To think the nursing crisis could be helped by

[CurryBelly]

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

Oh and as an RNMH and a manager I still cleaned up sick and shit yesterday. BSc and MSc trained nurses will still put gloves on and clean up.

I don’t see people arguing that any other profession should stop being degree level educated, but people seem to think going backwards with nursing is acceptable. We don’t want non-degree teachers, social workers etc but apparently nurses are fair game.

I’ve worked at everything from old money grade A to band 8a and cleaned up poo at all levels.

I for one would love to retrain as a nurse, but I am nearing 50 and have an 11 year old child and a mortgage to pay. Absolutely no possibility of going to uni for 3 or 4 years unless..... there was some form of bursary.

Same for lots and lots of people I would imagine. They just can't afford to train. Unless you know, at 18, that you want to do nursing and get yourself a place at uni at that point, then you've no chance.

Outcomes for patients are better where there is a higher proportion of degree educated and registered nurses.
We should not make nursing a less educated profession.
We should remove tuition fees and reinstate bursaries.

I suspect that nurses are cleaning up body fluids from walls and floors because they have been told it’s their job by other nurses

In our Trust it is most definitely a nursing job. I'm not defending this, but it is the unfortunate official position. I wonder if this is a mental health thing as @doublebarrellednurse sees this as standard too.

@doublebarrellednurse If you do any further training paid for by the NHS it's normally a condition of your contract that if you leave within a couple of years that you have to pay at least a proportion of the training costs back. I don't see why a similar system for nurse training is so ridiculous?

Mental health nurse here and we have a Trust cleaning policy that literally itemises everything on the ward/ clinic into shoe responsibility it is to clean it (maintenance, nursing, domestics). Bodily fluids are definitely a nursing responsibility, although toilets are domestics.

Don’t want to derail the conversation but the body fluids thing is strange as where I work (acute trust) the patients create very little mess but the public and staff loos are disgusting and nurses don’t get called to clean those. I would contest the Trust policy if I were you. No one minds cleaning up some poor soul or the mess they’ve made but it seems a bizarre policy. Paying a band 5-8 registered and understaffed group to do a job that’s done in the public areas by band 1-2.

I trained under the the diploma doublebarrell 20odd years ago ,I was also given the keys within a few months of qualifying and expected to just get on with it ,the job certainly has changed but it's not a new thing being thrown in at the deep end and there were no matron s in those days and particularly at weekends and night shifts you were pretty much on your own.

just care work? .... carers are often expected to handle medication, hugely challenging behaviour etc the descrepancy is training and pay. Sorry off topic. But yeah totally agree that nursing tutition should be lowered.

I think that changes need to be made to encourage, retain and support nurses. Removing bursaries was one of the most calculated things the conservatives have done to undermine the nhs

There are many ways to get a degree. I have several nephews and nieces. One did a degree over 6 years while working and earning a wage, sponsored by the company they still work for 15 years later.
Another joined the military, signed up for 7 years. Doing a degree as well as working and learning loads of skills.
Another has done a degree and a masters through OU while working. Has a family and a good job in a related industry.
I think nursing lends itself very well to this type of learning while learning practical skills in hospital and community.
I mentored lab staff doing masters degrees whilst working in the nhs, sponsored by the nhs. It works very well.
I understand the modern nhs reasonably well having worked in it for over 35 years, written numerous policies and procedures, costed entire services, set up hospital and community services, written business cases and worked through 3 government reorganisations.

Properly staffing wards would help. The bigger problem is retention rather than training new nurses.

Proper staffing which gives nurses and doctors time to learn new skills like cannulation, ultrasound. Also have skills certifications that hold between trusts and refresher programs. Learning new skills is often done in someone’s spare time... sometimes at a personal financial cost too.

@Namenic can't have proper staffing until we have enough people to fill the slots though - chicken and egg for sure.

@Waitrosescheapestvodka we are the poor relation 😂 could be a MH thing, we just muck in. I wouldn't ask anyone who works for me to do anything I wouldn't be willing to do myself either from cleaners to nurses. Admittedly when I look at the workload of my nurses and what they are being paid they probably have more pressing things to do but needs must at times. A willingness to do it if it's needed and there isn't a more suitable person around with nothing else to do at that time. It was a very pressed day when I was out cleaning bodily fluids and the staff were exceptionally busy, I mucked in because I can take work home and finish it. They can't and I like them to have a shot at leaving on time.

@Reallybadidea I think generally because the vast majority of MH & LD services are no longer NHS managed they are outsourced to private beds. There are more private beds than there are NHS beds in non secure MH (secure is still NHSE but there is a good % of private beds). Also a massive amount of care is carried out by private care in the community and by residential and nursing services. A great deal of these services are commissioned by the NHS on a patient by patient basis.

If you've trained enough nurses to fill the market they won't all be able to work for the NHS because they will just create a hole for all the other services out there and in theory wouldn't be sufficient jobs in the NHS. Then you have the opposite problem, a surplus of staff who can't work cause they are tied in!

Also individual trusts don't fund places it's NHS Education England so trusts with large universities are always going to do better than trusts without one or smaller ones. The uni I went to covered 5 trusts and the ones further away from the uni struggled to recruit.

This was discussed at length when they talked about cutting the bursary, it was decided it wasn't feasible because of the way things were set up across the health service now.

I have done a lot of CPD and never been contracted to stay in a certain time. I could understand things like MSc models for instance but some CPD is part of and expected of the job and therefore can't be tied to contracts, like mentor ship for example - now an expected part of a band 6 role.

Teachers get a huge bursary to train but aren't tied to any one role or location, why should nurses?

There are many professions I would consider don’t really require a degree - including both primary teaching and nursing.

It isn’t because I don’t see primary school teachers and nurses as high quality professionals. It’s because I question the quality of an undergraduate degree and think they have become devalued. Anyone claiming they are a professional because they have a degree immediately looks unprofessional.

Incredibly well put @Endofthedays.

@ Waitrosescheapestvodka I think it might be a MH thing. I’m an RMN and our domestics aren’t ‘allowed to clean bodily fluids’. Dirty protests, blood from self-harm etc. is all us/support workers.

Thinking about it though, they do clean the patient toilets 🤨

www.bmj.com/content/365/bmj.l4224 David Oliver argues very well against the downgrading of nurse education in this BMJ article, particularly the “ every 10% increase in degree educated nurses was associated with a 7% reduction in patient mortality”. www.bmj.com/content/365/bmj.l4224

It’s because I question the quality of an undergraduate degree and think they have become devalued.

This is a fair point but a nursing degree has standards that have to be met for everyone across the county set by the NMC and Health Education England (in England obvs).

It's not a geography degree for instance which will vary across the country in content, outcomes, marking criteria. It's heavily regulated, evidenced and supported by health professionals throughout the process. It is checked on and has to register to very strict rules.

Students are meeting strict standards across the board, ironically (for this thread) its the marking and feedback in placements that wildly varies. Failure to fail is a recognised problem.

Why is an alternative system of nurse training a downgrade though?

All degrees have to meet a set standard because higher education is regulated.

By making professions like nursing and primary teaching undergraduate degree subjects they have been lowered in value to the level of a geography degree.

Teachers get a huge bursary to train but aren't tied to any one role or location, why should nurses?

Do they? I never witnessed this?

@Endofthedays as a primary teacher I agree. I do think both professions should become qualified to this level but I often found the best teachers were those with life experience and common sense, rather than those that went straight into a degree course.

Since the end of the bursary many more mature people have started their training.
These were mainly women with an established family and who mostly trained and stayed.
What we have now are 18 year olds with little life experience and aocten a romantic view of nursing,the attrition rate during training is Hugh and of those who finish some do not take up posts and many leave in the first few years.Burn out and the simple fact that starting a new family and working shifts is very hard to manage and pay really doesn't match against child care.
I think there is a march to the bottom.More training is available for HCAs upto band 4.There is no clear pathway behind(which would also enable older non degree nurses to develope too).
This suits the NHS as it is cheaper and if less people are filling the registered nurse places that's OK because you can have one in charge.
Except even before degrees all the evidence is that adequate staffing with registered nurses improve patient outcomes and shorten patient stays in hospital.
I am very old style,38 years and would have jumped at the chance to do a degree but just missed on timing and in a time of enough nurses training up wasn't a thing as training new nurses as students was cheaper.I don't think I'm better or worse than differently trained nurses(I have done lots of updating and non recognised training on the way.
At the moment nurses are paying to work,they're learning a lot on the job and newer training means they will not be supernumerary(so effectively paying their tuition fees to work full time).When I trained we were paid for the work we did,thatay be why there were so many of us.
We are all coming near to retirement and because of state pension age I will be going part time.I would stay on but stress/workload/responsibility isn't enough for what I am paid.I can't see many of us staying so ,as nursing unions keep pointing out there are going to be a lot of us leaving soon.
Successive governments had been told this for so long,we could have lanced the boil but instead have a rip ,roaring infection with sepsis ignored in the wings.
Non of the parties are really addressing it.If a miracle happened and all these nurses trained(not sure how hospitals are expecting the hard pushed trained staff to do their role and train a massive increase of students in their area) no longer be is not nvestingating why so much is invested but so many do not complete training.As for retaining staff,how?12 hour shifts,rotation to nights,weekends and poor pay for most nurses added to what the work actually is and I have not heard one politician say how.
And yes,any bodily fluids around the ward ,outside normal areas (like toilets)it is (traditionally )a nurse who has to clean these.(The kind of thing you'd attack with a bleach spray,scourer and robust rubber gloves we have to use disinfectant wipes and thin disposable gloves).

Student Nurse here. A bit of a late starter as I'm almost 50. In Wales so fees are paid for and I get a (very small) bursary and a maintenance loan. I'm having to work almost full time just to keep my head above water. But I love it.
However, nursing has definitely changed. I'm more than capable of caring but also of completing my degree.
There was a discussion on Radio 2 yesterday and a retired nurse was complaining that nursing changed so much she no longer had time to set her patients hair. I'm sorry I have not gone into this to get the rollers out.