I said in my blog last time that I’d probably be acting the old curmudgeon (love that word) so this week I’m on the government’s case about its half-baked scheme to make nursing training all degree level by 2013.
Before Christmas, Hospital Dr editor Mike Broad referred in a blog to a letter I wrote on the subject to The Times. There were other letters in The Times - several from nurses - making the same point and only one opposing voice, that of the President of the RCN (as you might expect, given that the driving force for the change is the hankering of RCN apparatchiks for more professional status).
While Mike described it as an “interesting” letter, he had the temerity to disagree with its main premise that mandatory degree entry was a bad thing.
However, the week after my letter this article appeared in the same paper, confirming the fact that degree training is not appropriate for many of those who currently enter nursing, and that making it mandatory will only exacerbate the shortage of nurses in the UK.
I also know that I’m right because I recently discussed the issue with the only two people who can hold a candle to me when it comes to curmudgeonliness - my wife and daughter. Lin is a retired midwife and school nurse, and my daughter Kate is a practising midwife (yes, I share my house with two ‘madwives’ - I’m not going for the sympathy vote or anything but…).
Anyway, Kate was bemoaning the fact that trainee midwives get so little practical experience on the wards now and I was saying that it’s getting that way with medical students.
This set Lin off reminiscing about the days when we met at the Central Middlesex in the early seventies, and how there were so many medical students and junior doctors on the wards that the student nurses would often latch on to the informal teaching that was going on, or even buttonhole an SHO and ask them for a quick tutorial on something they were finding difficult to understand. And, of course, both the nurses and medical students were doing stuff as well as listening; they were acquiring the practical skills that were essential to their respective roles. Not any more, it seems.
We’ve become familiar with the concept of qualified nurses who can’t wash a patient’s dentures because they haven’t done ‘the course’, and we seem to be going down the same path with medical training. For example, as far as I can tell, today’s medical students don’t learn any anatomy - I expect they’re all too busy with their empathy workshops - and we risk producing doctors who are lovely little communicators but who don’t have anything useful to say.
It really worries me that, just when I’m likely to start needing medical attention myself, the doctors providing it will, literally, not know their arse from their elbow.
Nurses with clipboards everywhere you look round here, but just you try and get someone to actually feed a little old lady who can’t reach the bedside table…
He speaks sense that one.
I’ve taken to handing out drinks with straws to all my dehydrated patients on my ward rounds lately. The juniors don’t like it as it slows us down, but no-one else seems to do these simple things anymore, so the consultant has to. Actually that’s depressingly familiar, though I’m usually thinking about registrars not doing their own jobs any more.
That was when doctors and nurses applied to medical or nursing school when they both wanted to be doctors or nurses. Now doctors want to be management consultants, and nurses want to be doctors.
Well said Bob. But do not worry about when you may need care. By then, all you will need to do is type into a computer all your symptoms; a response will order all sorts of blood tests and “scans”; you will then get a comptuer-generated diagnosis; if you need surgery it will be done by a robot. Furthermore, if something goes wrong you will not be able to sue anyone because it will be YOUR fault - if you put ‘rubbish in’ you will get ‘rubbish out’!
Retired Orthopod
You’re right that most things that go wrong are down to basic nursing or medical skills - ie pressure sores, untreated anaemia, dehydration, etc etc, which you shouldn’t need more training to avoid. In my view we have a lack of leadership from both the medical and nursing heirarchy on the wards, and also a lack of willingness to take responsiblity and learn from things that go wrong.
Dear Curmudgeon,
I have, for the first time ever, sat through a bed meeting to deal with our latest bed crisis. Present were all the Modern Matrons (did we ever openly acknowledge any ancient ones….?) some thirty souls, all with earnest expressions, clipboards and the like - the insignia of extreme importance in the Organisation. There were impressive computer graphics, simulating the arrival patterns at Heathrow, all predicting when and where beds would become available. This is the latest management “tool” which, in the company and circumstances always raises a schoolboy snigger amongst coarse surgeons like myself. These meetings happen five times a day. In fact, the beginning of the next closely follows the end of the last - rather like chain smoking. It would have been churlish to suggest that replacing all these very dedicated and highly paid people with eighty staff nurses (equivalent in pay) or putting student nurses back to work on the wards where they belong, might allow us to open the required number of beds, and get rid of the problem at source………
Yup, the earnest clipboard jockey (mostly nurse-trained or antipersonnel officers) to frontline staff ratio has appeared to increase exponentially over the past generation and, gradually, the kudos has shifted from the ward to the (mis-)management meeting. This is also the case in wider child care settings where fist-step child protection meetings are graced by various acronyms (e.g. TAC and MAT)and often many professionals attend, indeed some draw in the same numbers as the population of an average British village, but little in terms of direct action to help children actually results, indeed there is often a delay in referral to appropriate health agencies who can help. This is deeply symptomatic of the burgeoning bureaucracy involved in ‘delivering’ health care and welfare to those who most need it. Quite how the axe will fall in meeting our national debt over the next few years, but I feel an Adamsian ‘Ark Ship B’ solution may be required for these self-important noodlers. I think we should all remember that before this suit-fest started the NHS was the cheapest eguitable health system in the world and hospitals seemed to manage with doctor and nurse superintendants supported by a small and dare I use the term very ‘lean’ administration.
Quite so Brambo, and I like the idea of the Douglas Adams option. Facilitators and counsellors would get on like a house on fire with the telephone sanitisers.