I have been in a training seminar today. The training was intended for the newly qualified nurses who have gained employment in the hospital. There are many exam's which I have to do, portfolios to pass and have so far spend two and a half years slogging through the sheer head-banging-against-wall frustration which is the modern day nurse training. When I think back over what I have done I soon realise just how irrelevant the training of today's nurses is. I used to think that this was simply because they were trying to make nurse training as far removed from the real world as possible and wanted students to have no clue. Seriously, the most progress we made was in the last half of second year when we were being groomed for the critical care placement and were expected to actually know something about the care of patients. If you look in the dictionary, the definition of nursing is to aid people's recovery through periods of illness or infirmity and help them meet needs which they cannot meet themselves (see the Roper Logan and Tierney 12 activities of living). Today though, I have found the real reason.
The training was for BM monitoring. Now, I thought this was simply the companies making a plug for selling their equipment. Turns out that for once, I was wrong. The reason this was to be done was (and I quote) "Before using ANY piece of equipment in the trust, you must be trained on how to use it...including thermometers". What? A bloody thermometer? The thing you put in the ear and take the temperature with? I am not suddenly finding myself in an alternative dimension of time and space where this is a name for a technical bit of surgical equipment? Unfortunately, no. I really could not believe what I was hearing. No wonder nursing is so disorganised and shit this day and age. I happen to know a fir bit about anatomy and physiology. I spent time studying ambulance aid so know of fractures, cardiac conditions, spinal injuries, the systems of the body, and read up on drugs. In the nursing school, none of that was considered important. BASIC NURSING CARE! Where was that? BASIC does not mean the same as SUPERFICIAL. Though maybe that's typical of the glamour obsessed self serving tossers who are considered "too post to wash" when back in first year I went through 4 vomit bowls brimming with sick to recover a patients lost dentures (which were actually in another vomit bowl back in the bay), yesterday was racking through a bedpan full of loose stool to do a sample and dredge paper from, then did the same for a urine test. Hardly glamorous but then I am a mildly pudgy bloke who wants to genuinely help people. Some nurses must be females who are living in some pink and blond valley in California who must be living the "hello!" celebrity culture who think that doing bed baths, checking observations, doing aseptic dressings, taking BM, Blood's, care of central lines, catheter care, dealing with relatives, talking to patients and working with the doctors and possessing a nursing and medical knowledge base not glamorous enough. I personally don't care about the glamour because I know that without all the non glamour stuff, patients would have a hard time of it. Yes, the cardiac surgeon did a great job on the coronary arterial bypass graft (CABG- and for goodness sake call it a graft in front of one surgeon and not a "cabbage" because I saw one person get yelled at for that)...but also having a relieved patient thank you for showering him after 5 days without having one brings it's own rewards.
I think there was about 3 sessions which really covered basic nursing care/skills. Manual blood pressures? Most staff would go running for a dynamap, which is hardly surprising as in my nurse training I spent only one 2 hour session on manual BP. Yet countless hours listening to people bang on about "Holistic [.sic]" care who spectacularly never managed to mention the patient or just exactly how an example of care meets this "Holistic [.sic] care". Honestly, I have often said that these people have spent too much time in a hippy commune somewhere on the west coast of the USA because there is no way on earth that a massive arterial bleed will stop by telling the patient "Stop bleeding, stop bleeding, oh God, please stop bleeding".
This is the problem. I have had SOME good training. Legal and ethics will stop me from getting sued, covered confidentiality, cleared up consent and keeps me on the legal straight and narrow. Evidence based practice was nice...but went on way, way, way too long and became near irrelevant. Foundations of clinical (in)competence was too short, principles of practice was boring, a full module on nurse education pointless, and even doing an essay seems pointless as it seems after three years of training I am not even allowed to take temperature or do a BM, would be elite as I can do a manual blood pressure and have to fill in a form bigger then the yellow pages just to have got the application. So who does that leave able to do the hands on care.
HCA's that's who.
5 comments:
There really does seem to an unfortunate culture of "you can't do z-y-z until you've done the course" that seems to have infected nurse training. I blame the same health and safety idiots who want to stop children playing conkers in the school playground.
Luckily, on most of the wards I've been placed on, a bit of common sense prevailed. As I recall, on my final 3-month placement of my degree, I spent those 3 months doing non-stop trachae care, despite never having done a training course on the subject (I was a mental health student, and they don't usually have trachaes on the psych wards).
In the absence of a training day, I just read up on the subject, and got the qualified nurses on the ward to show me what to do. But shhhhhh, don't tell anyone! ;)
I'm off now for my first day as a staff nurse rather than a student nurse...
"health and safety idiots who want to stop children playing conkers in the school playground."
Indeed. Because Health and safty are really the cancer of a civilised society. Lets fact it, by getting into university you have proven that you are not a driveling simpleton who needs three tries to get your name right.
But for the health and saftey, reality is far removed from things. Which is why I feel we are all left banging our heads against the wall by the great faceless system. And I am sorry, but they must realises that as I have said before on placement, a 3rd year student nurse does not walk around the ward on a Friday a dithering buffoon who sticks needles into patients eyes instead of their buttocks or try do-it-yourself emergency dental surgery, though walk on the same ward on the Monday a fountain of knowledge. You should hit the ground running.
Of course, I also said that as a student I should be able to sleep in till 11am and get drunk every night, though funny how when it comes to that they are quick to throw the professionalisim card up.
I'm an Operating Dept. Practitioner (basically a theatre nurse, we are qualified to the same level as nurses but specialise in theatre) The description above matches exactly the garbage i went through in training. All holistic this and that but no mention of how to actually do the job. I only started to really learn what i was doing when i was let loose on real patients, unsupervised, AFTER i qualified and got my first job. The liberal educationalists have ruined nurse/ODP training. I tried to protest but got nowhere. Just told to "Reflect" on my thoughts. AAARRRRGHHH!!!!!
I have just read your blog and wish to comment. I have been looking after an elderly relative and due to their health issues have been forced to spend alot of time with them in a major, class leading teaching hospital. I am not a health pro, but I am science trained. I am concerned with your attitude to training that some things are just so basic and aren't necessarily important, and that practise is the only place to learn. I had that attitude early in my undergrad course. But what I hope you understand is that everything that is taught is KNOWLEDGE. It is IMPORTANT. It did not simply fly out of someone's behind. It may not seem relevant or important to you and it may seem obvious, but it is there often for those who don't see it as obvious. Basic nurse training? During my time in hospitaI, I was assisting the nursing staff with temperature observations. About a good 50% of them had no idea how to use their digital thermometers. They were so used to taking oral temps, that when an axillary temp was called for, their digital thermometers were not set as such, resulting in measurement errors that were the difference between febrile and afebrile. Difference between discharge/treatment. Difference between treatment is working/not working. Common sense things like "is the patient hot, should I just re-take temp to be sure?" were often raised by me and resulted in correct temperatures being taken when initial measurement was in error. Simple things yes. Insignificant things no. So I implore you and all in your profession to have the right attitudes towards your training. If its boring/dull its because you havent personalised it. Just because it may seem mind numbingly dull, it doesnt make it unimportant. I think what you need to reconcile is the difference between theory and practise. Practise feeds theory and vise versa. Both go hand in hand. This is the only time in your professional theoretical life when someone will take the time to sit you down, talk to you, tell you what you need to know and then take questions from you. That is golden. And its not going to happen on the job like that.
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