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

HouTx, BSN, MSN, EdD · Feb 12, 2010

Hmm - I haven't experienced this so much with students. It seems like over-reaction on a slow news day. But I am continually surprised by the negativity towards nursing by the British press. Nursing is still very highly regarded in the US. The rare 'nurse gone bad' story always seems to fade away without a surge of related 'nurses are awful' stories. Could this reaction because the switch to HCAs is fairly recent? We haven't had nursing students used as staff since early in the 20th century. There's bound to be some role confusion after a major change like that.

In the hospitals I work with, we are having the opposite problem. We are trying to move toward team nursing to decrease labor costs but the RNs don't want to 'give up' ADL tasks to nurse aides. It's like "I'll agree to team nursing when you pry this washcloth from my cold dead hands!!"

The fact is, RN work should NOT be focused on areas that can be performed by lesser paid staff. It doesn't make economic sense in an environment that is reeling from double digit increases in health care costs. Of course, I don't mean that RNs do not ever perform physical care duties... that would be ludicrous. I'm just saying that we can put more hands at the bedside (for less cost) if we can adopt care delivery models that include all levels of staff.

StNeotser, ASN, RN · Feb 12, 2010

The British press are having a competition right now to see who can devalue nursing the most. I'm surprised to see the BBC has put in an entry - I did think better of them.

I don't believe it for a moment. However, I do remember a few clinical placements here in the US where I was saddled with the alzheimers patient who had broken a hip and was really being used as a sitter. Obviously I didn't learn a thing on those days. I'm sure that's what nursing students mean when to quote the article 'clearing up poo will not help me learn - student nurses reject basic care'.

I'm sure most nurses, whether LPN, RN or BSN will clean up feces or blood when needed. They just won't be doing it when there are a couple of CNA's sitting around with laptops catching up on either their homework or Facebook.

Silverdragon102, BSN · Feb 12, 2010

Personally I feel that the British press love to blame nurses for any issues that occur in the UK. Seen it many times where nurses blames when most problems where management.

Saying that I remember when I trained back in the middle 1980's it was normal to see 4 trained staff, anywhere from 2-5 students of various years and 3 care assistants and prior to me leaving the NHS it was normal to see 2 trained staff (RN or EN (similar to LPN)), 2 care assistants, 1 (HCA) and 1-3 students although they was supernumerary and not included on the numbers and this was to cover a patient load of 28-34 depending on size of the ward. Many of us felt things got missed, stuff was regularly moved onto next shift as it didn't get done and staff felt stressed and unappreciated.

Otessa, BSN, RN · Feb 12, 2010

I think it varies-depends on the college attended-all are not created equally.

otessa

Otessa, BSN, RN · Feb 12, 2010

Hmm - I haven't experienced this so much with students. It seems like over-reaction on a slow news day. But I am continually surprised by the negativity towards nursing by the British press. Nursing is still very highly regarded in the US. The rare 'nurse gone bad' story always seems to fade away without a surge of related 'nurses are awful' stories. Could this reaction because the switch to HCAs is fairly recent? We haven't had nursing students used as staff since early in the 20th century. There's bound to be some role confusion after a major change like that.
In the hospitals I work with, we are having the opposite problem. We are trying to move toward team nursing to decrease labor costs but the RNs don't want to 'give up' ADL tasks to nurse aides. It's like "I'll agree to team nursing when you pry this washcloth from my cold dead hands!!"
The fact is, RN work should NOT be focused on areas that can be performed by lesser paid staff. It doesn't make economic sense in an environment that is reeling from double digit increases in health care costs. Of course, I don't mean that RNs do not ever perform physical care duties... that would be ludicrous. I'm just saying that we can put more hands at the bedside (for less cost) if we can adopt care delivery models that include all levels of staff.

I have to disagree with you. I did my BEST skin, psychosocial, education and mental evaluations, etc. while taking care of my pt's ADLs. You truly get to see those slight changes with a primary care nursing approach. I remember the days of team nursing where the RN assessed 12 patients the LPN gave meds for 12 patients and the CNA gave baths(ADLs) to 12 patients-I remember because I was the CNA. By the time I was done with college it had gone to primary nursing where I had 4 patients and had an aide to help with things on an as needed basis.

otessa

Angie1011 · Feb 12, 2010

I think part of the problem is that students resent (and rightly so) being used as Health Care Assistants by the wards they are placed on.

I trained in the UK and was often irritated to find that instead of being placed on the shift with my mentor, I would be placed on the shift they were short-staffed for, taking the place of a Care Assistant. On a few occasions I was even called at home by the charge nurse to change my shifts around because they were down a HCA for that shift and wanted me to work that one instead. I would spend entire days washing, showering, feeding and toileting patients, but wouldn't be allowed to do the drugs rounds, wound care, charting etc. I would have been happy even just observing! I was desperate to learn how to be a good nurse and whilst I agree that also means knowing how to give excellent personal care to patients, there comes a point when you have just about learnt how to give a bedbath and should be allowed to move on to other tasks. And no, that does not make me 'entitled', just eager to learn.

Now, I am in NO WAY belittling the role of nursing assistants, they are just as vital to healthcare as any other member of the MDT. But as a student, I was there to learn skills that fit within the job description of the RN, skills I would be expected to learn by the university and future employers.

I should also say (before the flaming starts) that it isn't the fault of the mentors/perceptors, who are often working with ridiculous staffing levels and high patient loads and don't have time to spend teaching students as they would like to. But in the UK, students are often not taught ANY clinical skills by the university nursing schools (my program allocated just 6 hours per semester to this!) and they are therefore required and expected to learn these things on their clinical placements.

Unfortunately, sometimes you do have to stand up and say 'No, I'm sorry, I'm supernumerary', I'm here to learn!'

I was lucky enough to have some awesome mentors (I am proud to say I'm still friends with a few of them) and I was able to learn good clinical skills safely, effectively and with excellent supervision. Some of my classmates were not as fotunate. One of my friends got through her second year of nursing school and had not so much as been allowed to take a set of obs. The skill set in our graduating class differed radically, surely that should not be so.

WalkieTalkie, RN · Feb 12, 2010

Um, heck no... I have a BSN and CCRN, and I'm still wiping up poo!

dudette10, MSN, RN · Feb 12, 2010

With re-reading the article and Angie's post, it seems that the headline is quite sensationalist. As a student nurse, I can say we want to learn everything we can learn during a clinical post, and once we have done ADLs on 15 patients, we expect to be able to do different things that are also necessary to patient care.

In my first clinical rotation, I became comfortable with ADLs within the first two weeks. After that, I still did ADLs, but I also pestered the PCTs and RNs to call me when they had to do other things, like changing ostomy bags, do vitals, changing foleys, etc. It took some initiative on my part, but I was lucky that my clinical instructor and the employees of the facility were willing to let me observe or allow me to do it myself.

If the situation that many student nurses face in the UK is like Angie's description, I would be upset, too. Only doing ADLs throughout our clinical experiences will make us undertrained--and unsafe--nurses. This is definitely a learn-by-doing profession, and students need a variety of hands-on experiences to increase their confidence and skill sets.

Silverdragon102, BSN · Feb 12, 2010

Just shows how different universities in the UK work, I know when we had students on the wards some where happy to work with their mentors and others wouldn't. We always tried hard that the student worked with their mentor but when the ward worked a internal rotation and the mentor was on night duty then the student didn't work with their mentor but this would probably happen once every 6-8 weeks. Many times I did ADL's because staffing levels meant if I didn't do it then the patient could be left for a while waiting and that was not acceptable to me, I have no problems rolling my sleeves up and I expect the student who is working with me to do the same not come up with excuses not to assist and that happened several times. Students like this did not get a good report and things where mentioned to their tutor. I even on a couple of occasions had the student comment they didn't need to know this stuff cos they didn't plan on being a bedside nurse but go straight into management, sorry but that isn't always as easy to do in the NHS as some may think.

oramar · Feb 12, 2010

I think part of the problem is that students resent (and rightly so) being used as Health Care Assistants by the wards they are placed on.
I trained in the UK and was often irritated to find that instead of being placed on the shift with my mentor, I would be placed on the shift they were short-staffed for, taking the place of a Care Assistant. On a few occasions I was even called at home by the charge nurse to change my shifts around because they were down a HCA for that shift and wanted me to work that one instead. I would spend entire days washing, showering, feeding and toileting patients, but wouldn't be allowed to do the drugs rounds, wound care, charting etc. I would have been happy even just observing! I was desperate to learn how to be a good nurse and whilst I agree that also means knowing how to give excellent personal care to patients, there comes a point when you have just about learnt how to give a bedbath and should be allowed to move on to other tasks. And no, that does not make me 'entitled', just eager to learn.
Now, I am in NO WAY belittling the role of nursing assistants, they are just as vital to healthcare as any other member of the MDT. But as a student, I was there to learn skills that fit within the job description of the RN, skills I would be expected to learn by the university and future employers.
I should also say (before the flaming starts) that it isn't the fault of the mentors/perceptors, who are often working with ridiculous staffing levels and high patient loads and don't have time to spend teaching students as they would like to. But in the UK, students are often not taught ANY clinical skills by the university nursing schools (my program allocated just 6 hours per semester to this!) and they are therefore required and expected to learn these things on their clinical placements.
Unfortunately, sometimes you do have to stand up and say 'No, I'm sorry, I'm supernumerary', I'm here to learn!'
I was lucky enough to have some awesome mentors (I am proud to say I'm still friends with a few of them) and I was able to learn good clinical skills safely, effectively and with excellent supervision. Some of my classmates were not as fotunate. One of my friends got through her second year of nursing school and had not so much as been allowed to take a set of obs. The skill set in our graduating class differed radically, surely that should not be so.

I find your post thought provoking and informative, I hope no one flames you for it. I just wouldn't understand why anyone would do that. That is just the kind of information that is needed, straight from the parties involved.

Angie1011 · Feb 12, 2010

Just shows how different universities in the UK work, I know when we had students on the wards some where happy to work with their mentors and others wouldn't. We always tried hard that the student worked with their mentor but when the ward worked a internal rotation and the mentor was on night duty then the student didn't work with their mentor but this would probably happen once every 6-8 weeks. Many times I did ADL's because staffing levels meant if I didn't do it then the patient could be left for a while waiting and that was not acceptable to me, I have no problems rolling my sleeves up and I expect the student who is working with me to do the same not come up with excuses not to assist and that happened several times. Students like this did not get a good report and things where mentioned to their tutor. I even on a couple of occasions had the student comment they didn't need to know this stuff cos they didn't plan on being a bedside nurse but go straight into management, sorry but that isn't always as easy to do in the NHS as some may think.

I completely agree, there are some awful students and I knew a few classmates who were in distinct need of an attitude adjustment. But, as my grandma used to say, there's good and bad everywhere and that goes for both students and mentors.

I had no issue completing ADL care, but as Dudette10 says, there is a limit and you should be able to progress onto other tasks, not spend three months strictly showering, bedbathing and handing out lunch trays because I truly feel that hampers your education.

Personally, I was happy to be involved in whatever task my mentors happened to be doing, whether that be ADL care or helping out with the charting and I regularly stayed after my shift had ended on several different placements to help out as they were so short staffed.

However, when I found myself working essentially as an HCA (one particular placement springs to mind), neither my mentor nor any other RN ever carried out any ADL tasks at all. It was the HCAs and me completing ALL the ADL duties. I had no supervision, no teaching, I was merely treated as an extra nursing assistant. I was told to take my break when they did and direct any questions to them, I barely saw an RN all shift. I was even told to give the charge nurse a months notice if I arranged a spoke placement and would be off the ward for the day, so they could hire a 'bank' HCA in my place. I honestly believe that even as a lowly student, there sometimes comes a point when you do have to (politely) stand up for yourself.