Over on Nurses Universe (the Nursing Times’ group blog), there’s a bit of a hoohah going on about this blog post by Erin Docherty. She’s a student nurse who, although deeply committed to nursing, has had to drop out for 7 months in order to restart the semester, because she’s failed an essay. This has caused an almighty row over at NHS Blog Doctor about whether or not this is a fair way to treat a student nurse.
To some of those in the debate, she’s a dedicated nurse being treated unfairly because of a university system that values academic essay-writing at the expense of practical, hands-on nursing. To others, she’s a silly little girl who should have studied harder. Which viewpoint is correct, this one?
So the NHS has lost the services of a student nurse with two years training. She is going to work in a call centre. WTF is going on? What is this doing to her morale? Can Dame Christine explain why young girls, girls with obvious vocational enthusiasm, are treated like this? Why is Erin being labelled as worthless after two years training?
Or this one?
She failed an essay, presumably because she didn’t work hard enough at it. She is being given an opportunity to do it again. Would you be playing the same violin for a medical student who failed their exams but was griping about – oh boohoo – having to do them again? Erin really needs to get over herself.
Although I’ve already expressed some fairly forceful opinions over in the comments thread, I think I’m going to use this post to try to come up with a balanced view that’s – hopefully – fair to both sides of the argument. And by extension, also fair to Erin.
To start off with, reading through Erin’s blog post, there’s clearly much to admire in her attitude. In her blog post, she lists ten tips for student nurses on placement. A quick sample:
1. Always show the utmost respect to the auxiliaries. These people know the wards inside out and will take the time to show you how to make a bed properly. If you’re ever looking for something they will know where to find it and you can be sure that, if you form good relationships with the nursing assistants, they will support you through the nine weeks.
2. Always make sure you know what you are doing. If you are asked by another member of staff to carry out a task, then don’t second guess it. Make sure you understand and are capable of doing exactly what has been asked. Nobody will think less of someone for being careful.
3. Never be afraid to make the tea! No matter what anyone says, making the tea on the tea break can go a long way. It shows you aren’t afraid to muck in and can also lead to a few invitations to staff nights out!
I’ve read through the ten tips, and they’re all good advice. I’d recommend this advice as something to print out and hand out to student nurses.
Also, reading the post, it’s hard not to feel her palpable disappointment at having to taking 7 months out until she can restart the semester. Going back to a previous post, where she was panicking about the essay that she eventually failed, her passion for nursing clearly comes across.
If a patient needs me to explain their medication, I can help. If I’m about to finish my shift, I will stay and explain it another way so i can go home knowing I gave 100%. This is not because I wrote an essay on it – it’s because I believe in it and I was born to do it.
This is all excellent stuff, and reflects extremely well on her attitude.
But…
Here’s the brutal truth. If she’s been asked to repeat the semester, that means she didn’t just fail the essay. She failed, resubmitted it, failed again, resubmitted it a THIRD time…and failed again.
And the pass mark? 40%.
To get just below that pass mark, here’s the sort of standard that she would have been writing to.
Weak 35%-39%
Answer showing minimal achievement in all areas, but containing some elementary
relevant information. Reliant on a minimal range of reading and poor attention to
detail. May be repetitious, consisting of a string of weak statements/opinions which
may not relate to each other. Assertions without supporting evidence; minimal
reflection, poor planning and presentation; sources very inadequately cited.
And to be having to retake the semester, this would be the absolute best she’d have done, after three attempts. This simply isn’t good enough.
At this point in a blog post, arguments usually erupt over whether nurse training has too much sociology, or too little anatomy and physiology, or too much reliance on reflective models or problem-based learning or whatnot. At this point, that debate simply doesn’t matter. Whatever the subject matter of the essay, this ain’t good enough.
Is this a student who’s adequately developing her knowledge of the clinical, professional, legal and ethical issues that a staff nurse has to deal with? Absolutely not.
In her blog posts, Erin actually gives some glaring clues for why she failed the essays. Here’s an example:
Well, here’s my contribution to the research: essays are nonsense. I spend hours and hours using a thesaurus to try and find big words to put on paper so I come out looking intelligent. Why not have a conservation with me instead, ask me my opinion on patient-centered care, ask me any drug calculation you want, or even ask me to explain the new mental health act.
Well, yes Erin. If you spend that amount of time with a thesaurus looking up long words, your essays will be nonsense! You’re training to be a staff nurse, not Brian Sewell.
Put the thesaurus DOWN. Instead of looking for big words to make you look intelligent, demonstrate that you are intelligent by doing the reading, looking up research, linking the research to what’s happening on the ward, putting together a coherent argument…and if you’re still stuck, e-mailing your tutor for advice. In summary, you need to spend less time with your thesaurus and more time with CINAHL and Google Scholar.
There’s also another clue to why she failed.
Right now I am literally tearing my highlighted hair out. It’s 4.30am and I can’t sleep as tomorrow is D-day – the dreaded end-of-year essay is due. Should it fail to come up to scratch, my whole career could be down the drain.
So, you’ve left the essay until 4.30am on the morning it’s due in, and funnily enough it turns out to be a big load of bollocks?
You really need to manage your time more effectively than that. Doing your essay at the last minute is just a really, really bad idea – not least because if you get bogged down, there’s no longer any time to ask for support.
I think at this point I should clarify my own position on the “academic vs practical” debate in nursing. I went down the honours degree route, and came out with a first. I’m proud of that, and I think I’m entitled to be. But I’m equally proud of the fact that no colleague of mine has ever accused me of thinking myself too important to wipe a backside, serve a meal, make a cup of tea for a patient or a HCA, or just sit and chat with a patient. Like any staff nurse, I’m forced to do lots of tedious paperwork – notes, care plans, risk assessments, nursing reports – that take me away from patients. But I work hard to manage my time effectively so that in between the red tape I can get out of the nursing office and onto the ward floor. A HCA recently told me that, “I’ve worked with too-posh-to-wash nurses, but that definitely doesn’t apply to you.” I took that as the highest of compliments.
Too-posh-to-wash staff nurses annoy the absolute living piss out of me, but so too do anti-intellectual reverse snobs who loudly proclaim that nurses don’t need any of that fancy book-learnin’, and all it will do is overheat their tiny little nursey brains. In my experience, when student nurses say that, “Essay-writing is cobblers, and has no relevance to nursing”, what they actually mean is, “I can’t do it.” You don’t get many nurses who got good grades in their assignments saying they didn’t learn anything useful from it [flame-response from E in 10..9...8...].
Nurses don’t need to develop knowledge and apply it? I’ll remember that next time I’m writing a nursing report for a Mental Health Review Tribunal that I have to be sure won’t get ripped to absolute shreds by the patient’s solicitor. Or when I’m sitting in a ward round having to justify my recommendations to an entire team of professionals, including the consultant psychiatrist. Or when I have to work out if I’ve committed a criminal offence by breaching the patient’s rights under the Mental Capacity Act.
That said, I do want Erin to return to her studies in 7 months time (though I’d suggest she enrol on the nurse bank as a HCA rather than taking the call centre job she mentions). But when you come back, Erin, manage your time effectively, start your essays well before the due date, make sure you do your reading, and above all seek support from tutors early and often if you’re running into trouble.
Oh, and for crying out loud, try to lose the thesaurus at some point in the next 7 months.
Since I avoid Blog Doctor, I had no idea there was a big argument going, but I have read the original post before.
I too have heard plenty of students say things like “why do I have to be able to write an essay to be a nurse?”, and they’re always the ones that are struggling.
I fail to have sympathy when someone still can’t pass a resubmission.
Feedback and support is always on offer and students should take advantage of it.
I’ve also heard students say that they only changed a couple of sentences and resubmitted the same piece of coursework, which is absolute bollocks since it will be going through an online plagiarism programme and more than likely be marked by the same marker, or at least another marker will have the original.
Keenness alone isn’t enough. Although I want to add that some really bright cookies still fail now and again and there were a few from my year that I am amazed that they actually made it and are now registered!
My own (anecdotal) experience is that those who are genuinely committed sometimes struggle but usually get through the course eventually, though they may have to resubmit a few times.
If somebody flat-out fails, it’s usually because they haven’t done the work,
I have a friend who is a middle school (12-14 year olds) social studies teacher. When he can’t convince his kids in any other way that what they are learning is worthwhile he tells them that for anything they want to do with their lives there will be hoops to jump through, some of which may seem silly to them now and may still seem silly when they come up, but he doesn’t want them to be preventing from doing what they want because they never gained the skills to jump through those hoops. I would say that Erin needs to learn hoop jumping. It seems she still thinks those hoops are silly. I don’t think they are silly because I see their value, but either way she needs to write essays in order to become a nurse. I think nursing-ish experience in the mean time is fantastic, but if it is the essay-hoop she is worried about rather than the nursing things, perhaps she should consider enrolling in a basic essay writing class. Then, the essay learning will be more gradual and less painful when she gets back to nursing school.
I wonder how she got so far without being able to do better than that on every essay. If the problem is indeed that she didn’t put forth sufficient effort, I would question her dedication. Though not a nurse myself, I am sure that there are many similarly un-nursey things that are required of real-live nurses. If she won’t do those things now, who’s to say she will do them later?
I was reading comments on my OU course forum yesterday & one of the tutors said that she only starts to undertsand new or difficult subject matter when she starts writing about it. Which struck a chord with me.
Nurses who aren’t good academically tend to be crap practically as well, in my experience. And that’s all I’m saying.
I would recommend that she goes to her university support services. They have things in place to help you structure essays and will give support in these cases. It maybe that she didn’t fully understand the way she was taught to write. Some 1 – 1 coaching may help.
Speaking from personal experience, I expect around half of my cohort (there were 60 of us initially) to drop out over the three years. This is based on the large number who have already had to resubmit various pieces of work in the first year; frankly, if you are requiring resubs at that point you need to do something serious to turn it around. I would say roughly 90% of these people were no great loss to nursing, to be honest. Hmm, that makes me sound like a bitch. But a lot of them had just fell into it as a way to get their parents off their back and because it paid a bursary. I’m not saying it needs to be a calling, but some interest in MH does help.
It also seems to me that the academic stuff is one way of sorting people out; my own belief is that it is easier to get help and support to scrape a pass in an essay on the third attempt than it is to become a good nurse if the underlying personality traits (or whatever) aren’t there. I work bloody hard on my essays, because I learn a lot by doing them – if the topic interests me. If not, I jump through the hoop.
For example, I do think evidence based practice is important. But nurses at ground level simply don’t need to have some of the research skills we are being taught. I have never met any band 5 who has had the ability to make any major changes on the ward or the time to do so. To me, being able to interpret and evaluate a piece of research is something that should happen at policy level and be filtered down to us, and thus be post-grad stuff. If you want to be implementing changes in the workplace, do the extra qualification. If you want to just get on with being a nurse (and I’m talking in the old fashioned sense, not the all-singing, all-dancing supernurses of today) and have the important bits of EBP land on your desk in a sanitised, pre-interpreted format, then the basic course could include something more useful. IMO.
Ok, that was a bit off topic. Erm, Erin. Yes, get some tips on hoop-jumping off the uni, and bank work on the wards. And maybe work a bit harder, instead of complaining that it’s all bollocks just because you can’t do it…
Regarding Beakie’s comment that, “Nurses who aren’t good academically tend to be crap practically as well, in my experience. ”
In my experience the inverse is also true. I keep hearing about how there are nurses “with first class degrees, but crap at patient care”. Maybe I’ve just been lucky, but I simply haven’t met this nurse who was awarded a glittering degree but is regarded as lazy and incompetent by their colleagues. My impression of students with good quality degrees is usually that they work just as hard on the wards as they did at their essays.
There’s a newly-qualified nurse who’s just started on our ward after previously having done a placement here. She got a first in her degree. If she’s such a head-in-the-clouds, airy-fairy academic, why did the ward staff practically beg her to come back and work for them?
I got a first in my Nursing degree, of which I am extreamly proud. I put it down to good old fashioned hard work – I slogged away on my placements (st/n’s are still the bottom rung of the food chain) and put time and effort into my essays. Having said that, uni was a great social opportunity for me: I met all manner of people and had the good fortune to have many varied experiences.
I have witnessed nurses whose patient care is second to none but with little understanding of the drugs they are administrating or the pathology of their patients illnesses. Likewise, I have some scarily intellegent nurses whose communication skills are somewhat lacking, to say the least. It is hard to define where the appropriate balance lies, but I believe that courses which are increasing nurses academic skills (such as critical reviewing of research studies) help to raise our professional credbility
Just when I think I can piss off Beakie provokes me.
If we assume that we`re going to have a 40 year working life, then it`s a big decision to spend 7.5% of it ( minimum ) on further education. You have to be confident the rewards will justify the effort. Otherwise you`re minimising your chances of paying off your mortgage and acquiring a pension fund. The first issue is whether nurse education needs to be 3 years long. N.B. Erin might be poor at time management, Z, but she might just have been working. Your not good at managing everything or you wouldn`t be bleating about your student debt, would you ?.
The second issue is whether nursing needs to be a degree entry profession. I don`t think it does but contrary to popular belief I`m not about to take to the barriacades in opposition. What isn`t acceptable is the current system of dumbing down, blatant coaching and rampant plagiarism to usher those who aren`t degree level through the course.
Finally, I too think this too posh to wash thing is a red herring. The core tasks of nursing can be as repellant to a NA as an academic. The problem is that academics who aren`t too keen on the basic tasks have a ready made escape route into management or education where prevailing “wisdom” believes they are suited. If this blog teaches anything it is to vigourously question that.
To return to my bullying role, Beakie, you raised your game on the “riches” thread but you have reverted to your usual buffoonery. Your comment on this thread indicates you are that far divorced from reality as to fall off the Glasgow Coma Scale.
Likewise, I have some scarily intellegent nurses whose communication skills are somewhat lacking, to say the least
Autistic Spectrum Disorder, anyone?
buffoonery
Can’t you just smell the Brilliantine on a big ginger ‘tache?
{For the youngsters among you:
Brilliantine is a hair-grooming product and was created at the turn of the 20th century, when French perfumer Ed. Pinaud[1] presented a product he called Brillantine (from the French brillant meaning “brilliant”) at the 1900 Exposition Universelle in Paris. It consisted of a perfumed and colored oily liquid and was intended to soften men’s hair, including beards and moustaches, and give it a glossy, well-groomed appearance.}
Not playing out Beakie ? Or are you too busy writing your new biography of Einstein in which he plays centre forward for Real Madrid and principle cello for the Berlin Philharmonic, climbs the fourteen 8,000 metre peaks in the world and shags more gorgeous women than Warren Beatty. I should be grateful your ignoring me, you are a waste of my time.
OSB, I’d respond to your point, but I must confess I’m a little unsure what your point is.
Crazy Nurse, yes, I agree that it can be difficult to work out where the balance should lie. Personally I’d say at about 50:50
I have witnessed nurses whose patient care is second to none but with little understanding of the drugs they are administrating or the pathology of their patients illnesses.
If a nurse cannot explain what drugs a patient is on, or what effects and side-effects the person might expect, or recognise side-effects when she sees them, or is unable to distinguish between depressed mood and the negative symptoms of schizophrenia, or is unable to offer patients some kind of explanation of what might be going on with them then to my mind, their nursing care is deficient.
Schizophrenia is known as the graveyard of research, the super intelligent are reluctant to grapple with it for fear of association with failure. It is still classified as an illness in the same terms as were used by Buhler 103 years ago. It may be renamed Dopamine Dysregulation Disorder when there is no evidence that a dopamine imbalance causes ( as opposed to being a consequence of ) psychosis. 99% of mental health nurses have no clue as to the haphazard, and frankly distressing, way the drugs they administer were developed. We`re all talking a good game.
And that`s my point really. The acid test, is always, what you would want in terms of care for you or your family. If I had the choice between a compassionate, caring Erin and a Beakie protege with their stab at an explanation of what might be going on, I`d choose Erin.
How about a caring, compassionate Erin who’s also taken the taken the time to do her essays?
It doesn’t HAVE to be an either/or thing, you know. I think we’re entitlted to expect nurses to be compassionate AND to have worked to expand their knowledge base.
Then you may as well go take a pint down the pub for your therapy OSB.
Ethel the voluptuous barmaid is probably as knowledged – and will have equal person-handling skills – but also provides beer.
Grade 6 pay for barmaids all round!
You know, it kind of amazes me that everyone goes on as if they know Erin is this fabulous nurse who’s so good practically and so caring and compassionate when all we have is her own account of how brilliant she is.
None of us has any corroboration to indicate that we are any good at what we do.
I am tempted to say that as I don`t believe psychotherapy is routinely more effective than a chat with a wise, serene soul and as I would rather eat my own shit than take clozaril, whilst conversely I appreciate beer and voluptuousness, I am willing to go with Ethel. However, I realise that`s a bit simplistic and flippant.
MN itself leads us off the scent here. We`re not representative of nurses. Z and Beakie want us to bask in the glow of their intellectual superiority. Mr Ian ( and Mental himself ) seem to enjoy the pondering the imponderables. E has a bright and inquisitive mind and I just enjoy a rant. Bloo is much more like the real thing. Not many of my colleagues are any loss to the world of astro nuclear physics and the brightest in society won`t, as a rule, be drawn to this job. We have to be very careful where we set the academic bar.
We don`t know the real Erin. Some people struggle with essays. Some whilst reasonable at English have huge problems structuring their assignments. Personally, I find that difficult to understand but algebra, chemical equations and most modern technology are beyond me.
I`ve been married a long time now but my marriage was only 3 months old when Mrs OSB developed orthopaedic problems. If you add the time I`ve spent in hospital with her to my own practice (and I`ve moved around a lot ) I`ve seen a good bit. Time and time again it is the nursing staff with the core personality traits who make the difference. If Erin possesses then I am more than willing to overlook essay writing deficiencies.
@OSB
I am tempted to say that as I don`t believe psychotherapy is routinely more effective than a chat with a wise, serene soul and as I would rather eat my own shit than take clozaril, whilst conversely I appreciate beer and voluptuousness, I am willing to go with Ethel.
While I (at least partly) agree with you on both psychotherapy and the relative pleasantness of Clozaril vs eating one’s own shit, I think I’d still prefer someone with a bit more knowledge than Ethel if someone was planning my post-discharge care, or writing my nursing report, or if I’d just gone into an oculgyric crisis.
However, I realise that`s a bit simplistic and flippant.
I was with ya – right up to that point. I don’t think it’s that flippant.
But without ya talented Dr Nurseys – who’s going to tell them it’s better to eat your own shit than take clozaril? Taking that example – nurses are up against pharma; psychs and even the great London School of Economics it seems nowadays when it comes to determining care.
And don’t forget formal scientific research is not only notoriously difficult in mental health – it’s also not the forte of nurses – we’re still developing.
Yes, this is not the ‘finished product’ – these are the experimental generation of nurse researchers who will pave the way for those who will once and for all bring down the tyranny of all that is psychiatry in its most evil forms; to emancipate our inalienable nursing right to bask in the glory of holism and sociology as a hard science; to feel free to wear crocs, drink tea, smoke cigarettes and play pool all day knowing – just KNOWING – that out there some nurse researcher demonstrated unequivocally that THIS, my brethren, this IS the pathway to righteousness and sanity – and hence denounce the power of Big Pharma and forcibly propel its propagandistas into the abyss of the Gobi desert while we pass the hob nobs between patient and staff (except for the guy in the corner who seems a bit iffy – and not sure if he’s staff or patient – but he referes to himself as ‘the consultant’).
And on that day – I sir will stand proud – and tell it to the crowd – I did it my way.
It’s been getting a bit sunny here lately…..
I would answer your post, Mr Ian, and point out that nurse researchers are already looking into extremely important areas of psychiatric care such as enforced medication (as you already brought to our attention), restraint and violence on acute wards and so on. But I’m way too busy basking in the glow of Zarathustra’s intellectual superiority.
I think I`m pretty good at nursing reports, Z. Most of my colleagues aren`t. But I`m not the best at detail things such as discharge planning. As for oculogyric crisis or other nasty facial dystonic reactions ( I haven`t seen either of them for a long, long time ) even a gibbon could detect something was desperately wrong and intervention was required. We`re not good at everything. I`m just saying nursing needs to be built on a platform of core personality traits rather than academic ability.
Beakie can put all his faith in research into violence in acute settings. My first Staff Nurse post was in, anecdotally, the third busiest male acute ward in the country. Nothing or no one I have encountered since has been half as adept as the elderly, chain smoking N.A`s dripping in maternal goodness who countered most of the hostility and aggression on the ward. I didn`t ever get to assess their essay writing skills.
Mr Ian, Our place in the sun still seems a long way off. As I still shine my shoes, I won`t be joining you in the wearing of crocs.
Jumping ship here chaps, rather busy. Hope to reappear before too long.
I`m just saying nursing needs to be built on a platform of core personality traits rather than academic ability.
I couldn’t agree more, OSB. I’m just saying the knowledge side is important as well.
I tend to agree, on balance, that a nurse’s practice is their most important attribute, however, as part of a multi-disciplinary team, nurses are working with other professionals who are educated to at least degree level.
It can be quite daunting when the language used reflects a particular academic style and relates to theories that are not usually the subject of the working day.
[...] A Tale of Two Erins by Z got a fair amount of discussion. Over on Nurses Universe (the Nursing Times’ group blog), there’s a bit of a hoohah going on about this blog post by Erin Docherty. She’s a student nurse who, although deeply committed to nursing, has had to drop out for 7 months in order to restart the semester, because she’s failed an essay. This has caused an almighty row over at NHS Blog Doctor about whether or not this is a fair way to treat a student nurse. [...]