The Daily Mail’s xenophobia against overseas nurses

Thanks to Tim Fenton for (a) pointing out the Daily Mail stoking bigotry against nurses who come from overseas to work in the NHS and (b) providing a link I could use that won’t boost their online advertising. Today’s Fail front page screams, “4 IN 5 NEW NURSES ON NHS WARDS ARE FOREIGN”. Filthy foreigners, coming over here, healing sick people.

As is usually the case with such Mail headlines, the report is a mix of empty assertions, half-truths and dogwhistle politics that stoke up racism.

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Nurses have enough to deal with without body-shaming

This morning I clicked on the Guardian’s Comment is Free website to discover an article by Christian Pattison giving a novel criticism of the nursing profession. We’re all too fat.

If you go anywhere near the NHS, you can’t fail to see it. The woman who marches you over to the scales and carefully records your weight, the man who asks you to roll up your sleeve and tells you to expect a “sharp scratch”: what they often have in common – apart from a desire to help – is that they’re pretty damn big.

Oh dear. Where to start?

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Nursing degrees aren’t the problem

On the Andrew Marr show today Ann Clwyd MP was speaking angrily about the poor care her husband received while at the University Hospital of Wales. She argued that nurses no longer display compassion, and one of the reasons for this was because, “since they made nursing a degree course the wrong kind of people are entering the profession… we do not need a load of snooty-nosed pen pushers”.

A couple of days ago Jo Brand gave a response in the Guardian to Mrs Clwyd’s recent statements on nursing. Her view was that nurses are not any less compassionate than they used to be, but that poor management, spending cuts and privatisation were eating away at standards of care. She too raised the question of nursing degrees, though she describes it as “a complex issue that is difficult to read.” She expressed concern that it might have “closed the door to a wealth of potentially impressive nursing staff whose academic skills were not up to degree level.”

I fully appreciate Mrs Clwyd’s anger and upset at her husband’s (lack of) care. Who wouldn’t be angry? But I don’t think nursing degrees are part of the problem, and I’d like to give some reasons why I think that. I hope this goes without saying, but in doing so I am not attempting in any way to excuse or minimise the failings with regard to her husband. Patients are entitled to dignity and compassion at all times, and if he did not receive it that is clearly unacceptable.

Nursing has been an all-degree profession in Scotland and Wales for some years now, and is in the process of switching over in England. I’ll declare an interest here in that I’m a degree-educated nurse who graduated with first class honours from a well-regarded Russell Group university. It was a tough, challenging course, which stretched me far harder – particularly emotionally and physically – than my previous degree in the humanities.

The first point to make is that the difference between a nursing degree and a diploma really isn’t very much. The length of time is exactly the same (three years) and crucially, the clinical placements are exactly the same. Whether a student is doing a degree or a diploma, they spend half their time in university and the other half out on placement – in hospital wards, outpatient departments, community teams. At the end of the third year, they spend the last three months of the course in a clinical area, taking on all the responsibilities of a staff nurse under the supervision of the qualified staff. At my university, the difference between a degree or a diploma was little more than whether you did a dissertation or an extended essay in the third year.

So, if the clinical placements haven’t changed, what about the suggestion that bringing in degrees has attracted a horde of snooty people who are, to use the media expression, “too clever to care”? Personally, I don’t see that it has. When I was a newly-qualified staff nurse on a ward, I certainly didn’t think that my fancy education meant I was too intelligent to wipe a bum. On the contrary, I felt very strongly that I needed to gain the respect of the nursing assistants I was now leading, and that meant demonstrating that such tasks weren’t beneath me. I really don’t see why having more intelligence would make you less compassionate, or that being clever makes you a bad nurse. On the contrary, when I think of the most outstanding nurses I’ve ever worked with, they’ve all been intelligent people. As for the bad ones, they’ve usually been…well, a bit dense. Nursing requires you to juggle a caseload, calculate medication doses, keep accurate records, liaise with patients, carers and fellow professionals, and think on your feet in rapidly-changing situations. Funnily enough, it helps to have something between your ears.

Then there’s the argument that degree courses are deterring people who would otherwise make good nurses. Again, I’m not convinced. I’m willing to stand corrected on this, but I haven’t heard anyone say, “I was planning to apply for nursing, but now they’re abolishing the diplomas, I’m not going to.” In an era of mass education, university degrees simply aren’t the elite qualifications they used to be perceived as. These days it’s practically a rite of passage school leavers to head off to university, and most people with a reasonable amount of intelligence and self-organisation can pass a degree. Some of the students on my course struggled with the essays, particularly mature students who had been out of education for some years. But crucially, those who kept at it did pass. They might not have got stellar grades, and they might have had to re-submit the odd essay, but they did get through. Once they’d done this, a nursing graduate who scraped a third is just as qualified as one who sailed through with a first. As for those few who flunked completely despite opportunities to resubmit work, they really didn’t come across any great loss to the profession.

Finally, it’s important to remember that many things can affect patient care and dignity besides nurse education. The ratio of nurses to patients. The ratio of qualified nurses to unqualified nursing assistants. Levels of support – is there a ward receptionist to deal with phone calls and queries so the nurses can get on with caring for patients? Equipment issues – for example, is the ward getting enough fresh linen? The calibre and personalities of the senior nurses. Even cultural factors can play a role. Those who gaze wistfully back to regimented wards under the dictatorship of Matron might wish to recall that back then Britain was more, well, regimented. When the NHS was founded it was the era of national service, with the Second World War still fresh in everyone’s memory. The values of nursing at the time were essentially military values. We don’t have that culture in Britain any more.

That said, there is the question of whether enough is being done to weed out bad student nurses and stop them qualifying. It makes a good headline to say it’s because universities only want them to write essays. But as is so often the case with a good headline, the reality is more complicated than that. For people who are interested in this topic, a good read is Kathleen Duffy’s seminal 2003 study on “failing to fail” student nurses. Unlike in the tabloid headlines, her focus wasn’t so much on the universities, but on the mentors; the qualified nurses who teach and supervise students while they’re out on placement.

I’m a mentor myself, and I regard it as one of the most rewarding parts of my job. Every few months I have a student nurse with me for six weeks, so they can develop their knowledge and clinical skills. It’s up to me to support them and also to assess both their skills and their professional attitudes. I’ll not just be looking at their ability to perform a task, but whether they interact well with patients and families, whether they respect confidentiality, actively seek out learning experiences, and so on.

For the most part, the students I’ve had come to me have been excellent. Keen, bright, eager to learn. But there remains the question of what to do with a bad student. Hence why Duffy’s paper was required reading when I did my mentorship training. She identified various reasons why a student might not be performing but still pass a placement, which she placed in four categories.

  • Leaving it too late – not identifying and addressing problems until the last week of the placement, perhaps not having a mid-placement meeting as you’re supposed to.
  • Personal consequences – an awareness by the mentor that this could result in a student’s career ending before it’s begun, with all the ways that might affect them and their families.
  • Facing personal challenges – a lot of nurses simply don’t like failing students because they feel it’s not a “nice” thing to do, particularly in a profession that’s supposed to put a premium on being nice.
  • Experience and confidence – mentors not feeling sure of their judgement in these matters, or perhaps being worried about getting a hostile response from the student.

Obviously none of these are valid reasons for passing an under-performing student nurse. Ultimately it’s our responsibility as mentors to flag up problems promptly and address them, for the benefit of the public. The take-home message from Duffy’s research is that if the wrong people are being allowed to qualify as nurses and join our ranks, then it isn’t the university’s fault. It’s our fault.

RCN withdraws Castlebeck sponsorship of learning disability award

Yesterday I and others blogged and tweeted about how a Royal College of Nursing award for learning disability nurses was being sponsored by Castlebeck, the company responsible for the Winterbourne View abuse scandal.

Today, the RCN announced that Castlebeck’s involvement has been withdrawn.

Castlebeck, the company that owns Winterbourne View hospital, will no longer be a sponsor of RCN Publishing’s 2013 Learning Disability Nursing Award.

RCN Publishing took the decision to accept sponsorship from Castlebeck last month based on the substantial developments within the company since the first Panorama television programme was shown 16 months ago.

However, the very strong reaction from many learning disability nurses across the country has led to RCN Publishing withdrawing from the sponsorship arrangement. 

In a statement, the Royal College of Nursing said: “The RCN supports the decision of RCN Publishing to withdraw from its sponsorship arrangement with Castlebeck, due to the strong feelings of some members, including the whistleblower Terry Bryan, given the serious crimes committed against vulnerable residents at Winterbourne View.”

While RCN Publishing is a wholly owned subsidiary of the RCN, it is editorially independent.

In all fairness to Castlebeck, it appears that it’s been working hard to transform itself, sacking incompetent managers and bringing in proper clinicians. Even so, I don’t think the RCN should giving the company any leg-ups in trying to restore their reputation. They need to do that themselves.

Winterbourne View owners sponsor learning disability nursing award. Satire dies.

The abuse of people with learning disabilities that took place at Winterbourne View “care” home was utterly horrific. Castlebeck, the company that owned the home, took £3500 per person per week from the taxpayer for mostly unqualified staff to abuse and assault its residents.

I have to thank Mark Neary for spotting this. He noticed exactly what Castlebeck are doing with their dirty money, and who’s taken it. The Nursing Standard, the weekly magazine of the Royal College of Nursing, has announced its Nurse of the Year Award. Scroll through the categories, until you get to the Learning Disability Nursing Award. This is “for nurses working within the field of learning disability who can clearly demonstrate that their initiative has improved the health, well-being and social inclusion of people with a learning disability.”

And who’s sponsoring the award? Unbelievably, it’s Castlebeck. While I’m hardly surprised that this sordid company wants to try to mend its shredded reputation by associating itself with such an award, I’m utterly shocked that the RCN would accept their tainted gold.

Remember that when Castlebeck trousered public money to take in these deeply vulnerable people, they didn’t provide the Winterbourne View residents with psychology input, or an occupational therapist. They didn’t even have that many learning disabilty nurses. The overwhelming majority of the staff were unqualified support workers. Tragically, some of them turned out to be the sort of thugs that I wouldn’t trust to look after my cat.

I’m not entirely surprised by the RCN. They’ve always had a bit of a reputation for shameless establishment schmoozing. It’s for that reason that several years ago I switched my union membership from the RCN to Unite. Even so, this is an appalling decision on their part. I don’t know how they keep a straight face and a clear conscience from doing so.

Don’t Cut ‘Me’ Out

The following is a bit of a rant and a ramble through current health and social care provision based solely on individual experience but I thought I would share it with you anyway.

If I don’t have a care plan…………………………..
If I don’t have a care plan I don’t have individual needs
If I don’t have individual needs I do not have a choice
If I don’t have a choice I do not have a voice
If I don’t have a voice I am not empowered
If I am not empowered I am not valued
If I am not valued I am not a human being
If I am not a human being I am merely an animal
If I am merely an animal I have been dehumanised
If I have been dehumanised I am not very far from being abused
If I am being abused then I am being neglected
If I am being neglected then I or my needs don’t exist
If I don’t exist then it is possible that I have physically and/ or spiritually died
If I don’t exist is the only valid reason for not having a care plan.

Nurses to Teach David Cameron How to be a Smug, Careerist Tory

Following last week’s comments by David Cameron on nursing practice, a team of nurses has been set up to return the favour by showing him how to do his job.

Several surgical nurses have been despatched to a corporate function to ensure sufficient loud braying about stock options. Meanwhile, a health visitor will conduct hourly checks on the number of times Cameron mentions “benefit scroungers” while completely ignoring the Spartacus Report.

Some nurses expressed concern about the way Tories are being trained. One A&E nurse said, “We are seeing worrying moves away from the traditional training grounds of Eton, Oxbridge, then being parachuted into the life of a career politician, with maybe a stint in a PR consultancy or an investment bank. Some of the recent crop of Tories have actually had jobs in the real world. This undermining of standards simply won’t do.”
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Nurses should talk more but is anyone listening?

When governments tell people how to do their job it makes the job they do very political. I recently made the observation that nurses can be sacked for not completing paperwork but not for not talking to the people in their care. The recent announcement by the prime minister that nurses should talk more and do less paperwork is however a paper tiger . How are the nurses going to prove that they have followed the PM’s request? With more paperwork of course!

Paperwork is not the problem however, it is what is demanding the paperwork that is the problem. A market led health service will never work as the people who require it are not customers; they are patients (in more ways than one). People who are ill or impaired are vulnerable and weakened by the nature of their illness. They do not always want to to be asked what they would like or even if they are having a nice day. In such a vulnerable position (often made worse by very inadequate clothing in some very public places) it is usually information that is required in order to help people get out of the situation they find themselves in.

To be greeted with a ‘How can I help you ?’ may often generate a response like – ‘Well if I knew that I probably would not be here!’

Some eminent professors of health and social care call it the MacDonaldization of society, I wonder if that is really what they mean when they talk about the Big Society.

Have a nice day!