Let’s begin with my training back in the early 1980’s. When I was training to be a nurse, most of my experience was gained in the clinical area. We were part of the numbers, were employed by a hospital and was paid a modest wage. The ward sister was responsible for our end of placement reports and oversaw our educational,supervision whilst on their ward or department.There were clinical tutors who visited us regularly. They were on-site at the hospital, as there was a School of Nursing attached to that hospital. They came on to the wards and helped us learn to do a bed-bath properly. We were reminded to change the water, the first bowl for the hands and face, the second for the body. Mouth care, eye care, hand care and even hair washing was taught both in the classroom and on the wards. Even now, I remember that to wash the hair the bedhead would need to be taken off first. Who has had their hair washed by a nurse whilst on bed rest recently?
There were four assessments that had to be passed. One of them was called total-patient care. This is where you were assessed solely on the care of one patient or a small group of patients. This meant that all elements of care had to be considered. Clinical observations including blood pressure,fluids, charts, dressings, medicines-everything. A tutor from the School of Nursing or senior nursing team on the ward would be responsible for that assessment. We were all nervous of course and I remember mine to this day. For me, I was in ITU at the time and looked after the cardiac patients.
Then education for nurses changed. Project 2000 came into force and this was the start of the nurse being seen, not as a pair of hands but a student and supposedly supernumerary- not counted as one of the shift numbers. Nursing was becoming a profession that first saw the Diploma of Higher Education qualification and then onto the graduate status. Why? Well, this was to reflect the growing complexity of the role and to give the profession more status as a profession.Schools of Nursing were moved to Universities and the clinical tutors became redundant. There was to be more theory taught. The terms evidence-based practice was part of the new terminology for care and this was led by current research.
Let me stop there and say this, which may surprise some of you. I am all for a graduate profession. The reasons why will be discussed in another post. While, I accept you do not need a degree to wash patients,I am totally behind seeing a workforce who questions the care they give and why they do it based on the best quality research available. Learning a skill is not enough in 21 st Century nursing. It needs to go a lot further than that if we are to deliver safe and effective care. The increasing advanced skills we are asked to do and the complex conditions we now treat, where sometimes several pathologies have to be considered is another reason……
Tomorrow: So what needs to be addressed with student nurse training? And why sometimes student nurses do not feel supported as they move towards registration as a qualified nurse.