brianbooth

There's a standard joke in Brith nursing - no doubt you have equivalents - 'I know how I want to die. At the age of 90, shot in bed by a jealous husband'. We have family in Texas; they also spent three years in Oklahoma. I have learned a lot about cultural differences but the best example was, when buying some jeans, to be asked about whether we had denim in Europe. I'm not wandering here - cultural differences matter, and as nurses, we need to know about them. Smoking, body mass, faith - they are all part of the job.

Take a moment to award yourself a common sense award

Thank you, MSOforu. I am going to reiterate my comments so far, so we don't stray off track. My entry into nursing was strongly contested because on the form, under 'religion', I entered 'none'. Yet my worst experiences, and my wife's, have been under nurses and one particular midwife who all believed that women bore Eve's curse, and should suffer for it. If you smoke - as I do - it does not matter a toss, providing you can move fast in an emergency, and you don't exhale tobacco breath over your patients. Ditto with weight. BMI is a nonsense. If you can run, you are OK by me. Let's appoint nurses by ability, not ticked boxes.

Some fascinating information here for Brit nurses. On age as an employment bar: a major UK company chain called B&Q, which sells hardware, decorating materials, fitted kitchens and bathrooms, gardening stuff - and more beside - tried an experiment in the 1990s where they actively employed older people, including (mostly) those beyond the state retirement age. These were floor jobs. They found that these people worked more efficiently, were more punctual, used up less sick leave - and tended to be able to answer customer queries more knowledgeably. In no time flat, they upped the programme, and a lot of other similar companies scrambled to get on the bandwagon. A lesson to be learned there.

I can't comment on US nursing working pactices; I can only say how I worked it the UK, and believe, on the whole, my way worked. Others may disagree. As the nurse in charge, if I couldn't leave the ward, then hard luck. In my absence, staff seemed to get that they followed my rules or paid the price.

I completely agree, but it seems once again I have failed to make my point clearly. Smoking breaks are not a right ; they could be construed as fraud. However, having run a ward or two, I believe that there are times when nurses should be allowed to get outside and sort themselves out, without waiting for a scheduled break. The smokers have the excuse of 'needing a cigarette' - better than saying 'this is all too much' - so I have always extended the offer of 'fresh air' to non-smokers, shared fairly. Giving someone an unscheduled five minute break is, I believe, preferable to having them crack up on me. And if any smoker took a 30 minute break - I would sack them on the spot.

Considering that I have some experience of writing about nursing, and encouraging others to do so - feel free to check me on CINAHL, Medscape and other sources - I seem to be doing a pretty poor job at deposition. I ask your forgiveness for repeating things I have mentioned elsewhere. Please note: nursing candidates applied to universities, not hospitals, from the early 1990s, making all that follows mere history. When I started nursing in 1979, in the UK, you had to go to the occupational health (OH) nurse before the interview. That person could veto your application, or delay it, on the spot. This is general medicine. Mental health - another story. I'll give some examples of decision making. None were ever scientifically based, and in the current climate, may be seen as 'wrong', but that was how it was at the time. Smoking: normal then. All wards had smoking areas for the patients. Being a smoker did not matter to the assessment process. Weight: the OH nurse weighed you, and without anything other than their visual observations, the candidate could be asked to lose a few pounds and reapply when they had achieved the (subjectively chosen) weight. Skin conditions: anyone with an obvious facial condition was told to get treatment and reapply. Visible tattoos: not a chance. Goodbye. To some of you, this may all seem odd, perhaps outrageous. But that is how things worked 40 years ago, and I can't help but wonder whether there are lessons to be learned.

Thank you. I can only add to this that in my opinion, BMI is a largely useless measure of anything. I once nursed a super fit boxer whose BMI made him out to be obese. You could have used his abdomen as a carving board.

I think I have failed to make my point about this thread, which comes down to me not explaining myself well. 1. The debate about nicotine and its effects is separate, I believe. 2. If employers wish to refuse hiring nurses on the grounds of lifestyle, they might consider widening the parameters.

I refer you to a thread elsewhere here, where you can see my comments on this idiocy. Feel free to stomp on me. But in the case of an emergency - and I speak from experience - give me the smoker over the calorifically challenged any time.

To follow this thread: I wish to make a plea. Every contributor has made pertinent comments, and I especially like the demands for evidence. But it has become split; the question about nicotine is one thing. My son, a passionate anti-smoker, bought me the top of the range vape. That is for one thread. The chief thing I'd like to see is a discussion about refusals to smokers' applications for nursing jobs. That. to me, is beyond stupid and needs to be challenged. Please find a way out of this. As a UK nurse, I feel that it should be left to you lot to get talking about these issues separately. Brian

Testing for chemicals: I have had bit of experience dealing with people working on building sites in the UK. Employers conduct random tests which can detect a rather large selection of drug use, and over the years, they can date traces back to 90 days or more. Nicotine as a sole marker? Oh come on...

Please bear in mind that our UK 'free at the point of delivery' healthcare service does not mean we are a Communist state. It is about looking out for each other.

I think it might be worth thinking about how much smokers contribute to society. We pay tobacco duty and die young.

dear Jakehose - No, I am not in favour of a nicotine ban . Any initiative which helps smokers to quit - fine by me. But so long as nurses aren't breathing cigarette smells onto patients, a non-hiring smoking ban seems silly.

From the UK: There is a rather large gap between 'what should be' and 'what really happens'. Where do we start? I suppose it must begin with: I don't really understand the niceties of North American nursing, even after spending many hours discussing the subject with my sister in law, who retired from nursing in the US after some years, and my visits to US and Canadian haspitals, then professional organisations and conferences as part of my job as clinical editor of Nursing Times (which I left in order to return to practice). So: please don't stomp me. This a Brit view from someone with forty years in the job, and my wife, ditto. Declaration of interest: I still smoke. My wife gave up 25 years ago, and is very much against the practice, but we probably agree on some things following here. A lot of attention is given to smoking as a stress reliever. I would like to re-word that: it is a great excuse to relieve stress. The nurse who says 'I can't handle this' is a wuss; the one who says 'give me five, I'm going for a smoke' is OK, it seems. And that is why, when running a ward, I always tell the non-smokers to grab a five minute break, if it is possible, and on their return, the smokers can get outside. If I were the sole registered nurse in charge, there was always someone to cover me from elsewhere, but only when they could be spared. A restricted hiring policy on smokers. Good luck with that on the doughnut and other ultracolorific eaters, the people who wish to spread their version of passive smoking - which I call passive bigotry, I don't want to be subjected to inhaling idiotic bias - and the rest. Brian

In the UK, we have been following the US model of nurse 'education', and having read everything posted above, it saddens but confirms me in my belief that there is a fundamental flaw in the reasoning behind it. If a nurse wants to pursue higher education, then that's a good thing. I would never dissuade anyone who wanted to deepen their knowledge. Any learning experience, in any subject, that promotes deeper thinking has to be beneficial. However... What guarantees are there that such education, provided by people who may have relatively little bedside experience, will improve the experienced practitioner's skills? In the UK, we used to have 'registered clinical nurse tutors', who brought higher level knowledge and skills directly to the student nurse at the bedside. They did themselves out of their jobs by allowing themselves to be allocated more and more to the classroom, as cheaper versions of their chalk and talk colleagues. Now we're an all-graduate profession over here, we on the floor are left with filling in the gaps between theory and practice - sometimes, a painful process. I repeat, in a slightly different form, what I posted earlier: how can classroom learning ever compete with bedside experience, backed up with academic support? And how can we respect 'teaching' from individuals with limited practical experience of the subject?

I'm an old codger (aged 57), nursing as an RN in a different country - and continent - to those who have put up such thoughtful and meaningful comments as those above. But, as Chris Griffin asked, 'what is this chase, and how do I cut to it?' The experienced nurse, asked to undertake university education, may well find themselves being 'taught' by people who have a mere fraction of their nursing knowledge, and an even smaller fraction of their clinical experience. My career in the UK has been held back by my refusal to sit in lecture halls listening to, and taking notes from nurses who fled clinical practice at the first opportunity, quoting my own published words back at me. And then asking me to 'critique' them. (Not a joke: but it is a bit weird to hear your own words quoted at a national conference.) I can't wait for someone to prove to me that a 'degree' is better than 'experience gained through getting it wrong, and then swearing to get it right in future'. Letters after one's name mean nothing. What you do is another matter

In the big shake-up of UK nurse training in 1986, the reckless idiots in charge of it said that nursing was about promoting health, not dealing with sickness. As a result, 'stuff' like A&P was relegated in favour of sociology and similar drivel. I'm still waiting for a patient to turn up, desperate for an explanation of their health needs in relation to neo-con economics

"ummm... Who are those two old people in her bedroom, with feeding instructions pinned to their nightclothes?"

How well I know what you're talking about... patients asking 'why aren't you a doctor?', and not having a snappy comeback, even all these decades later, is irritating, to say the least. If anyone supplies one here, I will be eternally in their debt. However: this depends on the person asking the question, and their capacity to think things through - try 'if you were stranded on a desert island with one other person, and little chance of rescue, would you prefer that they were a doctor or a nurse?'

In the UK, A&P has been relegated by some universities to a later place in the curriculum, which I believe to be a serious mistake. (It was the first thing we did when I trained, and we would continue to learn about it, in increasing depth, as we progressed.) I recently had two students nurses to whom I was explaining some very basic stuff about patient positioning in conditions like cardiac failure. I had to stop and take them off for a session on the mechanics of respiration; they were aware of something called the diaphragm, but had no idea about what it did. My colleagues and I could provide far too many other examples.

Now that patients in the UK can ask to see their medical records, a lot of acronyms have had to go. Some examples: The Isle of Sheppey, near where I live, was once relatively inaccessible, with the result that the gene pool was, shall we say, a bit shallow. When I moved to the area, and saw in a patient's notes 'NFS', it had to be explained to me that this denoted a mild degree of learning disability - 'normal for Sheppey'. I've since heard of NFN, meaning Norfolk In A&E (ER, ED) the card completed by the admitting nurse would sometimes say 'PAFO', alerting you to the fact that the patient's injuries had been sustained whilst intoxicated - '****ed and fell over' And after discharge, a consultant's letter to the GP (family doctor) might end with a diagnosis of 'GOK' - 'God only knows'

I understand, and sympathize with, contributors who see nurses who smoke as being hypocritical when it comes to patient education. May I suggest that there is another side to this? As a nurse who smokes, when I talk to patients who would really benefit from giving up, I am immune to the 'that's easy for you to say' gambit. Add to that discussions about why my wife succeeded in giving up and I haven't, looking at the different approaches we used, and I believe my contribution to individual 'health education' may be more useful than hypocritical.

'Catch them doing something right...' Why have I never heard that before? Genius