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

[madwife2002, BSN, RN]

like so many of the pointless rituals of UK nursing the treatment of maile catheterisation as an extnded role is one rlated to victorian views of what is is proper for well brought up young lady to do ...

there's not much crimea sand in Uk hospitals either but the pillows still take account of it

I dont understand what you mean? I did male catheterisation in the Uk starting back in 1995. I have never heard of victorian views in any of the 10 hospital's I have worked in. I certainly disagree that we do pointless rituals. Where on earth have you worked in the UK some country hospital in the back end of beyond?

[MaryAnn_RN]

like so many of the pointless rituals of UK nursing the treatment of maile catheterisation as an extnded role is one rlated to victorian views of what is is proper for well brought up young lady to do ...

there's not much crimea sand in Uk hospitals either but the pillows still take account of it

The Crimean War...wonder what Mary Seacole and Florence Nightingale would make of the current state of affairs?

[Whisper]

I dont understand what you mean? I did male catheterisation in the Uk starting back in 1995. I have never heard of victorian views in any of the 10 hospital's I have worked in. I certainly disagree that we do pointless rituals. Where on earth have you worked in the UK some country hospital in the back end of beyond?

I work in a tertiary referal centre, a huge trust with two major hospitals, and outlying cottage hospitals. we can't catheterise men, unless we have been on a course, and to get on the course is a nightmare. Despite the hospital being built (at least the main building) in the '60's we have a lot of victorian attituides, the pillows for instance, despite the lack of sand all have to face the same way, away from windows and doors... only now we say it is for the ward to look tidy!!!

[karenG]

like so many of the pointless rituals of UK nursing the treatment of maile catheterisation as an extnded role is one rlated to victorian views of what is is proper for well brought up young lady to do ...

there's not much crimea sand in Uk hospitals either but the pillows still take account of it

I've never cathertised a man- never needed to! and it wasnt something we were taught.. outside our scope of practice.

pillows.. hmm well have to say, I do like to see a nice neat ward!! I worked mostly in eyes.. and the wards had to be tidy.. with everything in its place.. and the same place each time. working with blind and partly sighted people, thats essential unless you want accidents.

[karenG]

The Staff nurse who took over from me on nights, laughed at how little i knew though about some of the patients condition, or when my pronunciation was off. She'd trained a good while ago, and her general knowledge was much better than mine, where as my knowledge base is very specific to where I work, I didn't like to tell her that I'd had to google many of the conditions, because I'd never come across them before. If what she said was true, about nurses being trained to work any where and being able to do a basic role on any ward, then we need to go back to the old system, because every time we move i feel like a fish out of water, the last time i moved i went to ortho, and ordered an air matress for a patient with a fractured NOF!!!

Whisper

ps, found out about ot using the matress just after i'd inflated on an empty bed, so nobody was harmed, except my ego

I'd say that in some ways, this illustrates what was good about the 'old fashioned' training I had; we were able to go onto any ward and work because the basic nursing care was the same on all wards - even down to the pillows all facing the same way and the wheels all facing way (and yes- I still kick wheels into shape when I visit a ward- its a deeply ingrained habit!). lots of stuf was considered extended role.. but its stuff we learnt once our basic nursing skills were embedded.. I am sure i could still walk onto a wark and happily work.. ok, some of the electronic stuff might throw me but I'd survive!

by the middle of your third year training, you were expected to manage a ward.. and often did. dont think that would or could happen now!

[Whisper]

Students taking charge of a ward?! I can't ever see that happening again. not as they are 'supernumery'

whisper

But an interesting aside, i've just been on youtube to look up intaosseous needle insertion, and US paramedics, and the UK army practice such skills on each other!!! bed baths are one thing, an IO needle or drill is another thing entirely

[Silverdragon102, BSN]

I have left a few medics and nurses practice inserting cannula or needle for taking blood on me as I have such good veins that everyone's eyes light up when they see them (all within reason of course)

[Whisper]

I've had my blood taken once or twice1 but would have to be unconscious for an IO!.... or a bed bath

[Hyacinth55]

I do my pillows like that at home too (facing away from the door and /or windows) - it`s that ingrained in me! Bloss

[cheshirecat]

Me too, blossom. Drives my husband mad.

[Hyacinth55]

My sheets are also done the same way just as I learned as an SEN in the UK back in 1979! Some things we learned as 18 yr old nurses would be very difficult to undo 25-30 yrs later, Bloss