Page last updated at 05:49 GMT, Wednesday, 13 January 2010

Do degrees mean nurses will not 'dirty' their hands?

VIEWPOINT
Dr Helen Allen and Pam Smith
Centre for Research in Nursing and Midwifery Education, University of Surrey

Nurse at bedside
Researchers say students feel technical care is valued over bedside care

The training changes that have given students the opportunity of getting a degree in nursing at university have provoked fears that the basic care of patients will suffer.

Two University of Surrey researchers conducted a study that showed the modern student nurse does not always see it as their role to do the 'dirty' things like cleaning up blood and faeces.

Dr Helen Allen, director, and Pam Smith, professor of nursing, say it was not an attack on nurses but on a health system that devalues care.

Our study 'How student nurses' supernumerary status affects the way they think about nursing: a qualitative study' was headlined on some websites as 'clearing up poo will not help me learn - student nurses reject basic care'.

Our fieldwork took place in acute wards where trained nurses told us they faced increased pressures to meet NHS targets

It illustrated the dilemma faced by students and nurses to provide vital bedside care to patients while remaining at the heart of nursing.

The response to our article, resulted in over 90 comments from students, nurses, health care assistants (HCAs), teachers and mentors demonstrating just how acutely and passionately that dilemma is felt.

'Too posh'

The background to our study arose as a response to the 'too posh to wash' debate following the changes in nurse education that removed student apprentices from the formal workforce, replacing them with HCAs.

Given the current pressures, trained nurses are unable to deliver bedside care

We also wanted to find out who provided the leadership for care in a changing NHS and a system that has uncoupled formal education from practice.

Our fieldwork took place in acute wards where trained nurses told us they faced increased pressures to meet NHS targets.

Although they maintained that bedside nursing is still central to what they do, we found that the pressure from targets led to the work becoming routine and a hierarchy of tasks.

Bedside personal care primarily performed by HCAs has been divided from the technical work performed by trained nurses who administer drugs, dressings and undertake organisational work.

'Routine care'

Making bedside care routine is not new.

It existed in the 1980s when the new nursing challenged routine and hierarchy and sought to personalise care through the nursing process and primary nursing in a spirited attempt to give holistic patient-centred care.

We make very clear that it is the system not the student that is at the heart of the problem - both the way education is de-linked from practice and the hierarchy of technical nursing over personal care

Given the current pressures, trained nurses are unable to deliver bedside care.

This situation reinforces the perception that technical care is valued over and above bedside care as a source of learning for students' future roles leaving them feeling unprepared to be trained nurses.

Our research showed that students conceptualise nursing differently to qualified staff because of an intensification of the division of labour between registered and non-registered staff.

Consequently students often observe HCAs performing bedside care and trained nurses undertaking technical tasks.

The absence of clear role models leads students to sometimes question bedside care as part of their learning to become a qualified nurse and to put greater value on learning technical skills.

'Difficult positions'

Our research does not suggest that students are the problem.

Rather it analyses the system that puts them into difficult positions.

We make very clear that it is the system not the student that is at the heart of the problem - both the way education is de-linked from practice and the hierarchy of technical nursing over personal care.

As one respondent said, 'mentors don't know what to do with students, so they use them as a spare HCA'.

Many of the respondents agree with our findings that trained staff in placements don't always know what to do with students and that students can end their placements in a rush to achieve their learning objectives having spent their time beforehand fitting in and 'not alienating their colleagues'.

Furthermore mentors must organise patient care at the same time as supervising students and receive neither recognition nor rewards for their efforts.

Our research neither attacks students nor devalues care but analyses a system that does.




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