idea was to work for a year as a HPA to be eligible NHS funding for a nursing degree...This doesn't appear in the BBC article.
Cynically, I'm thinking this is a way to bring in fees for nursing degrees.

I agree with the RCN, it's a stupid idea.

It already takes four years to fully qualify as a nurse, adding another year to that will put some people off going into the profession.

I have two cousins who are nurses, both say that basic care is covered within the current training, as part of the four year degree. There is no need for this extra layer of training. They say what is needed is MORE nurses and LESS paperwork/admin/faffing about doing things that take nurses away from actual nursing.

I think it's a very good idea indeed. I used to think the nursing qualification was enough. After a few stays in hospital in recent times I'm beginning to think it's not.

It also models what teachers are asked to do before applying for a teaching course.

FWIW I think prospective doctors ought to as well.