Are we deskilling

[XB9S]

I have had a really busy day today and as part of my job I am the nurse practitioner for surgical outlyers. We don't get them often but today we had a few on medical wards.

One of these patients was a bowel obstruction, distended, vomiting and poorly. He was going to be treated conservativly with IVI and NG tube. I got to the ward and the staff nurse informed me that his NG had come out, she was in the process of bleeping the doctor to put it back and there were no nurses on the ward who could put NG tubes in.

Now when I did my training we were taught to insert ryles tubes, is this no longer the case. I find it worrying that the doctors that she bleeped are house officers and haven't put NG tubes in (our surgical nurses do it) and there weren't any nurses that could do it. I did it which is fine but I wonder what happens tomorrow on my day off.

I worry that as nurse pracs we are doing these things but not allowing the ward nurses or new docs to learn because we always do them.

Not sure what the solution is, if I were a patient I would want the most experience person doing things like that for me but we all have to learn sometimes. I do try to teach when I do these things but the nurses on the ward today weren't interested, as far as they were concerned they hadn't done a course to put NG tubes in so they wouldn't do them (OUr trust doesn't rund a course by the way)

Not sure what my point is, I know I am rambling a bit, but I do wonder (and maybe Ayla can answer this) is nurse education lacking in clinical skills, is this the sort of thing we should be learning in nursing school and encourage our students to be doing and do we really need a study day to be able to put a naso gastric tube in? (or catherise for that matter) or is this something that should be covered in nursing school.

ANy thoughts from anyone else

[cheshirecat]

In some trusts, zippy students are being used as unpaid HCA's. Managers keep costs down by rostering students on at the weekends, and giving HCA's days off.

Could you manage on a bursery of £400 per month? Could you pay your rent, food, gas, electricity on this? I could not, I will be honest.

If students are on the wards, they should be supernumeray. If some trusts can manage this, then all trusts should.

[Zana2]

students are not 'unpaid workers' for the following reasons

1. if this were the case the placement area would be pulled

2. students should not replace staff once the minimum acceptable staffing for an area is reached

3. these 'unpaid workers' get their bursary gross s well as the other advantages of being a full time student e.g. council tax exemption / reduction ....

then there's all the other allowances that would not be legla should we return to students being paid

1.You're right, that's the theory. In practice, I've been supernumerary once. They know that, we know that. I don't mind it terrible, makes me feel part of the team. If it's an organised ward with a really good ward sister, everybody knows what they're doing and work together as a team, it works just fine.

2. If i only had a penny for everytime the ward sister asked if i could stay on a long day because so and so called in sick, the agency didn't show up etc. Again, what you say is correct in theory.

3 My bursary is £6,500. I pay transport (£50 a week-no trains or buses where i live). The council tax is reduced by 25%, out of £1,600. I pay 1 pound less at the swimming pool. I don't qualify for childcare, because my husband earns over £10,000 a year. He earns £12,000 before tax. I pay childcare £11,000 a year, at the University's nursery. We pretty much live out of the family tax credit, which is about £2,600 a year.

I just thought I give you a rough idea what that bursary helps with. I'm not the only one in this situation. And it's hard, but it's only for 3 years, it won't kill us. And i've done my maths before I started, it wasn't a surprise for me.

Had i been in full time employment, the childcare element would have taken care of a massive chunck of our expenditure. As a full time student, you don't qualify for that. It is not the same as being employed.

[Zana2]

RGN1, you're right on the ball with that one! I had placements that had nothing to do with my module, I was told I could do visits in order to achieve my learning outcomes. 'It's all in the attitude!'

I just think it's a shame it's not better organised, because one would hope that working alongside a nurse, albeit newly qualified one, would give the more experienced overworked staff nurse a bit of support. In practice, it's the staff nurse who has to teach everything to a new grad, oh, the joy...

[madwife2002, BSN, RN]

I too trained when we were employed by the hospital and we got a wage but were part of the work force and counted in the numbers. We worked hard and were trained by the second and third year students. Standards were high and you learn't quickly how to time manage, you learnt how to manage staff and you quickly learn't that if you got the 'nursing auxillaries' on your side you would have an easier time. You studied in your spare time, you partied hard, the atmosphere on the wards was fun. The weak lazy nurses were quickly weeded out. At the end was produced a smart, knowledgable new nurse ready to take on new responsibility. The weaker nurses had fallen by the wayside because they learn't during the training nursing wasnt for them. Nowerdays nurses do not have the stress of working on the floor as a 1st,2nd,3yr student they dont learn the comaradary which was always present on the floor. In the US Rn's train for just 18 months and there are even fast track courses which take 1 yr. They come onto the floor for a morning twice a week to work with the pts no wonder they are so stressed after becoming an RN.

But I have to say it is the nurses who trained in the UK in the late 70's and 80's who have a lot to answer for. We are the ones who did moan and complain we were used as cheap labour and we complained about working on the wards such long hours still having to study and do constant exams. We wanted things to be easier for student nurses and we got what we wished for. Nursing lost a lot when we moved from the hospital into the University.

[madwife2002, BSN, RN]

In some trusts, zippy students are being used as unpaid HCA's. Managers keep costs down by rostering students on at the weekends, and giving HCA's days off.

Could you manage on a bursery of £400 per month? Could you pay your rent, food, gas, electricity on this? I could not, I will be honest.

If students are on the wards, they should be supernumeray. If some trusts can manage this, then all trusts should.

We did manage on poor wages but we had cheap housing I think I paid 46 pounds a month for student nursing accomodation, and my god that was money well spent and great fun. so when we earn;t about 250 pounds we spend 50 more on food, (cup-a soup,pot noodles and crackers) the rest on going out.

Sorry I am off topic.

Sorry CC I cant agree with students being SN this is why we have the current deskilling problem.

[cheshirecat]

Students should have supernumeray status if they are not being paid to work on the ward. They should have clinical teachers on the ward, and not expect staff nurses to do all the clinical training. It is getting teachers on the cheap.

If students were trained properly and not used as ward fodder, they would have the skills needed to be effective newly qualified staff.

I did my training in the early 80's (started 1981). No way would I like to do the training the students do now. I loved my nurse training.

I just feel that in many placements students are being abused, and that is why the training is felt to be ineffective.

[madwife2002, BSN, RN]

You know what I find when they are called supernumery they immediatly think it means they dont have to do any work, I have heard it said we are supernumery we just have to observe.

[Silverdragon102, BSN]

I agree that sometimes I have had students that said we are sn and can do what we want but on the other hand I have had many students just roll their sleeves up and get down to learning. Think some actually open their eyes and look at what is happening as a qualified staff and try to gain experience before they are thrown in to the wolves where others say that they want management jobs and looking at the quickest route to go

[madwife2002, BSN, RN]

ok I generalised

[ZippyGBR, BSN, RN]

In some trusts, zippy students are being used as unpaid HCA's. Managers keep costs down by rostering students on at the weekends, and giving HCA's days off.

yes, whatever... and the placement coordinators , lecturers and taff side are all complicit in it ?

Could you manage on a bursery of £400 per month? Could you pay your rent, food, gas, electricity on this? I could not, I will be honest.

i did, well i lie slightly, i did with a modest amount of support from additional work and from my parentns but only a 100 gbp or so a month

[ZippyGBR, BSN, RN]

You know what I find when they are called supernumery they immediatly think it means they dont have to do any work, I have heard it said we are supernumery we just have to observe.

the problem there lays with university staff

when i was pre-reg the diploma and degree were run by different HEIs - ironically ye more prestiguous HEI ran the diploma , but equally had inherited most of the 'old' lecturers ... supernumerary to them and by association to us meant - you are not there to be HCAs ... sadly some ofthe lecturers at the (ex)poly dfelt differently and the degree students had a different view of what supernumerary meant

[ZippyGBR, BSN, RN]

Students should have supernumeray status if they are not being paid to work on the ward. They should have clinical teachers on the ward, and not expect staff nurses to do all the clinical training. It is getting teachers on the cheap.

If students were trained properly and not used as ward fodder, they would have the skills needed to be effective newly qualified staff.

I did my training in the early 80's (started 1981). No way would I like to do the training the students do now. I loved my nurse training.

I just feel that in many placements students are being abused, and that is why the training is felt to be ineffective.

the 'blame' here is on staff on the wards for not working effectively

develop your relationship with the HEI and perhaps the link tutor or other lecturing staff will come and work with your students , perhaps they'll even fund a lecturer practitioner rioole ...

it's incredibly easy get 'heads in ' and run around like an idiot when things get a stressful, and a lot of nurses even Ward Managers and Site Managers do this ... Nursing needs to learn from the Airline Industry and start treaching and using CRM techniques - peri-operative environments often use this kind of methodology unwittingly , dittio Emergency Departments ... but a lot of other areas don't...