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AIBU?

To think the nursing crisis could be helped by

257 replies

CurryBelly · 25/11/2019 07:30

Going back to the old secondment system?

Get rid of the degree requirements, train HCAs, pay them whilst they work. Keep the degrees for nurse prescribers and specialist nursing.

I’m a nurse and have always found that most HCAs would make better nurses that the people fresh out of uni, some of who have very little caring experience.

Going to uni, especially without the bursary is just impossible for a lot of people who would make excellent nurses. The associate program seems to be doing well but I think we’d encourage far more people into nursing if we scrapped the degree

OP posts:
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CAG12 · 29/11/2019 09:33

If its the same material surely it doesnt matter where you do it? We had a lot of outside speakers/guest lecturers on my nursing course. It may as well be delivered at an institution that can award a degree. Why stop short?

Time in hospital is important - placements made up 50% of my nursing degree. I also valued the variety of placements. Having a wide base of knowledge that can be transferred to different environments is important - for example its common for a medically unwell patients to also have a fractures NOF, therefore medical and surgical nursing knowledge is needed.

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endofthelinefinally · 29/11/2019 09:47

I don't think there are any in house nursing schools any more. DGHs are usually in a group affiliated to the university hospital in a trust.
I trained at a university teaching hospital but all my practical experience was divided across about 6 hospitals and the community. Our tutors came to us some of the time and we attended blocks of lectures in various locations at other times.
I did SRN plus diploma (70s). But when I later wanted to do a masters, my existing qualifications were considered to be equivalent to a degree.
I think a paid apprenticeship type of training over 4 years with an agreement to work in the nhs for a suitable period post qualification would be better than the current system.
I don't blame older nurses for wanting to move away from the wards. My feet and my back took nearly 20 years of punishment. I was happy to move into teaching and specialist clinic work in my 50s.

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Namenic · 29/11/2019 09:56

The difficulty with teaching being delivered in hospitals is that it is highly distributed - so dependent on lecturers travelling and doing multiple lectures for 1 topic. Not every hospital will have people experienced in delivering education for every aspect.

I wonder whether the paradigm of delivery should be shifted - perhaps to make use of online learning and quizzes IN ADDITION to Centrally delivered simulation days, classes with actors and perhaps even groups of patients - wouldn’t it be a good experience to be able to see arterial vs venous ulcers and different grades ‘side by side’ (can be in different rooms but shown in the same session)?

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Kazzyhoward · 29/11/2019 10:08

The difficulty with teaching being delivered in hospitals is that it is highly distributed - so dependent on lecturers travelling and doing multiple lectures for 1 topic. Not every hospital will have people experienced in delivering education for every aspect.

They could do what happens in other professions such as accountancy, where trainees work in firms all over the country and then do their formal "lectures/study" in central colleges/universities on day release, or longer periods. KPMG accountants, for example, have their apprentices in their city centre practices doing real work for several months of the year and then they go to universities for intense lecture/study periods of several weeks at a time (usually in the uni breaks when their full time students aren't there, i.e. Summer).

It's not a binary choice between doing everything based at/around a Uni or everything based at a hospital.

And yes, as mentioned by a poster above, there's always the opportunity to be made of online resources, etc which are becoming ever more intelligent. I do all my CPD training on line these days as an accountant. Long gone are the days of passively watching a video of a lecture. The modern training is interactive and responsive - you're forced to watch short videos in between periods of forced reading, followed by on line tests that you need to "pass" before you can move on to the next topic, etc. When it comes to software training, you have to "do it" on screen, i.e. change settings, make data entries, produce reports, etc., before you can progress to the next stage. Look at the online driving test risk awareness section where you have to click when you first notice a hazard. Interactive media is the next big thing and could revolutionise studying.

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endofthelinefinally · 29/11/2019 10:10

The OU type of learning could be a good model for some of the material.

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doublebarrellednurse · 29/11/2019 10:17

They could do what happens in other professions as accountancy, where trainees work in firms all over the country and then do their formal "lectures/study" in central colleges/universities on day release, or longer periods.

I mean this is essentially what happens except they are employed by the NHS not a particular hospital. It's more efficient and central to do that.


And yes, as mentioned by a poster above, there's always the opportunity to be made of online resources, etc which are becoming ever more intelligent.

With all due respect to some of the great training out there you can't do basic life saving on a computer for instance, or person centred assessment without a person. Some CPD needs to be based around people and needs the unpredictability of actual people.

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doublebarrellednurse · 29/11/2019 10:20

Can I just speak from a branch perspective as well that a lot of the talk on this (very interesting) thread is very very aimed at RN (general) nursing. There are 3 other branches and midwifery to consider as well, as well as the fact that the vast majority of care doesn't happen in hospitals anymore and is community based.

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CAG12 · 29/11/2019 10:25

Yes they exist. Whats your point? I cant speak for midwifery but I think a failing in nursing training (or my nursing training at least) was that it was 90% hospital based. A lot more needs to be done in the community

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HappyHarlot · 29/11/2019 10:40

I disagree with you OP. Nurses are no longer 'Doctors Handmaidens' who just do as they are told.
HCAs already do a lot of the jobs that were traditionally the nurses responsibilities. Likewise, the nurses now do a lot of what used to be the junior doctors roles. Removing the degree won't give you better nurses. Removing tuition fees will help enormously. You can't be on placement full time hours with study and family commitments on top of that plus have to have a paying job to keep a roof over your head.

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Londonlassy · 29/11/2019 18:47

Australian registered nurse here. We are degree based qualification and there is no bursary. Nursing degrees are highly competitive and university places fill fast. We will always need more nurses as nurses retire or change careers but retention here is very good. Often new graduate nurses find it difficult to get new graduate jobs as the demand is incredibly high!
The difference between the Uk and Australia pay is better working conditions, are better and we have ratios (Victorian Hospitals). Multiple immigrant UK nurses have commented that are working conditions here are better
If an employer wants to recruit and retain staff ( including nurses) you need to treat them with respect and value them. This is fundamental. Until the NHS does this the glut of nurses leaving won’t change. Changing the requirements to become an RN won’t make a single difference

I am definitely not saying Australian hospitals are perfect but there have been real improvements in workforce planning

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doublebarrellednurse · 30/11/2019 22:05

@CAG12 well that was kind of my point! I was responding to talk about basing training in hospitals. It doesn't match the health service as a long whole. The training and degree needs to match the modern health service. It's all well and good saying "base nursing training in hospitals" but somehow I don't think that's going to cover all branches given that a small % of the workforce , particularly in MH and LD work in hospital setting.

My training was one hospital one community placement per year which was good, I appreciated that, my management placement was community and that was an eye opener. 2800 hours in total.

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doublebarrellednurse · 30/11/2019 22:06

@Londonlassy yaaaas! Sadly I can't emigrate but I wish I could

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endofthelinefinally · 30/11/2019 22:39

I trained for a year in the community and 3 years in hospital. Of course training should include both. But nurse training is a vast body of knowledge, theory and practical skills. It is a degree subject and I am not sure 3 years is enough.
Medicine is 5 or 6 years basic training and at least a further 3 years training after that.

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LucheroTena · 30/11/2019 23:31

@endofthelinefinally I agree, 3 years isn’t enough, it should be a 4 year course and post grad pathways need to be formalised, this should also come with a large increase in pay. Anyway, training is largely a moot point. We have always had nurses in training, our big problem is retaining the experienced ones. On holiday in California I found out a job with far lower responsibility than mine would be 3 x the pay. And yet housing costs etc were lower.

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CAG12 · 01/12/2019 08:20

I totally agree that postgrad pathways should be formalised. The RCN has released an emergency nurse competency pathway which outlines career pathways from band 5 onwards (managerial, clinical, education) but they arent linked to any postgrad quals which is a shame.

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Namenic · 01/12/2019 09:15

I agree that the body of knowledge is degree level, but is there any benefit to make it all done in 3 years of being a ‘student’ or could it be done parallel to a job over 5 or 6 years - taking the same exams. I would say the same for medicine too. Might it also help with funding?

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doublebarrellednurse · 01/12/2019 10:02

@endofthelinefinally I totally agree, I think it's ridiculous to suggest it's not a degree subject. I also think holding it in hospitals is not viable.

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LakieLady · 01/12/2019 10:39

Some of the best nurses I ever worked with didn't have degrees, once it became a requirement those with degrees often saw patient care as beneath them.

That's one of the things my recently retired RGN friend says. She also feels that the degree course fails to weed out those with no common sense, which is also a necessary nursing skill!

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CAG12 · 01/12/2019 13:39

No @LakieLady, what doesnt weed out the ones without common sense are the nursing mentors in clinical placement who dont fail those students. If they're not good enough, they shouldnt be passing the placement. Thats everyones burden regardless of level of qualification

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Countryescape · 01/12/2019 14:42

The only thing HCAs do where I live is clean, get patients cups of tea and help them get changed. Nurses need to be skilled.

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QueenofPain · 01/12/2019 14:48

@GiveHerHellFromUs Are you a nurse? You speak with a lot of confidence.

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Thehagonthehill · 02/12/2019 00:24

I agree with CAG 12,if students think basic care is beneath them they need to be challenged during training.Too many nurses are scared to not pass(fail) students and we've all seen the results.
Worked based assessors need to realise that if they pass a nurse through their area who isn't up to scratch then they are responsible for poor patient care that student gives,even after they move on.
We have more of a problem now the bursary is gone as we have list the new starters with life experience.18 yr olds often have very little idea of what the job really is(I think there is a 25% attrition (drop out)rate during training and some don't take a post after training and then there is a high fall of again in the first few years.ost other countries have nursing as a degree but maybe the lack of understanding of what nursing now involves and the very low regard it's held in in this country is part of the problem.

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Thehagonthehill · 02/12/2019 00:29

A lot of our cpd is online and as long as you can memorise the content long enough to answer the set questions you can pass easily.Whether you could answer the same questions a day after is debatable.Online tests short term memory rather than teaches you anything
But,as long as the boxes are ticked...

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Kazzyhoward · 02/12/2019 10:13

A lot of our cpd is online and as long as you can memorise the content long enough to answer the set questions you can pass easily.Whether you could answer the same questions a day after is debatable.Online tests short term memory rather than teaches you anything

Sounds like a badly designed online system. They're only as good as the people who design them. I've experienced good and bad. What is undeniable is that they're being rolled out more and more into every trade/profession so the weak will be pushed out and replaced by the robust systems. My son has been doing some online modules from the Open University. They were certainly not short-term-memory based at all - not just watching a video and answering a few simple questions (That's an old/antiquated type of online training and I'm surprised anyone can still get away with it).

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Kazzyhoward · 02/12/2019 10:19

Worked based assessors need to realise that if they pass a nurse through their area who isn't up to scratch then they are responsible for poor patient care that student gives,even after they move on.

Applies to Uni based courses too of course! My OH worked in a dentists. They take on a VT every year and one of OH's jobs was to shadow and support the VT during the first few months of treating "real" patients. Over the years, OH shadowed probably 5 or 6, usually for 3 months at a time. Most were really good, but there were two who OH said didn't seem to have a clue what they were doing and needed almost constant help, even for the simplest/smallest of dental treatments, often needing for one of the partners to come in to take over. Neither lasted more than a month before they were "let go". Those had come through dental medical university, had the formal on the job training/evaluation from the dental university and had "passed" their degree and training and been certified to be let loose onto the general public.

So even the universities aren't infallible in passing people who simply aren''t up to the job.

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