43 comments on “There’s an answer here Polly, somewhere

  1. At the time I left school, girls were much more limited in their career options. If they were not especially academic, they took their five O Levels and headed to the nearest teacher training college. The bright girls stayed for their A Levels and then became student nurses. It might not have been a graduate career in the old days but it did attract the better class of girl.

  2. I’m married to one. They only take three years to train because of the vast amount of unused time – something like two days a week (not 9-4) and a ‘study day’ e.g. do nothing either. The on the job part of the training is hard work. The academic part is a joke.

  3. Someone very clever once said that the essence of nursing is to do for the patient what the patient can no longer do for themselves. These functions invariably involve some very unpleasant tasks. During my infrequent hospitalisations, invariably only the nursing auxiliaries bothered themselves with such tasks, in more highly qualified apparently having more important things than patient comfort to consider.
    Ward discipline is not helped when the ward sister spends 2/3 of his/her time in meetings of various kinds away from the Ward. Patients who cannot feed themselves get left with their meals going cold unless some more mobile patient takes pity on them. Bodily functions are taken care of using catheters and hydration is by drip. The patient is stripped of dignity and humanity. The whole business reeks of soullessness and inhumanity, and is a disgrace to the nation.

  4. None of the nurses I know are graduates, and probably highly unlikely that they would have become nurses had that been the requirement.

    It was complete lunacy, but then we all knew that at the time.

    It has been marginally tempered by the grade inflation that has taken palce; as everyone’s a graduate today…

  5. By requiring a degree they’ve blocked off the biggest pool of potential employees: mothers and grand mothers.

    Apart the ability to change nappies and feed the younger ones the rest is about nurturing, crowd control, letting them have fun and teaching them to be social animals. This comes naturally to most of those who’ve brought up their own children.

  6. The techie side of nursing (drug delivery, maintaining clinical notes, etc) is fast becoming automated. The unskilled side (changing a bed pan, spoon-feeding, etc) is less easily digitised.
    So in response to needing lower skill levels, we demand higher qualifications. Madness.

  7. Perhaps they should get men to do it. Men will do any shitty job if you give them either a uniform or a toolbox and a suitably masculine job title. For instance, if you want men to be receptionists, you give them a quasi-military uniform and the job title of “security guard”.

    So, rename it “bodily services engineer”, supply some kind of toolkit, and have them wear blues. They won’t want a degree, they’ll do the cheery chappy working class schtick with the patients, and the labour supply problem will solve instantly.

  8. Ian B

    Made me laugh but also think.

    Your cheery, cheeky (you forgot that one) chappy working class schtick will probably take 2 days off the average stay as it contributes to happiness, eliminates lonliness and makes people feel good.

    So we save cash AS WELL

  9. To actually answer Polly’s question, and we can tell she has not set foot inside an NHS hospital for decades, we recruit them from the Philippines and Africa.

    That is where we will find some.

    Of course we could train our own. But for some reason we are incapable of doing so any more in adequate numbers.

  10. Yes, we could plunder them from other countries, who can less afford to piss away resources training people who then bugger off.

    Then again, if nurses have to be graduates, how can we get them from abroad? Surely they don’t insist on graduate nurses?

  11. Rob – while I share your concern about harming foreign health systems, in some places like India and the Philippines, there is a sizable private training industry aimed squarely at the export market. It doesn’t cost the government a fortune (indeed they expect to benefit from the remittances) and they aren’t people who would otherwise have been working in local healthcare (the Philippines could not afford to hire all its nursing graduates but they wouldn’t be trying to work locally anyway). That’s the sort of import of human resources and services I can live with, even if it does show up inadequacies in our training system. A lot of the recruitment from African health systems, though, is contemptible.

  12. The NHS merely insists on nursing qualifications. They are different elsewhere and at least some countries are more into on the job training.

  13. @”PF
    October 14, 2014 at 9:11 am
    None of the nurses I know are graduates, and probably highly unlikely that they would have become nurses had that been the requirement.

    It was complete lunacy, but then we all knew that at the time.”
    I agree in the 90’s student nurses finished with savings if they were careful not debt, possibly enough for a deposit on a house now they finish with debt – why did the unions want this to happen?

  14. Re: Bringing in foreign nurses.

    With my tin foil hat on I could almost imagine some Labour minded civil servants viewing it as a form of foreign aid and pro-immigration policy. Terribly colonial of course. UK native nurses necessarily having to be ‘better’ qualified in order to remain superior.

  15. MyBurningEars – “in some places like India and the Philippines, there is a sizable private training industry aimed squarely at the export market.”

    The problem is that the Philippines government has decided to give up. They have no economic policy at all except to send its young overseas to do really poorly paid work, in conditions of varying degrees of exploitation, and sit back and wait for the remittances to flow in. They would all be better off if they elected competent governments with sensible domestic economic policies rather than the in-bred kleptocrats they prefer.

    Gareth – “With my tin foil hat on I could almost imagine some Labour minded civil servants viewing it as a form of foreign aid and pro-immigration policy. Terribly colonial of course. UK native nurses necessarily having to be ‘better’ qualified in order to remain superior.”

    Easier explanation:

    After the uprising of the 17th June
    The Secretary of the Writers Union
    Had leaflets distributed in the Stalinallee
    Stating that the people
    Had forfeited the confidence of the government
    And could win it back only
    By redoubled efforts. Would it not be easier
    In that case for the government
    To dissolve the people
    And elect another?

    They don’t like British voters. The voters vote Tory. They want something else. Brazil is their model by the looks of it.

  16. Ian B,

    We could also tell potential recruits that hospitals are likely targets for terrorists and therefore give them mandatory monthly hand-to-hand combat classes. We’d have a nurse surplus inside a week.

  17. Bilbaoboy-

    I kind of envisaged the “cheery” doing double duty with “cheeky” by implication 🙂

    Having been a maintenance man, I mean “building services engineer”, that is, I believe that the presence of cheeky working class chaps is a major source of sunshine in dull environments. A dose of “‘ow’s my favourite girlfriend then today?” to old ladies with no visitors would surely improve patient outcomes.

  18. SMFS,

    > Of course we could train our own. But for some reason we are incapable of doing so any more in adequate numbers.

    The reason’s no mystery: our hospitals are horrible places.

    When you’re growing up, you go to hospital occasionally (as kids do). If you live in Germany or France or Singapore or the US or somewhere else with good healthcare, you might well look around you and think “Yes, I would like to work somewhere like this when I grow up; I would like to help people the way these kind professionals are helping me.” If you live in the UK, you are far less likely to have that thought, and far more likely to think “I never want to set foot in a hospital ever again.” Hence a shortage of enthusiastic trainees.

  19. ” why did the unions want this to happen?”

    Presumably because they think that requiring a degree turns a ‘job’ into a ‘profession’, and so everyone gets to earn £30k+?

    I wonder how that’s working out for them.

  20. ”why did the unions want this to happen?”: doctor envy.

    Why did economists want a counterfeit Nobel Prize?

  21. We’ve invented this extraordinary thing called modern medicine. We need to work out how best to apply it.

    One model, being applied in most of the developed world, is to have very highly trained doctors, who make diagnoses and choose (with the patient) the appropriate course of treatment, quite highly trained nurses, who administer treatments and make minute-by-minute decisions about them, and nursing assistants, who do for the patients the things they can’t do for themselves.

    Perhaps better models are available. What do you suggest?

  22. @ PaulB

    Whatever the models – before nursing became “graduate entry” in the UK, I don’t think our system was actually broken…

  23. “quite highly trained nurses, who administer treatments and make minute-by-minute decisions about them”

    and why does that need 3 years of training? It’s not like they’re unsupervised on the wards, is it?

  24. My brother trained as a nurse before it was a university course of study. It took three years then.

  25. > quite highly trained nurses, who administer treatments and make minute-by-minute decisions about them

    Nurses make decisions? Do they fuck. Doctors won’t let them.

    If a doctor has made a note along the lines of “If patient’s X reading goes above Y then drug dose Z must be reduced OR IT COULD KILL THEM”, and the reading goes above Y at the weekend, when doctors aren’t available for some reason, then you need to have a pretty bloody big fight with the nurses to stop them giving the patient drug dose Z, because they’re not authorised to reduce it. I speak from first-hand experience.

  26. PaulB
    October 14, 2014 at 3:36 pm
    If we have this thing called modern medicine, why are you advocating a top-down, demarcated, quasi-Stalinist 1950’s management system to deliver it?

  27. Unions supported the switch to graduate status in an effort to improve the status of nursing, and, presumably, to continue attracting good quality candidates. Even prior to graduate status, I suspect on-the-job training was beyond fifty percent or more of kids leaving school. If they had not bumped nurses up to graduate level we would probably have ended up recruiting the sort of intake that works for minimum wage in care homes.

  28. The unions pretty obviously supported the move to graduate nurses as a way of drawing the ladder up behind those already working as nurses. Now that one’s dealt with…

    Nurses need to be graduates because these days nurses are no longer nursing assistants, ward cleaners, food-servers, and so-on, but have their specialised skills reserved for specialised tasks which they do best. It’s something called the ‘division and specialisation of labour’ or some such, I think it’s been heard of round here before. Obviously, as they have had their efforts focused on their specialisation, it’s become worthwhile to spend more on their training because their productivity has been increased, so the ROI is higher.

    This really is simple, basic economics. Tim obviously hadn’t had his coffee this morning.

  29. Vocation?

    Nursing used to done ‘in house’ didn’t it? Good ones shone, the bad ones were sent on their way.

    Um, now they all qualify and the bad ones usually get promoted – it’s a union PC thing and then the wrong uns move into NHS Trust management, hence malpractice is understood, entrenched and pervades the ethos – of the NHS. A little jest and a running joke put about by NHS employees; “it would be a great job, if it wasn’t for the patients”.

    Ho, Ho.

    Main problem;
    i. and biggest problem is unionization and unions,

    ii. the culture of abnegating responsibility a direct consequence of total lack of any real accountability – ref Staffordshire Trust.

    iii. Then, post modern nihilism added to narcissism – common to most – it’s the way society teaches them to be, ref XFactor, bog standard schools.

    It all means that, the ‘modern’ nurse will not even care for her mother when she grows infirm – still less care for anyone else’s mam.

  30. Last time wife was in hospital with bad legs the doctor that saw her the 2nd time she was admitted in two weeks was not the same as saw her 10 days previous. So he called in a student nurse that had been taking details from the wife when she was admitted the previous time, unbandaged her legs and asked the student if the legs were better or worse than 10 days previous.
    This despite the several photographs we had taken on mobile phone we could show him of 10 days previous and whatever medical notes could be read….. the whole thing relied on the words of a 1st year student.

    The 2nd time, luckily enough, they gave the correct dosage and treatment.

  31. I think a lot of nostalgia for the days when “the nurses were caring” might come from the rebranding of auxiliary nurses as HCAs (i.e. the lower-trained ones).

    Prior to graduate entry there were still nurses who were higher trained – the training taking years. They were a different kettle of fish to the auxiliaries. Whether it’s a good thing or a bad thing, stuff that takes years to train for and which has a fairly standardisable curriculum, is these days tending to tip over into a university-certified training route.

    But I don’t think in this case that it makes so much difference. Regardless of the manner in which training is delivered, there is an inevitable and historical division between higher-trained workers more involved in the medical side of things and lower-trained workers performing more routine tasks and more involved in personal care. And it can be justified economically in terms of specialisation of labour.

  32. Borrowing the tin foil hat for a moment without all the overseas nurses they wouldn’t be able to say ” look how wonderful immigration is, without it the NHS would collapse”. Which is to incorrectly equate all immigrants as working for the NHS.

    In my recent experience with the NHS I was surprised how grossly overweight a lot of them were.

  33. Having said that – I’m not convinced that standard university timetabling (termtimes and holidays) makes much sense for people doing essentially vocational courses. If the classroom or lecture hall aspect is intended to be a complement to on-the-job training, perhaps the courses could be delivered year-round with briefer breaks.

    On a more theoretical course, pursuing a degree in that way might be regarded as “accelerated”. The University of Buckingham, as I recall, runs two year academic degrees not by cutting out content (lots of unis offer two year undergrad degrees to retraining graduates, who can skip classes they can be awarded prior credit for, but I mean students taking the full-fat of a three-year degree) but rather by compressing holidays, having more hours of work per week, and scrapping the many months of summer vac which are the norm at other unis.

    But for vocational study I’m not convinced such a scheme should even be regarded as “accelerated”. If you’re taking the course with the intention of working in the profession, and the work is year-round, then why not train that way too? That might help solve Polly’s “what if we can’t train a nurse in 3 years” riddle.

  34. “There’s an answer here Polly, somewhere”.

    “There’s an answer here, pollys(technics), everywhere”. Fixed that for you.

  35. Dave

    Nurses “need” to be graduates

    Nope. I know nurses pretty much as far up the nurse food chain as one can go (practising that is rather than sitting on their backsides) – and with their various newly learned specialisms (you are absolutely right on that one).

    Not gradautes at all, and as I said earlier would not have trained to be nurses had that been the requirement. For them, the drive was vocational rather than professional or academic; ie, they were the caring types first.

    I actually do understand where you are coming from with the “specialism” theory, it is that “need” word that simply doesn’t translate into the real world.

    Nurses come at different levels and grades, and earned over many years rather than “a passed exam at 21”, and which deals more than adequately with any ability to deal with specialisms.

    Yes, of course I accept that the “qualification” concept does work, but as I said earlier, this wasn’t a system that was in any way broken at all or in need of change.

  36. We had a Fillipina student working part time (a few hours a week) as her visa allowed while she trained as a geriatric nurse. The minute she qualified as a nurse, her student visa expired and they kicked her out of the country. Apparently we don’t need qualified geriatric nurses….

  37. Ears,

    > But I don’t think in this case that it makes so much difference. Regardless of the manner in which training is delivered, there is an inevitable and historical division between higher-trained workers more involved in the medical side of things and lower-trained workers performing more routine tasks and more involved in personal care.

    Yes, but I don’t think that’s the difference that patients have noticed. What appears to have grown in recent years (judging from my own experience and the many many complaints from patients) is the “Not my job” attitude. We used to have more highly trained nurses with a bit of medical qualification who, if they saw some shit on the floor, either cleaned it up anyway, qualifications be damned, or made sure someone else did, and quickly. Now far too many of them just leave it, because such considerations are beneath them.

  38. Squander – yes that is definitely the anecdatal experience, point taken. Though hard to prove Not My Jobism stems from a particular training route – if nurses had a different colour certificate, from an institution that wasn’t a uni, would they care more? (I can see the argument that they might – if they had to work their way up from an HCA or auxiliary type role, it’d screen out those who felt above delivering personal care perhaps. But would also also mean a lot of intelligent and well qualified young people, who may well be perfectly caring, would face quite an offputting career entry route and might find better prospects in other career paths, which wouldn’t help with the recruitment gig.)

  39. Having said that – I’m not convinced that standard university timetabling (termtimes and holidays) makes much sense for people doing essentially vocational courses. If the classroom or lecture hall aspect is intended to be a complement to on-the-job training, perhaps the courses could be delivered year-round with briefer breaks.

    Um, in plenty of places they already are. As an example, York gives seven weeks’ holiday across the year to its nursing students [link].

  40. PW – that would make sense, thanks. I don’t know how universal that is; some recentish nursing students I’ve known got more than that for their summer holidays. If students at York doing nursing do more weeks of study and training than their peers doing other subjects, do they get their degree sooner?

  41. My wife is a midwife who trained before the days of direct entry (which means that she had to qualify as a nurse before training to be a midwife), she is a graduate and one of the smartest cookies I know with an extensive medical knowledge.

    She would scrap the whole training system (which is based on people who couldn’t hack it as a nurse) and go back to the old system where you mixed formal teaching with actually going out on the ward and looking after people. She would also encourage a system where the capable auxiliaries who were not so academically gifted would also have a more practical route into nursing.

    The current system is designed by academics and as such it is more fitted to producing people who want to theorise about nursing rather than actually do it.

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