Education and Training: Nursing

www.faxfn.org

Training for nurses

16apr98: Nurse A: Planning my escape.

I work as a staff nurse in a nursing home, previously I worked in a large hospital.

Nurse training is now Project 2000, a two year course for graduates, and also a nursing degree. Previous methods of training have been superceded. Both of these courses were meant to improve the education and status of nurses. But the education has not yet reached the correct balance. Theory is not put properly into practice: Most of the students of Project 2000 that I have met were unhappy with their training.

At present, I am studying something entirely different. I am unhappy with status, pay and conditions in nursing so the country may lose another trained and experienced nurse.

9may98: Nurse B: Decline in patient care.

When I trained nursing was a selfless profession where we put the patient first. But now we cannot afford to be patient centred. The nurse must protect herself and watch her back - because she may well be sued. But whose interests does this protect? Certainly not the patients.

The personal touch has been replaced by an emphasis on contractual obligations. Long term patients seldom get the same nurse twice. Contacts are short and bank nurses come and go. But elderly and psychiatric patients need to see the few faces caring for them on regular basis. Nurses need to feel secure in their employment if they are doing a good job. This is not possible with short term contracts.

I trained in the mid sixties. Training alternated three months in nursing school then three months putting training into practice on the wards under strict supervision. This pattern repeated throughout the three years training. The result at the end was a concentration of knowledge of the human body and how it works, and first rate practical skills, already implemented. We gained a great knowledge of basic nursing training and knew how to make a patient comfortable.

This does not seem to be the case today. Common sense does not seem to be present anymore with the training emphasis on management and psychology (in theory) but not implimented.

And on the wards, there is endless paperwork on care plans but no time with the patient. Helpless patients no longer are being fed properly - there is no time. Fresh water is not to hand on many wards. Proper fluid balance, essential for hydration and patients well being, is not being monitored.

Many patients in state hospitals develop bedsores. Nurses are not adequately taught to regularly turn and change their position and monitor and record when this is done. Cries for the need for toiletting go ignored for long periods of time and loss of dignity occurs.

This is happening every day in the hospitals with the newly trained nurses of today. They do not know how basic nursing care is implemented on there is solid evidence of quite unnecessary suffering as a result of a total lack of common sense. Where are we going wrong?

10may98: Nurse C: Practical experience needed.

The postings from Nurse A and Nurse B fit my experience. I trained as a nurse a few years ago under the traditional sytem of training described by nurse B. I too felt it was a good system compared with the Nurse 2000 system which lacks the element of practical experience: there should be a happy medium between theory and practice.

A friend who trained on a Nurse 2000 course over three years ago recently had his first experience of working a night shift. Being trained, he was in charge. It seems wrong that someone should have this responsibility with no previous experience.

The nurse 2000 training has turned into an academic course. There is a place for research work and theoretical understanding. But at the cost of practical patient care.

And me? My job is hard work and poorly paid. So I am tired and poor but I am happy.

23may98: Ex-student nurse D: Nursing - Project 2000.

Last year I decided to train to become a Psychiatric nurse on the Project 2000 Course. I had just finished a degree and was looking forward to specialising in the psychiatric field. I was quite surprised to get a place straightaway as I had previously been told that the course was full but as it turned out, just a few weeks before the course was due to start, there were numerous places left.

Nursing 2000 is a 3 year course diploma (2 years for graduates) or a 4 year degree.

I had high hopes for this course and felt very enthusiastic about it but I soon become disillusioned. I found that there was a lack of support from some of the nurse tutors. Some of the lectures seemed totally pointless and it often felt like we were being treated as schoolchildren. I thought having just done a degree that maybe my expectations had been a little too high but it soon became quite clear that there were an awful lot of unhappy people on this course. In fact, I would go as far to say that I have never encountered such low morale. You may think this was just first year blues but I found that there was a general despondency amongst student nurses from years 2 and 3 also.

Since I have left the course I have regularly been in touch with my fellow student nurses and nothing much has changed, things seem to have got worse. Many others have left the course and many are thinking of leaving. When I ask people why they feel so disillusioned they usually feel that there is no communication between student and lecturer. Another problem that Nurse A mentioned is that often the emphasis is on the theoretical side on nursing but students often learn that a lot of this is impractical when they get out onto the wards.

A lack of money is also a big problem, even though nursing students get a bursary which is more than an educational grant they are not entitled to student loans. They do not get the long vacations that other students have so they don't even get the chance to do vacational work to supplement the bursary.

Nurse B complains that newly trained nurses aren't competent enough once qualified but the blame surely lies with the nursing lecturers? Student nurses get taught by these lecturers and follow what they learn in the classroom, if they are not considered competent when they go into the real world then the whole issue of nursing education needs to be addressed.

Project 2000 needs to be looked at seriously because it does not seem to be working. It is little wonder that there is such a shortage of competent qualified nurses.

04jun98: Nurse E: Senior Lecturer in Community Nursing : The Profession of Nursing

For good reasons, the nursing profession has wanted a more prominent role in healthcare. Nurses frequent contact with patients develops excellent experience and practical knowledge. And, for example, certain types of nurse led clinic have been shown to be superior to doctor led clinics. But the perceived low status of nursing had held back these developments. It is considerations like this that has prompted the nursing profession to improve its status.

The route taken has, however, been to make nursing more academic moving up from certificate to diploma and degree level and courses have moved from the Colleges of Nursing to Universities, often with the same teaching staff but with their emphasis now on university objectives where research has a greater role than training. Unfortunately this process has largely removed a vital ingredient from nurse training - practical experience.

This has resulted in nurses that may know some theory but lack necessary practical skills. The academic training has been seen as essential to the 'new' model of nursing in which the nurse is supervisor of care assistants, who perform many of the practical tasks of nursing. These care assistants would be trained to NVQ level. (NVQ level 3, for example, may allow a health care assistant to recover someone who had come from theatre after an operation.)

But even under the new nurse-supervisor model, it is absolutely essential for a fully qualified nurse to be able to practice these skills to ba able to manage them efficiently. There is the worry that the one-to-one, nurse-to-patient relationship will be lost and undermine the aspects of nursing that made the nurse-led clinics successful. If we follow the practice that is graoinwg in the USA we will find we have nurses wih a doctorates that become too expensive to do 'nursing'.

The change to an academic bias has caused other problems. Many students starting nusing courses are finding that more book learning is not what they expected and is not what they like so the drop-out rate on some courses is enormous. And because of the nature of the block grant received by universities, this drop-out rate does not affect funding. Courses in nursing are lucrative.

However, there are 'market-led' forces that are indirectly putting pressure on the trainers. Healthcare trusts (hospitals) are concerned that currently courses are not providing the kind of nurses they want.

The profession has recognised that the current situation may require some ammendment. The English National Board is currently conducting a review. It has a difficult task.

23oct98: Retired Consultant A: Who's in charge?

Some years ago it was possible to go on to a ward and immediately know who was in charge.This would nearly always be the ward Sister, a woman of mature years with a great deal of experience. She was intelligent, in control, and would know everything that was happening on the ward.

Today it is often difficult to find someone in charge. Walking on to a ward it can be difficult to find a specific patient. One is all too often faced with a junior nurse who needs to resort to the ward records. The feeling of organisation and control from an experienced hand has gone. Now nurses with their new degrees and little hands on experience expect to come on to the ward pick up a clip board and run it.

There were always some difficulties with the previous system: Consultants and the hospital matron could form a ruthless hierarchy. But nurses and doctors knew where they stood and they acquired more solid experience.

23oct98: Patient A: Nurses too casual.

Over the years I have been a patient in NHS hospitals. Twenty years ago nurses were well aware of the problems associated with operations and post-operative recovery. They were neat and tidy and you felt confident in their professionalism and sympathetic care.

Since then I feel there has been a gradual decline in standards. Nurses are lacking practical experience and are much more casual. For example, nurses now address patients by their first names. This informality comes across, not as being friendly, but as inefficient and to the elderly even impertinent.

22jan99: Andrew Heenan: More real nurses needed.

As a nurse of many years, I have read the previous notes with interest. Certainly, there are major problems with providing excellent nursing care, and the 'project 2000' training has varied tremendously around the country, but it is, let's face it, all too easy to blame P2000, whereas clearly, there are other factors involved.

Blaming everything on the type nurse training plays into the hands of government, as a 'hospital based' training for Health Care assistants (HCAs) would be much, much cheaper than three year (college based) training for registration.

So long as many 'academic' nurses demean the role of the clinical (read "bedside") nurse, these views (+'bring back matron') will prosper.

Picture the scene; a 65 year old woman, recently bereaved, has a stroke. All she needs, argue some, is a "Health Care assistant undertaking the vast majority of direct clinical work". Whereas the woman obviously needs all the skills - and more- of a registered nurse.

The defenders of the 'cheapo' approach, offer the catch-all "under the supervision of a registered nurse".

Hands up who knows an RGN who wishes to spend *ALL THEIR TIME* (this is the real world) supervising a team of HCAs; ie taking responsibility for Nursing that they could not possibly have seen, let alone *directly* supervised, let alone performed themselves.

I can picture the recruitment campaign:

"Become a nurse - well, not a nurse exactly, more a supervisor of nurses - well, no, you won't actually have any *nurses* to supervise - well, OK, it's sort of like a MacDonalds' Crew Leader".

(Note to nurses - a Crew Leader may have a qualification from MacDonalds' University. Or not.)

I must add that I have nothing against Health Care assistants; indeed, the NHS would collapse without them. But I am sure that Health Care assistants are sick of being expected to do things for which they simply have not been trained, just because the one RGN on the ward is too busy filling in forms after the last disaster!!

If patients need qualified nurses, then we must stand up and say so, not witter on about the fact that there aren't enough. If we do not stand up for the NHS, how long before Intensive care beds are staffed by untrained people - "because there aren't enough RGNs"

Of course P2000 needs watching - but don't let the government and their academic friends use this to *reduce* the number of qualified nurses.

Andrew Heenan RMN, RGN BA (Hons)
Real Nurse - and proud of it!

See also: http://www.heenan.net/nursejobs/

Newsgroup: news:uk.sci.med.nursing

28jan99: Senior lecturer B: Education gets the blame again.

I am a senior lecturer training nurses. I trained and taught under the old system and the new. Then as now education got the blame for everything that goes wrong. Every nurse seems to believe that there was a golden age of nurse training and it always coincides with when they themselves trained.

In fact if nurses today cannot practice basic skills upon registration then practitioners have to ask themselves a few hard questions; for example students spend 50% of their time working in practice under the supervision of registered nurses, most of whom trained under the old systems. How come they are incompetent then? Are these paragons teaching them nothing? My students tell me that they work as Bank care assistants to supplement their bursary. When they work as students their do the same work as they do as Care assistants. After three years they are expected to behave as registered nurses. How do they make the transition if they have just spent three years as a pair of hands rather than as someone under training.

Finally it is wonderful to hear practising nurses and doctors suggesting more time in practice. Where is this practice. Most wards cannot cope with the number of students going through now. How the hell will they when the numbers have increased and the proportion of time spent in practice has increased too?

Its nice to hear old timers tell us of the glory days but I've been around for 25 years and there were no glory days. There was always a mixture of good and bad; alas today the turnover of patients is so great and the rewards so low that nurses are being driven to other easier professions. 25 years ago it was much, much easier. The answer may be to go to four year courses BUT the Government could never afford that.

22jan99: Nurse F: Getting some experience before training.

I am an "untrained" bank nurse in an acute psychiatric unit and I have decided to do my nurse training to build on my experience of front line nursing which I have been doing for two years.

I have been lucky to work with some excellent staff nurses and nurses without qualifications. Only in a few cases have they made me feel uncomfortable for my lack of qualifications, mostly by "old school nurses".

On the front line, I get to see all the best bits and the worst bits of nursing. I have helped alot of people, sometimes by just being there to listen. But I have been punched and bitten and as a result I have had to have sick leave. As a member of a Control and Restraint Team, I have come in contact with alot of aggression but I don't have time off to recover because bank nurses receive no sick pay. I have been told I am not insured for injury.

I believe my experience will be beneficial in my training, I start it with good practical experience. My view of student and newly qualified nurses is mixed: alot of them have no idea of how to relate to a patient on the ward and one of them was physically sick while escorting a patient to seclusion. More ward based training is necessary for their sake as well as the patients.

I think there should be more ward based training for the nurse mentors and lecturers well. I had the (unusual?) case of a lecturer coming to work on the wards with me to learn more about the current state of front line nursing and what the staff (qualified and unqualified) did on shift. (I taught him how to do nurses corners while making beds!) He was surprised that he had forgotten how hard the work was and the importance of concentrating on the quality of interaction with the patients. It is very good to see some of the lecturers taking their job seriously.

15feb99: Mike Matheson: A pity about NVQs.

As a retired trade union official (NUPE) I support the comments of nurses about the deficiencies of Project 2000 training. However it is not only nursing which has gone from on the job training to academic. Craft apprenticeships are now extremely rare and training is now much more college based with the same drawbacks. The non academic pupil who does not amass a clutch of GNVQ certificates gets shut out.

My main comments are about National Vocational Qualifications - NVQs. As originally proposed they were to be an assessment of practical skills to enable workers who previously had no recognised qualification standards to receive recognition for their skills, however acquired, in a certificated form which could be taken from job to job. For example office cleaners kitchen assistants and care assistants were to be able for the first time to get an on the job qualification. However the scheme quickly went wrong in two ways:

1. NVQs were allowed to replace existing qualifications. Most City & Guilds qualifications were discontinued despite their widespread acceptance by employers. This actually reduced the access to recognised qualifications for skilled workers in, for example, catering, gardening and construction.

2. Because of the problem of maintaining a uniform standard by on the job assessors NVQs began to require written "evidence" to support the skills claimed. This has now resulted in massive bundles of paperwork, a mixture of handout sheets and exercises completed by the worker, being required even at NVQ Levels 1 and 2. This is making the qualifications inaccessible to precisely those for whom they were originally intended.

It's a pity, NVQs were a good idea until the academics got hold of them.

(This posting will appear in a future special section on qualifications. - Webmaster)

03mar99: Ex-nurse G: A disaster waiting to happen

Nursing has really gone downhill. This is due to the fact that student nurses today have no hands on experience.

When I trained 20 years ago, student nurses were part of the ward staff. They were included in the staffing numbers. They were the bedside nurse, giving total bedside care, changing dressings, making bedsseeing that the patients had their meals and were comfortable. Everything!! We were doing thedrugs round in our seecond year, always with another member of staff. You had to know all your patients and everyone was cared for through one day.

Now patients are looked after in a group, by a team, (blue team, yellow team etc). If a patient rings a bell and a member of staff is available from another team, they won't be seen to. There's fewer staff on the ward because there's only a few trained staff, the student nurses are doing the majority of their training away from the wards.

Now they are just academics. They may be very brainy, but, when they qualify they don't know how to take a blood pressure. The student nurses are not allowed to do anything. The care on the ward is suffering because there is not enough trained staff.

Two years ago my father was dying of cancer. When he came out of the operating theatre nobody saw to him at all. I had to change his bed and wash him in the hospital. And this was on the surgical ward!!! I was very angry but did not complain because I knew the nurses did not have the time.

Money that the hospital gets should be spent on front line nursing, and not on managers and administration.

I left nursing 10 years ago. Today I work in a children's nursery. My friends who are still in line nursing are very hard pressed. If there is still going to be a nursing shortage, then at least the student nurses should be properly trained to help out the regular nurses. If these problems are not resolved soon than the future of nursing will be a disaster waiting to happen.

05mar99: Freedom to Nurse: Return to the bedside

It is good to read the views of other nurses who want to put an alternative point of view to that of the nursing establishment which continues to argue that Project 2000 is working - those of us at the grassroots know this is patently not true. The figures speak for themselves with P2000 courses running 40% empty and a drop of 8000 in the number of nurses in training since 1994.

The group Freedom to Nurse was set up four years ago to support and publicise the views of nurses who were concerned about the move of trained nurses away from the bedside, the increasing substitution of health care assistants, and Project 2000. These three trends are linked together. Project 2000 was part of a deliberate government policy to copy nursing in the U.S. where one trained nurse is in charge of a ward with all the hands-on care being given by untrained auxillaries. The idea was sold to the UKCC and RCN as improving the 'status' of nursing, but it was just a way of cutting costs.

From the beginning nurses could see problems with this. We realised care assistants were no substitute for trained nurses or student nurses. They were a deliberate creation due to the consequences of P2000 which drastically reduced the number of students on the wards. At the same time the job of the trained nurse has become less and less satisfying as we spend less and less time delivering nursing care and more time on administration and management. The training given to students deliberately reflects the intention to turn nurses into supervisors and managers and many students drop out because that was not what they came into nursing to do.

Ironically, just as the chickens are coming home to roost in Britain with the drop in the supply of nurses which has caused the current crisis in the health service, the Americans have realised that this cost- cutting policy actually costs more money in the long run. With patients cared for by untrained staff complications are missed and they end up staying in hospital longer. The Mercy Hospital in Baltimore, USA decided that there should be maximum contact between patients and registered nurses and minimum contact with unqualified staff who 'do not have sufficient education and training about assessment, teaching and discharge planning'. The hospital switched to an all RN workforce employing an extra 30 full time RNs. Costs have been reduced by employing less support staff and by the lower turnover of RNs compared with care assistants. If this policy was employed in Britain we would not have the problems in recruitment and retention in the health service as nurses would have far more job satisfaction.

The piece 'Education gets the blame again' claims that it is the fault of the nurses on the wards if students lack practical skills as it is their job to teach them. The nurse lecturer blames the qualified staff for treating students like support workers. Yes, it is true students are treated in this way and receive little teaching. But there are important reasons for this. Firstly, students are supernumary for much of their training and their ward experience is limited and fragmented. This means students are wary of performing skilled tasks. The P2000 course structure also means students have limited experience of very sick people and may be frightened of them. Freedom to Nurse members have reported several cases which underline this:

students standing and watching while someone is vomiting, not knowing how to help.

One student, when asked to give a patient some oxygen put a facemask on the patient and held the tubing in the air because she did not know it had to be connected to the oxygen point.

A student was given the chance to remove a redivac drain with a trained nurse talking her through it and refused because she felt she couldn't do it.

This becomes a viscious circle, especially on busy wards where the trained staff, confronted by students lacking in basic skills, prefer to leave the students to work with healthcare support workers and the trained staff perform skills on their own to save time. Under the old training the 4 practical assessments - drugs, aseptic technique, total patient care and management - meant that ward staff had to programme time for students to learn these skills. This is now lacking and students can find themselves not being taught on the wards.

Some nurses are recognising these problems and are trying to do something about it. Sisters at one London hospital have re-introduced the drugs and aseptic technique assessments because of worries about P2000 nurses who qualified without having given injections or with very little knowledge of drugs. Again drugs used to be checked by 2 nurses and this was often a trained nurse and a student and was a learning experience for the student. Most hospitals now allow one nurse to do the drug round.

The emphasis on aquiring the 998 teaching qualification has meant many nurses see teaching as something formal, with an overhead projector, whereas what most students need is one to one bedside teaching of practical skills. This is a gap which trained nurses can try to fill by putting students in a position where they have to become involved in skilled tasks, albeit with the support of a trained nurse. Some Freedom to Nurse members have reported that although students are initially reluctant, if they do learn a skill it boosts their confidence.

Many students are aware of the limitations of P2000 themselves. They have said that they don't gain confidence until late on in the course when they are included in the numbers and are treated as part of the team and as an apprentice staff nurse. The idea that P2000 nurses on qualifying would be given preceptor status has been forgotten because of staff shortages and so they need to gain the skills during training.

I agree that the old system of nurse training was by no means perfect. I experienced 2 different hospitals during my training. The first was a well-staffed district general where I worked alongside a staff nurse at all times gaining lots of practical experience. The second was the busy infirmary where staff shortages meant I was left unsupervised and staff didn't have as much time for teaching (although still more than students get today). I always felt and still do that the trouble with our training was not that we were learning on the job but that some students were learning without help from trained nurses. I found that working on the wards was the most useful part of my training for it was there that the theoretical work came alive and I realised why things we studied in school mattered. I always linked different diseases with a patient I had nursed with that disease and it helped me to remember the nursing care which was needed. The problem with this type of training was not that students worked on the wards but that there were not enough trained staff to support them. P2000 has done nothing to change this - in fact it has made it worse. As a student my peers and I continually complained about the lack of support and teaching given on the wards by clinical tutors. I never see nurse tutors on the wards today and I feel it is totally unrealistic to put the whole burden of teaching on the shoulders of the trained staff.

Another problem with P2000 has come with the move into universities. The emphasis is on 'bums on seats' to fill places as the budget depends on this so the selection process is limited and young people may go into nursing for the wrong reasons. Some see P2000 as a way into other careers and don't go on to become nurses. Lectures are delivered to huge classes in lecture halls, often by lecturers without a nursing background and this again puts students into a passive role as there is no scope for participation. Students particularly enjoy lectures by clinical nurse specialists and nurses working in areas such as ITU who have up-to-date, practical experience and knowledge.

The UKCC has been responsible for destroying the support network for registered nurses. Rule 18 saw the demise of the SEN for a start. Project 2000 ended the supply of hard working student nurses who could earn a salary while learning their craft and kept the wards buzzing with their enthusiasm. We now have one or two registered nurses who manage wards without any hands on care because that is done by a permanent underclass of untrained and unregulated care assistants. Meanwhile we have Project 2000 students impoverished and frustrated without salaries, practical tuition and the opportunity to participate. All thanks to the UKCC.

The future of nursing depends on trained staff continuing to teach at the bedside and on us continuing to bring pressure to bear on the educational establishment to re-introduce practical skills-based courses with physiology related to patients.

Stop the pendulum swinging

For too long nursing has been the victim of fads, fashions and pseudo theories. We swing from extremes - primary nursing swings back to task-allocation to suit the enforced loss of trained nurses and their replacement with support workers. There are calls to bring back the discipline, hierachy and matron. Why must each wave of change throw out everything connected with the previous 'era'? If we use our common sense and discuss what is best for the patient, surely we can stop nursing academics and managers dictating the direction of nursing. We know patients prefer to be cared for by trained nurses. They would rather have nurses close at hand than constantly on the phone, at the nursing station or running around trying to solve the latest bed crisis. They would rather have a familiar nurse, who has had chance to talk to them, helping to organise their discharge and liasing with the doctors. At the same time they would like that nurse to have washed them - she then knows about their skin and pressure areas - taken their observations - so she can interpret them based on her knowledge of their medical history - and helped them with their food, toileting and tablets so she has a full picture.

At the moment the only place this happens is on ITU. I've often heard nurses on the wards say 'it's alright for them, they have a 1:1 ratio - it wouldn't work on here'. It certainly can't work with only 1 or 2 trained staff on a ward and the rest support workers. But on wards where there have been enough staff to put a trained nurse in every bay - say 4 or 5 per shift - it can. If students returned to the bedside and a new SEN was introduced we could provide enough staff. Our jobs could be far more satisfying and this would attract nurses back and young people into nursing. Isn't this what we should aim for if we really want to get back to bedside nursing?

If any nurses reading this would like to find out more about Freedom to Nurse, please write to: Freedom to Nurse, P.O. Box 37, Worksop, Nottinghamshire S80 1ZT.

21apr99: Ian Brown, RGN Staff Nurse: Project 2000 created by a self-serving clique.

Today I attended a breakfast debate at the Kings Fund in Cavendish Square London. The motion was "BSC or TLC - are we training nurses not to care?" The meeting was chaired by Niall Dickson the BBC's social affairs editor with Professor Sarah Cowley of Kings College and Ray Rowden, Director of the Institute of Health Services Management, as speakers.

Sarah Cowley referred to traditionally trained nurses as uneducated and mindless. I quote "we cannot go back to being uneducated and mindless". She waxed lyrical about the success of degree nursing in Australia and Project 2000 as a career opportunity for young women. Nurses should all be MSc's and have solely supervisory roles. Project 2000 was made to sound like the abolition of slavery.

Ray Rowden questioned the reports of success of the Australian experience and seemed taken aback by the description of pre Project 2000 nurses as uneducated and mindless. He questioned the need for nurses to have to be in practice to remain on the register and spoke of the hostility shown by traditionally trained nurses towards Project 2000 students.

There were speakers from the floor but no-one except myself challenged the whole idea of Project 2000. There were 200 delegates who were not about to change their minds. It was a real eye-opener and all the worst fears of grass roots nurses were confirmed. The audience were the power dressed, blue rinse and hair lacquer brigade. The emphasis of the debate was self-centres ie. me, I, my career, my opportunity and me first. There seemed to be no concern for the damage done to patient care. There seemed to be a determination to remove knowledgeable practitioners from the bedside.

The missionary zeal of denial of reality made it look like Flat Earth Society convention. There was a failure to appreciate that by insulting traditionally trained nurses with phrases such as mindless and uneducated that this created animosity towards Project 2000 students.

There appeared to be a determination to make nursing middle class and female ie. in their own image for the Project 2000 creators. Caring working class youngsters will be put off financially and ideologically. Apparently caring for your fellow human beings is not what nursing is about anymore.

The real scandal of this New Order is that Project 2000 is an empire created by a self serving clique. These people are cool and calculating The bloodless coup throughout Nursing brought these people to power. They will stop at nothing and will sacrifice patients, nurses and students to keep their new found privileges. There is no room for reform of this ruling clique. No matter how much evidence is presented of the failure of graduate careerism of nursing, these people will dig in their heels because, let us face it, turkeys do not vote for Christmas.

06dec99a: Frances Wheatley. State enrolled nurse: The ideals of project 2000?

The ideals of project 2000 are very sound, but have been badly implemented?

I believe the hospital based schools should have been kept on, at the same time establishing a strong link with universities, awarding nurses a diploma when qualifying, with every opportunity to go on to earn a degree. The training should of remained ward based, although in the past students were exploited to a certain extent, it was invaluable experience.

It was a tragic mistake not to incorprate state enrolled nurses into project 2000, not only are these loyal and hard working nurses grossly mistreated, but along with students and pupils, their traditional roles are a great loss to the ward. It has been proved since that young inexperienced (cheap) care assistants can not replace them.

Trusts were very quick to jump on the band wagon by fragmenting their staff, first by distrupting and victimizing their mature Whitney contracted staff, by implementing diabolical things like internal rotation, they also abused the grading system by forcing nurses to either be down graded or greatly extending their roles, from: S.E.N.'s acting up as staff nurses, day sisters to managers or specialists and night sisters to clinical practitioners and so on, without filling their former positions!

Students stand no chance of developing their knowledge and practical skills in the shambles of the supermarket ward, divided into self accountable nurse led teams, with every man for himself attitude!

11dec99a: Nurse H: "Professionalism" and shift patterns damaging patient care.

I am now a registered children's nurse. I started my training in 1980 before project 2000 started.

I think nursing has rather lost its way but it's not all the fault of Project 2000. In one way Project 2000 was very good because it introduced a modular training and a more academic focus. The way I was originally trained was very practical but it was short on explanation (eg why a particular procedure was used or a patient treated in a particular way).

The problem now is that nursing has become very technical and nurses have taken on a lot of what doctors used to do in the name of "professionalism". Often this loses the essence of nursing which is about caring and comforting and making connections with people. This is now seen as being too simple and not technical enough. But personal care is what patients want. They want skilled and trained nurses to sit and discuss their fears and problems.

This problem is made worse because of new shift patterns. Nurses work 12 hour shifts with three days on and four days off and then maybe one day on. Shifts used to be "earlies" or lates" and we were on for a week; getting to know the patient and allowing them to know and trust the nurse.

My nurse training wasn't a degree. I have done a degree since and I am doing a further one. My first degree was community health. It was a degree course where all the students had previously done nursing. I rated the experience very well: It gave a new, extra and different perspective.

26aug01a: Patrick Cooper-Duffy Solutions for the NHS.

Dear Editor

NHS SOLUTIONS

With ref to the present crisis in the NHS. I suggest given the fiction of the victims health. The following.

1. Adapt a strategy of patient advocacy speaking out collectively and taking direct action to protect patients.

2. Develop a charter for staff and patients rights and standing candidates across the country. To raise awareness of this long standing neglect and abuse.

3. Abandon forthwith the project 2000 system that has proved such a collective and expensive disaster.

4. Integrate immediately all trainee nurses into fully paid staff members of the NHS.

The failure of the management, medical nursing systems would suggest a radical rethinking of the issues are long over due. Only the ordinary people are holding the straining NHS service together.

They must find the means of exposing the lies and cant. While pressure needs to be applied to the trade union bodies for action.What do your readers think?

Yours Sincerely

Patrick Cooper-Duffy
RMN RNMS Dip Ruskin Bsc Cert Education Teacher
Nurse over 30 years

24jan02a: Nurse I: After Project 2000.

I was a State Enrolled Nurse (SEN) for 20yrs. I had to do Project 2000 to get promotion

The management side of P2000 was brilliant but if I'd been 18/20 year old student I would have gone on ward with no practical skills. There was some practical skills teaching on the ward during 3rd year - but not nearly enough.

The first and second years were lectures and essays etc. at university - like the Amercan system. We did 18 months before we had any real work on the wards.

Now I am staff nurse in medium sized hospital.

The apprenticeship way worked much better. It was learning on the job. Now when they are qualified they are thrown on the wards and have to learn the job.

Even students that had previously done a hairdressing or chef's apprenticeships adapted to nursing better - they were more in touch with people and the human side. They steamed ahead of those who qualified only academically.

People used to go into nursing because they wanted to and get the respect as a nurse. Now they want to go into research and management and high flying jobs like A&E - ie where they can get into helicopters - they do watch casualty.

Men do A&E, medical admissions and coronary care - ie. the exciting job.

But the system is changing back. HCAs (health care assistants) are now moving up to level 3 ie they have become old fasioned SENs (under a new name).

HCAs are the nurses that really do the nitty gritty.

10nov02a: Nurse J: Caring is top of the list.

I was pleased I did all my training (Nursing, Midwifery and Mental) in the late 1970s. A nurse is a jack of all trades, providing for the full needs of an individual whatever that might be. It may be closing a curtain or a full wound dressing. A nurse's job is caring not diagnosis. (Project 2000 nurses are not prepared to accept this.)

The nurse has no job description but it is 48 hour a day preservation of life with CARE at the top of the list.

I do have faith in nursing but it has lost its way since Matron was captain of a ship responsible for everything that was happening. She was responsible for her ward and had pride in it. Nursing needs intuition and instinct - things that can't be trained. It is a calling a bit like a nun's. It is an excellent profession for variety and job satisfaction but people should not go into it for glory - there is no glory.

When someone says they are in pain, a nurse of today will get out the blood pressure machine. I look into their eyes.

This keeps words to a minimum which is what they don't do these days.

AS well as nursing I do further education studying art, science and philosophy.

14dec02a: Another ex-student nurse: Should the nursing profession be attracting these people?

6 Reasons why Project 2000 is failing patients and students

Students commitment and shift work

1. Students rarely want to commit themselves to shift work (an essential part of nursing) because they see themselves as students in the conventional sense; they want the six-week holidays and the 9-5 lifestyle. Shift work is so important and many placements were unhappy that many students wanted to turn up at 9am and go home at 5pm (often after or before the real work was done). Car sharing and the cost of it was often given as an excuse. Obviously nursing students wanted the Bursary as well as the Student lifestyle. I was honoured to receive a bursary after merely receiving a pittance of a grant for three years whilst studying for a Degree, and I was one of the lucky ones. Nursing Students do not know how good they've got it but are always complaining.

Placement hours are not met and learning objectives are bluffed

2. Another source of irritation - the foundation programme. An excuse to `try out` (observe) areas of nursing that you would not normally be interested in. A good thing? Not if you find that after weeks of unfulfilling placements it is not your `cup of tea`. So, students generally use this excuse, put no effort into the placement. Placement tutors find these attitudes so unacceptable that they let these students go home earlier than others just to get them out of the way. The placement hours are not legitimately met and the learning objectives bluffed through. To cite one example, during the mental health nursing placement students were turning up at 9 o'clock when all the work was done, they were sent out on a daily basis with a community psychiatric nurse. When I asked if I could do the same as my counterparts for one day, I was told that this is something I should have done in the community placement earlier on! My experience of this unit was therefore completely different to those of other students.

Health promotion is important but nursing is about nursing

3. Yes health promotion is important but people are still going to get sick regardless. Nursing is about nursing and not preaching (to the already converted). There can only be so many nurses working out in the community so many students expectations of working out in the community after they have qualified are unrealistic.

Project 2000 students write pointless neighbourhood projects ...

4. Are RGNs (nurses trained the old way) left feeling that they are somehow less qualified than those Diploma trained? Do those who hold Diplomas see themselves as superior to RGNs?

If a trained nurse was to tell a member of the public that s/he had a Diploma they would most probably believe that this was in addition to an RGN qualification even though it takes just as long to study for a Diploma, three years just like the `old way of nurse training. A student embarking on a nursing course wanting nurse training would probably see themselves as just as qualified as RGNs but having the edge with the theory on community nursing, health promotion and basic knowledge on the social sciences.

Should we expect the same standard of care from Diploma and RGN students on a hospital ward?

The general public/patients are unaware that nurse training has changed entirely and the qualifications with it, and that as long as the uniform remains the same they are receiving the same standard and consistency of care. This is misleading. RGN mentor's can find that they cannot relate to students in the same way as they did before Project 2000, as there is so much difference in training and knowledge. But, if we cannot rely on RGNs to train and mentor new students, where would the future of nursing be?

Traditionally trained nurses do the doing while Project 2000 nurses think

5. There is a clear rift between traditionally trained nurses and those trained on the Project 2000 courses. Generally speaking, the former do the doing, whilst the latter spend more time thinking about how they are going to do it. Not such a bad thing you may say, unless of course you are faced with an emergency when time is of the essence. How many first year project 2000 students should it take to change a catheter bag if at all?

Is nursing still a caring profession?

6. Nursing is the caring profession or is it? I worked for some years as a care assistant providing the most basic care to clients. This and my time was what was appreciated and not someone dishing out drugs and doing observations with no time for clients. I firmly believe that you can find out much about clients by doing the menial tasks as well. Would it be advantageous for potential student nurses to gain experience on the caring level first in a caring setting as care assistants for at least one year before applying to become student nurses? Not only would this mean more care assistants with a genuine commitment to caring for others but would also be an invaluable experience.

Should the nursing profession be attracting these people?

I entered the nursing programme thinking that I could make a difference to patients in some small way, and left feeling that I had totally wasted a year with people wanting the nursing title and the pay, but without the commitment to care. My fellow mature students were ex-secretaries with very limited care experience and social skills, who did not even like sick people and who had to continue wearing nail polish just to feel human (in spite of the implications to patients). Should the nursing profession be attracting these people? I hope I never get sick!

22dec02a: Staff Nurse: Diplomas for the working class, degrees for the middle class.

I started nursing after access courses

From school I went to art college but at 18 I became the mother of twin daughters and looked after them full time until I was 23. I then started two years of access courses. After a year out I got a place at Salford University to do a Project 2000 diploma in nursing. I could not do a degree because it was too expensive for a single parent. A degree was for those that could afford it and this is still true. But with a degree you travel further and quicker up the management ladder.

Basically dipolmas are for the working class and degrees are for the middle class. For the first 18 months of the P2000 course diploma and degree students work together. It is after that they separate.

As newly qualified nurses we lacked practical skills

As newly qualified nurses, most of us felt that we did not have practical or clinical skills that we expected to have after 3 years of training. For example, with an MI (heart attack): if someone fell down I could have known what social class he was, what effect it would have on his life expectancy but I could have done nothing tho help him in the immediate situation.

In my case, I could probably have known it was an MI because I had a placement on a heart unit but most students would not evenn be able to tell that. In general, I felt there was far too little practical experience and this has been bourne out by the Peach Report.

The Peach Report : Project 2000 is now being terminated

The Peach Report critisised the Project 2000 courses because of their lack of practical content and Project 2000 is now being terminated.

Now students do get longer on placement and the training is more practical. I believe nursing is both theoretica knowledge and practice. The theoretical side of my training was essential, but there was not enough practical and much of it was poor quality. However, a few placements were very good like my placement with the heart unit.

(The Peach Report can be found on the Department of Health's website here.)

23dec02a: Nurse K: Patients need knowledge to get good treatment.

I work in a 2 star hospital but in reality it is a 0 star hospital. But there is still faith in doctors or the NHS. But the uneducated and poor people that are in my hospital's catchment do not have the knowledge and skills of the middle class to be able to demand good treatment.

08feb04a: Janette Trainor: Weeding out the students not emotionally suited to nursing

I started nursing in 1973. As students we were put on the worst geriatric wards where patients were doubly incontinent with Alzheimers. There were 40 patients to award.

We did total nursing care of patients who were often difficult and aggressive. I often got covered in excrement and suffered many bruises. But it was instlled in us that we treated our patients as our own grandparents. In life and death we were totally respectful and had a very strict code of conduct.

During the introductory period (3 weeks on the most dirtiest ward that could be found) students discovered whether they were suited to nursing. In particular, they found out whether they could take the difficulties and degredation. Over 75% dropped out.

As I remember, the requirements for entryy were 5 'O' levels. But more important than educational qualifications was to find out that students had the character and humility to become nurses. The discipline was almost military or perhaps like a nunnery.

Everybody that started was reasonably intelligent on paper but many did not have the ability to solve individual problems. Several of these were VERY intelligent but just could not cope with the day to day difficulties of nursing. There are difficult emotional issues to deal with in nursing and academic performance was not a preparation for what was required.

My initial training lasted 3 years. We went into school with our tutor for a month to learan theory. Then we did 3 months on the ward to apply the theory. This four month pattern was repeated throughout the three years. We did a different topic on each term. Topics included geriatrics, gynacology, genito-unary, general surgical, orthopedics etc.

Afer three years I became a staff nurse. I remember sister telling me I was now atthe start of what was now at the tart of what it was all really about. We were never allowed to get above ourselves.

I never felt that I ever knew everything and I continued learning and taking courses for the next twenty or so years. I became a night sister in charge of 9 wards.

In the mid nineties, I became very unwell and I have not worked since. I saw the NHS from a patients perspective.

Before I "retired" I saw changes in nurse education. Student nurses were required to have 2 'A' levels This was called Project 2000 where nursing being changed into an academic degree subject. I believe that many students went onto get degrees in nursing only to discover that they were not suited to the job.

There is one aspect of Project 2000 that was correct. During the time the students do spend on the wards, they were supernumery. This stopped one of the worst aspects of the system I was trained under: Student nurses, who were early in their training were often in charge of wards at night. This was very stressful and we couldn't always provide appropriate care.

I am in and out of hospital 4 or 5 times a year and recently, I have noticed an improvement in hospitals, mainly due to the improved level of staffing because the present government is spending more.

But, in general, University trained nurses have far to little practical experience and have not endured the initial assult course to weed out the ones who are not emotionally suited to nursing at the sharp end.