Why students should get a PIN number

(Above) A pill for every ill...

I have finally had a bit of a revelation on how to make nurse education better which I would appreciate a few moments of your time to tell you of. I am sure that some may have read my post of how I was in a training seminar that made my head explode. Here is why. You see, far from being a grumpy “Its all shit” kind of person, my anger stems from my passion for nursing. Think about it, we are not perfect, but we are the profession who are at the patients bedside, take the basic needs of the patients who need assistance, dispense and administer medication, provide support to both patients and relatives, and do take a role in the dressing of wounds, taking of blood, observations and the setting up of infusions. I am sure that most Doctors would agree that Nurses are an essential part of the care of the patient after they diagnose them, that the physiotherapists would like us to keep them doing exercises as planned by them and so on.

My analogy today comes from my St John Ambulance division. We have Patient Report Forms (PRF) to fill in when we treat somebody. This includes applying a plaster. To get around filling in a PRF for just a plaster, as long as we give the person asking for a plaster one to apply themselves (after asking to make sure they are not allergic to them), we do not need to fill the form in. Its that simple.

Back to the post. The reason I was so annoyed was the fact that I feel unhappy with the way that nurse education being dumbed down. This is NOT the fault of the university nor of my home trust. The fault is that of the blame culture that we now live in. This (with the deepest respect to any American readers) is an Americanisim that frankly we can do without. I am nearly at the end of three years of training and there has been £40000 of the over burdened British taxpayers money spent on training me. I am a very pragmatic person, so I do think that training should be a process of taking an individual who does not possess the specialist knowledge or skills to do a job and equip them with the rudimentary knowledge to do this with the minimum supervision. It would seem that at the moment because of the sheer volume of litigation faced that the best which can be done is that we [student nurses] are trained in a knowledge base which is very good but lack some of the skills which are expected as a staff nurse. The fact that after three years I am not qualified to even take a temperature is something that makes my liver fizz. It’s an insult to the intelligence of all students, after all by attending university for three years you have shown some degree of intellect, rational thought and that you are not a dithering simpleton. So you can easily see my argument of “Just what is the aim of three years of hard study?” as this seems to be simply nothing more then a paper exercise to say “I would like to be a nurse, this paper says you can train me up”.

Which is where my local ambulance service has a good policy for recruiting its new university trained Paramedics by advertising the posts as trust positions. The trusts advertises for student paramedics and then when the candidates are employed by the trust they then start with the next intake and come out with a job- much like hospital secondments but for all levels. If the problem is with the trust officially training you as an employer, if you work for the NHS trust and use the equipment as part of your training, ergo you are familiar with the equipment and would not have completed your training without using it. This is too straightforward only if you are seconded.

So, today, I give you my latest bright idea: Give third year students RGN status and pin number which is valid for one year and one year only, which to keep the RGN status and pin number must mean completing the third year of study and gaining the accredited qualification. This PIN number should ideally be issued when the student enrols for their third year (to do so at the end of second year would affect those taking a year out). Think about it. How many times do we hear student being told “You cannot do task X because you are not registered”. Quite a few I wager. I have said before, there is no sudden transition made from dithering simpleton student on a Friday afternoon to uber-knowledgeable staff nurse on the following Monday, so its not the time spent which is the problem. The problem is that nobody wants to risk their registration number for a student making a mistake. This is understandable. The idea that a student would panic over having accountability is not an argument which much substance: just what would anyone making that point think the individual would do WHEN they qualify. No, the sooner we stop thinking as nurse education as being an academic essay only but the foundation of the building of the next generation of staff nurses the better, and all the better for the lost art of basic nursing care. The public argue there are nurses “too posh to wash”. Very good, but it’s normally the students who are given the basic nursing care to do while training: tell them they have an RGN status and have to give Mrs Smith a bed bath; they will hardly have many grounds to refuse. Of course, they may not have the time to do such a task when qualified but instil the right attitude to mould them and the rest falls into place (with any luck).

This would allow students to give out medication, take responsibility for patients, and learn how to use equipment. An exam of their safety and competence on drug rounds (done without the student knowing to reduce stress) to allow unsupervised drug dispensing will develop experience for this task which is one most performed by the staff nurses. There is no legal requirement on who dispensed medication; it must be however on the written instruction of a doctor or other appropriately licensed prescriber. Once more, as a registered nurse the student would do this, and if a person has never done medication rounds before they will be only at the same level of a student (and just as incompetent). The idea of affixing a registered status to somebody will not automatically make them competent in a set task (as has already being highlighted, newly qualified RGN staff are not allowed to take a temperature or BM’s without post graduate training so imagine a drug round…). So, give a 3rd year one year to finish and remove the “non registration” inhibiting factor, and let the students grow!