I'm about to hop on a plane to make the long journey to Australia to see family and friends and, most importantly, to attend the 30 year reunion of my training group at Royal Prince Alfred Hospital, Sydney. We celebrated the beginning of our training (1979) and now we meet again to celebrate the end of our training (1982). Many of the group now have admin, teaching or research roles in Australia and beyond so it will be a great opportunity to compare notes.
Nursing in the UK appears to be experiencing the same aches and pains as we had in Australia when nursing education changed to a degree course. The same old chestnuts are being trotted out here in the UK about the inability of university-educated nurses to fluff pillows and respond to patient needs. I must say that I fell into this trap myself as I had been away from clinical nursing for some time and returned to find wards staffed by young, university-educated nurses. It took a day to change my opinion after watching these nurses negotiate lab results, complex nursing procedures and nursing informatics. At the same time, they responded to patient needs with added skill as they were able to assess the reasons for difficult patient behaviours in a way that we were unable to. They had been trained in critical thinking. We had been trained to complete tasks.
I tried to remember the sort of paperwork we completed when I started out in my training. I recall the patient record, of course but not much else. I seem to remember a communications book in some wards where messages were left. Probably about bowel movements! Most of the time,however, there was a lot of 'Does anyone know anything about Mr Smith's dressing?' or 'Does anyone know if Mr Smith has been for an X-ray or not?'.
We learned about the new 'Nursing Process' from America - assess,plan,implement,evaluate- and were a bit skeptical about it. After all, where do you keep the record of it? This is precisely why nurses have a lot of paperwork these days. It's important to record what has happened and if it is successful or not. The difficulty is in establishing a paperwork regime which is balanced and not recording every move the patient makes or doesn't make.
Recording patient information is an important part of nursing not least as a means to assess staff levels and the skill mix required on the ward each shift. It's also important as a means of assessing the effectiveness or otherwise of some of the treatments used e.g. dressings. Some of these treatments are expensive and need to be replaced if they are not doing the job. How will we know if we don't keep records for nursing research.
Nursing Research is a vital part of nursing and will only be taken seriously if done in a proper manner following academic procedure. This is another reason for insisting on nursing education levels which match the levels of other Health care Professionals. Nurses are told that they are at the coalface of healthcare yet denied the same status as other HCPs if they are not educated to the same level.
This brings me to my last point; that of the education of Aged Care Workers. I cannot help but compare the UK situation with that of Australia. In Australia, prospective workers undertake a 12 month Aged Care Certificate III where they learn about the specific needs of the elderly. They learn the skills needed to work with the elderly and their competency in undertaking these skills is assessed before they set forth in their new jobs. It is extremely worrying to see the situation in the UK which reminds me of how it was in Australia many years ago. Untrained or barely trained Aged Care Workers try to care for the elderly without the knowledge they require to understand the special needs of the elderly, particularly those with dementia. I recently worked in a large NHS hospital which is like any other in the country. Medical wards full of the 'very elderly', patients in their 90s with even more needs than the 'elderly'. This area of care is huge and growing rapidly but we are not training health workers adequately to deal with the challenges they'll face there. We are also not paying them a living wage to do so. But that's another blog..
Nursing in the UK appears to be experiencing the same aches and pains as we had in Australia when nursing education changed to a degree course. The same old chestnuts are being trotted out here in the UK about the inability of university-educated nurses to fluff pillows and respond to patient needs. I must say that I fell into this trap myself as I had been away from clinical nursing for some time and returned to find wards staffed by young, university-educated nurses. It took a day to change my opinion after watching these nurses negotiate lab results, complex nursing procedures and nursing informatics. At the same time, they responded to patient needs with added skill as they were able to assess the reasons for difficult patient behaviours in a way that we were unable to. They had been trained in critical thinking. We had been trained to complete tasks.
I tried to remember the sort of paperwork we completed when I started out in my training. I recall the patient record, of course but not much else. I seem to remember a communications book in some wards where messages were left. Probably about bowel movements! Most of the time,however, there was a lot of 'Does anyone know anything about Mr Smith's dressing?' or 'Does anyone know if Mr Smith has been for an X-ray or not?'.
We learned about the new 'Nursing Process' from America - assess,plan,implement,evaluate- and were a bit skeptical about it. After all, where do you keep the record of it? This is precisely why nurses have a lot of paperwork these days. It's important to record what has happened and if it is successful or not. The difficulty is in establishing a paperwork regime which is balanced and not recording every move the patient makes or doesn't make.
Recording patient information is an important part of nursing not least as a means to assess staff levels and the skill mix required on the ward each shift. It's also important as a means of assessing the effectiveness or otherwise of some of the treatments used e.g. dressings. Some of these treatments are expensive and need to be replaced if they are not doing the job. How will we know if we don't keep records for nursing research.
Nursing Research is a vital part of nursing and will only be taken seriously if done in a proper manner following academic procedure. This is another reason for insisting on nursing education levels which match the levels of other Health care Professionals. Nurses are told that they are at the coalface of healthcare yet denied the same status as other HCPs if they are not educated to the same level.
This brings me to my last point; that of the education of Aged Care Workers. I cannot help but compare the UK situation with that of Australia. In Australia, prospective workers undertake a 12 month Aged Care Certificate III where they learn about the specific needs of the elderly. They learn the skills needed to work with the elderly and their competency in undertaking these skills is assessed before they set forth in their new jobs. It is extremely worrying to see the situation in the UK which reminds me of how it was in Australia many years ago. Untrained or barely trained Aged Care Workers try to care for the elderly without the knowledge they require to understand the special needs of the elderly, particularly those with dementia. I recently worked in a large NHS hospital which is like any other in the country. Medical wards full of the 'very elderly', patients in their 90s with even more needs than the 'elderly'. This area of care is huge and growing rapidly but we are not training health workers adequately to deal with the challenges they'll face there. We are also not paying them a living wage to do so. But that's another blog..
