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Monday, 22 April 2013

Cheap labour

Potential nursing students should spend a year working as health care assistants before they start training, says the government. A move described by the RCN as ‘stupid’

I couldn’t put it better myself. The story first broke at the end of March but I hoped it had merely been suggested to test reaction and would not rear its head again. But no, here we are at the RCN congress and the government, dogged as ever, especially when it’s wrong, is going full tilt.

It’s an idea that completely misses the point of the recommendations of the Francis report and tries to lay the blame for the travesty of Mid Staffs on nurses, whilst Francis laid it on the NHS Trust Board and the strategic health authority. 

How anyone thinks that unleashing untrained people, often teenagers straight out of school, on patients with multiple care needs, will improve the care of those patients is bewildering. It demonstrates a complete lack of understanding of nursing and, I would suggest, of education.  If you don’t believe me then read  for a nurse who really knows her stuff.

Nursing is and should be a career, where educated people can be both caring and ambitious. The two are not mutually exclusive. Nurses can specialise and become expert in their field – increasingly a necessity in an advanced health service. There will always be room for generalist nurses but the days of a nurse being able to ‘work anywhere’ are about as realistic as expecting an athlete to be able to compete in any event just because they can run fast. Yes, nurses need to be caring and compassionate but they also need to be intelligent, educated and forward thinking.

How will a year spent as a wage slave facing the more grim aspects of life make someone compassionate and enthusiastic for more? Many young people will be more than up to the job and still want to go on to do their nurse training. But many, who would have made excellent nurses, will not. The ability to deal with the smell and misery and sheer grossness that comes with caring for the very sick, the very old and the dying takes maturity, understanding and compassion. The latter is not produced automatically like an inborn kindness duct present only in those who can be nurses. However, it will almost certainly develop as someone matures and is certainly something that can be learnt with the support of good tutors and good role models. 

The age old dichotomy between ‘educated’ nurses and ‘trained’ nurses is tedious and usually put forward by those who are not nurses or have been out of the profession so long that they can’t remember the bad old days.  Why would you not want your nursing workforce educated? At present student nurses spend more than 50% of their training in practical learning – on the wards, in the community and in skills labs. What will another year of hard graft at the minimum wage – making their training an unrealistic four years – add to the mix? 

Put young people fresh onto wards and into care homes and there is no knowing who their role models will be. Much of nurse training may be spent unpicking some bad habits and corner cutting learnt while on a year’s ‘compassion training’.  And anyone forced to do a year of apprenticeship might well see themselves above having to do any of the dirty work once they are trained – there is an army of untrained youngsters for that – thus having the opposite effect the government intended.

But of course this is not about nurses, nursing or patients. It’s about filling jobs cheaply with young people thus solving the care of older people and the young unemployed in one hit.

Learning unsupported and unsupervised will be bad for nurses, bad for nursing and bad for patients.

For more on the good old, bad old days: Remember when?

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