I can not find the link but I am sure I posted about this before but the NMC, those hard working fellows, have moved on to the second stage of their consultation on standards for pre-registration nursing education. Here is the blurb:
This consultation seeks your views on new standards for pre-registration nursing education programmes. These standards set out what nursing students must demonstrate to be fit for practice at the point of registration.
Woo.
If you are not a nurse this will be of virtually no interest. If you are a nurse it is still probably of no interest. I was initially intending to write a post called How To Speak To Mad People, but it is still gestating in my head while I try to make it even more offensive.
The NMC are conducting a high quality survey. You can find the link here. An academic, who could actually be bothered to read the draft standards, told me she thought the NMC was continuing it’s campaign to to away with branch specific training.
So what are they saying about this?
Nurses of the future will practise differently. For example, adult and children’s nurses will need to be better equipped to meet the needs of people with mental health problems, while mental health and learning disability nurses will need to be better able to care for people with complex physical needs.
Nurses of the future! It sounds thrilling. A paragraph like that should end with the promise of Jet Packs for all.
They go on:
Although the findings revealed a lot of support for retaining four specific fields of nursing – adult, mental health, learning disabilities and children’s nursing – many people thought that continuing with this approach might narrow our focus, restrict innovation and hamper joined-up care.
Apparently no one wanted branch (or fields of nursing) training done away with.
Right it is now tomorrow and I have come back to the post. Pretty boring so far. Time for a rant.
The NMC are telling us nurses of the future will have a radically different client group needing a new kind of nurse. Evidently they mean something more than a nurse with a higher quality certificate. They do not seem to explain why this change will happen. My reading of the above is that they want to increasingly ‘genericise’ (is that a word?) nursing training.
Unless they are intending to genericise Doctors and hospital wards none of this will make a difference. Mental health inpatients will still be cared for on a mental health ward under a psychiatrist, general patients will still be left on understaffed general wards. Nurses on both types of ward will continue to provide their specialised care and call in for expert knowledge when other issues become relevant.
When people think about a default nurse they tend to mean a general nurse. I certainly imagine a nurse in a starched white uniform, with a hat and a cheeky twinkle in her eye when I think about a nurse.
Sorry wrong link.
So I imagine what the NMC will do, [very snippy aside autocensored], is eventually get all nurses trained up to a general generic standard; which will essentially be a general nurse with some experience and lessons from the different branches fields. Following that if people want they can either choose to stay and do a six month speciality course in mental health or learning disabilities or *cough* get a job in the relevant area and hope their employer will pay for the specialist training. Based on what others have said in previous similar discussions this will not work well.
I went back and reread the above paragraph and thought what kind of new client are we expecting that has complex mental and physical health needs.
Old people of course.
Someone (The Shrink – Thanks DeeDee) pointed out that the general wards in their trust contained a higher number, significantly so, of people with dementia than the psych wards. But the general wards were phoning the psych people for advice. Which was odd considering the general nurses probably had more hands on experience than dealing with people suffering from dementia.
Before I go further I must say I am against the whole under 65 / over 65 thing in mental health. The fact that someone is forced to accept a new care team and system of care simply for getting a year older is an abomination in this day in age. In absence of other specific age related changes. It happens I have seen people shift from one consultant to another just for turning 65, new consultant decides to tweak their meds; poor soul ends up in hospital. Really annoys me.
In some cases though, where the condition is one generally associated with the older person, it is the right thing to do.
I do not think they should try to reduce the number of branches. I think they should add one, either as an entirely new branch or as an add on module at the end of current branch training. They should make Older Persons Nurse (or some more politically correct term) a specialty. I would love it, they should make it easy for nurses currently in practice to get on the training, care homes would love it, they could do cut down training for the support workers and replace the current NVQ system.
Rant over.
One last quick quote from the NMC to show where their priorities lie. Emphasis mine.
… it will need to be recognised that health graduates have choices beyond the traditional professional pathways and places of employment; the needs of patients, carers and communities and the demands of employers need to be balanced with the aspirations of new graduates.
Something about that does not look right to me.
Anyway I am off to send the NMC my picture so they can stick it at the top of their site.
It was The Shrink (Lake Coccytus) who posted about that.
So whatever happened to double training? Where two areas of competence were required, as in the sick ward of a psychiatric hospital, nurses at one time were routinely SRN (now RGN), RMN. This was easy to arrange when student nurses were employees and simply became post-registration student nurses in order to take a further training, or in some instances joined ab initio a four-year double training arranged between two hospitals.
Now, in the brave new world of bursaries, managers with OCPD won’t pay. As I recall, any RMN was competent at physical procedures when students receiving ward-based training had to carry out procedures as a matter of course, and for example had to learn trays and trolleys for exams. The NMC’s position is simply the bastard child of waffly training and thinking from Project 2000 onwards, in which students very often do not have the skills of rigorous criticism I would expect from a graduate or the practical experience which a registered nurse surely should have. Look at social workers: they went all generic after the Seebohm Report (?1969) and have had to reinvent specialism, as in ‘approved’ and ‘recognised’ SWs.
There was at one time a proposal favoured by some of the brightest in the profession, under the influence of Maxwell Jones and the therapeutic community movement, that RMNs should cease to be nurses, and instead do a specialist training as ‘social therapists’, combining the skills of nurses, OTs and social workers. If only! This thinking was killed stone dead by the Heath government, when Keith Joseph invented the district general hospital as the hub of all health care.
There seems to be some kind of parallel development in that some universities are now piloting a “foundation degree” in mental health. This is (I think) a 2-year full-time, or 3-year part-time course which enables you to come into the NHS at A4C band 4. You can then go on to do additional training which, so I am ledd to believe, will be more “social worky” or more “nursey” or perhaps more “OTy” according to each person’s particular bent. I don’t know how far down the line this has gone – I haven’t worked with anyone who’s been through it (Beaky – any ideas on this??).
I’ve also in my time worked with, and been treated by, nurses who were trained under the old regime where general and mental nursing tended to intermix, with potential RMNs doing placements in general environments and vice versa. These nurses have, by and large, been good at their jobs, both from a colleague and a patient perspective. The same crowd also lament the fact that the more recent general nurses have not done a psychiatric placement like they use to in’t olden days. This tends to happen when a general nurse rings up in a state of blind panic because they’re changing a bandage for someone who had a month of depression in 1972, and are concerned that with this patient’s history of severe mental illness there might be unacceptable risk factors (we’ll just gloss over the fact that psych staff tend to bleed just as heavily as any other “branch”).
So “whither nurse training?” indeed. Buggered if I know.
One or two universities offer a joint MH nursing/social work course but none so far as I know offer OT as part of the package. (Without arty OTism, essays are at risk of being constructed by students seeing how many ghastly sociobabble phrases like “issues around” can be packed into one sentence.) But having qualified, the graduate has to opt for one or the other. A long way short of what Jones was trying to achieve at Belmont, Henderson and Dingleton Hospitals, then.
I don’t think I’ve made myself clear in my last comment. Comes of typing while listening to The Archers. I’m talking about BSc not Foundation. The Foundation courses you mention are at least a start (literally). Not all psychiatric hospitals in days of yore employed OTs; some saw OT as a nurse’s job and had OT depts run by nurses. In the therapeutic community I’ve mentioned once or twice, on weekdays we spent the mornings on practical art work (once the community meeting was over), the afternoons in small group therapy, and some evenings in pairs carrying out domiciliary visits to recent ex-patients. In none of that did it matter a jot if we were nurses, medics, social workers or OTs, and all four disciplines carried out these tasks, with professional supervision provided by psychologists.
And as for the latest poll, it should be “Stop!…. in the name of love”.
The Supremes, 1965. Oh, the nostalgia! (Goes off into a rose-tinted reverie with butterflies, bluebirds and fluffy bunnies, a vacant smile on his drooling face…)
You mention replacing the current NVQ system. Bloody right! NVQ = Not Very Qualified (but thinks he/she has a better training than the nurses). I fear, however, all we may expect is Band 4 assistant practitioners in much the same way as the old geriatric hospitals (in former workhouse buildings) were mainly staffed by SENs.
OK – foundation degrees. Two year courses, work-based learning. In healthcare, are targeted at workers in bands 1-4 of the Agenda for Change spine. Provides a level 4 qualification – one level higher than A levels, equivalent to the first year of an undergrad degree – but students also study some modules at level 5 (equivalent to 2nd year of an honours degree). Once done, can be used to (for instance) apply for that STR worker post OR can be taken away and used to APL out of the first one or two years of an honours degree in nursing, social work, OT or indeed anything else that they desire. I think they’re A Great Idea all round.
New nurse education, fields of practice and all that jazz? Well, as anyone will tell you, general nurses go in fear and trembling of anyone with a mental health problem; psych nurses can’t do dressings and feel faint at the sight of a drip. Far better to recognise that there are commonalities between all the branches, that human beings do not organize themselves and their illnesses/conditions conveniently along nursing branch lines and that people with mental health problems get physically ill (to a greater degree than the general population, research shows us) and that people with physical health problems also get depressed, psychotic, manic &c. Does this mean nurses will do a 3 year common foundation programme? I don’t think so, no siree. There will be more cross-pollination between adult, mental health, learning dis and so on, more joint learning, more interdisciplinary education and that, my dear friends, can only benefit Joe Patient which is who we’re all here for at the end of the day, right?
The lesson is ended, go in peace.
PS – Is anyone running a sweepstake on the time it’ll take OSB to write a bloodvessel-bustingly rantalicious post about this?
Evens on 24 hours. What are the odds against him getting it posted before he has a CVA?
OSB must be busy Blanco-ing his cap-badge and lamp-blacking his webbing.
He’d have got his balls blacked with boot polish when I was a lad. OSB has responded in approximately 14 hours on the previous thread to this one. No sign of a CVA but he may yet run amok with a bayonet.
Stopped reading anything from the NMC some time ago so I hadn`t realised I was getting a ragging over here.
Not sure when you`re all going to realise that most NHS “advances” are initiated by a moron worried that if they don`t instigate some change they will be exposed as having little or nothing in their in tray. The latest change being inflicted on me would be mystifying at the best of times but it quite beggars belief in the current economic climate.
Remember Gerry Robinson saving the NHS ? He gave a good account of himself, posed some very pertinent questions and made some very sensible suggestions. Of course in the NHS he got nowhere. Didn`t have time to watch his follow up on care homes but I did see his appearance on Breakfast TV. He reported that the stand out care home he visited had a manager who focussed greatly on two particular questions at interview. Do you talk to strangers at bus stops and if I broke into song now would you join in ? Two year foundation degree ?? FFS. Around here new starter NAs are paid little over £13K. How the fuck does that justify 2 years of study.
Care is supposed to be centred on Joe Patient ( nice of the office boy to remind us ). If I`m offered the choice between the kindly people happy to sing backing vocals and the fat, sweaty breathless acadmemic, with a very keen eye on easy street supported by the melancholic nerd fretting about the regulation of psychotherapy, I`ll opt for the former, thank you.
Proper little ray of sunshine, aren’t you? They don’t make backing vocals like they used to in the good old days when Essex girls in white shoes danced round their white handbags and Essex lads in white socks incoherently tried to pick them up. You work on Karaoke Ward, then. I could give you a quick burst of Palestrina but you wouldn’t like it. A brain the size of a planet and they ask you to put up with fuckwits while the diodes all down your left side are hurting…
Ah OSB – never knowingly overinformed.
Good morning Beakie.
Morning Mental
You`re becoming a comic turn BM. I`m really not sure how you imagine that someone with their diodes hurting would find comfort in the presence of a STR worker ( do they still exist or were they just another quietly discarded flash in the pan ) who had spent two years of stultifying boredom listening ( or not when the welcome embrace of a kip with your head on the desk engulfs you ) to Beakie drone on about homosexuality and schizophrenia. I really couldn`t care less whether I bring any sunshine into your life. I just sit quietly in Tonbridge Wells calling it as I see it. Seems to me if you spend 10 years or so meandering through the further / higher ( don`t know the difference but mercifully I have Beakie to correct me )education accumulating lots of student debt you find succour in the presence of plenty of other idiots treading water with you – it would be a bit uncomfortable on your own, wouldn`t it ? Seems to me if you`re a fat, pretty much unemployable, waster you`ll say / do anything to perpetuate the system foolish enough to pump some money into your bank account at the end of the month.
When are you coming to blacken my balls ? Do I get a simultaneous, complimentary burst of Palestrina ? Karaoke must be so much fun in Bristol
I’m sorry your educational experience at the feet of Beakie wasn’t to your satisfaction but is it kind to go on about his weight? It’s been a matter of curiosity to me for some while now how you managed to survive Army life with your obvious inability to take a joke. Perhaps you didn’t, ragging certainly makes you furious, just like a certain sort of schoolmaster. In your utterances, not least those about China recently, you show yourself more than willing to dish it out. Yet you can’t take it. I rest my case.
Bristol Michael – you have to forgive OSB these little outbursts. It’s the only stimulation he gets, poor lamb, inbetween scaring youngsters on field trips and shouting at the wife.
I do think the lazy fellow could have taken the trouble to use an adjective to distinguish me from the other 60M people in this country he considers to be fuckwits, as in “You facetious fuckwit…You crass fuckwit…You Bristolian fuckwit”. Everything is so mass-produced, use today and throw away tomorrow these days.
My educational experience “at the feet of Beakie” was sadly curtailed when I was evicted to make room for a cohort of proper west African women. A crushing disappointment as I was enjoying a siesta when the bailiffs removed me.
Apologies but I`ve no recollection about saying anything about China. I did, however, write to the editor of the Tonbridge Wells Chronicle recently advocating nuclear obliteration as a means of global overpopulation control.
Off now to seek some reserves of kindness. Haven`t found any on previous searches so for the meantime bear in my mind that if you poke a stick in the tiger`s cage it might snarl. You fuckwit.
That will be: “You fuckwit, Sir!”
Your China remarks, all on DeeDee’s thread, ‘Mentally Ill Man Executed in China,’ 29 Dec 09, were posted at 10.22pm, 30 Dec 09, and 10.55am, 31 Dec 09. The first was replied to by dazedandconfused 3.10pm, 31 Dec 09, and beakie, 10.10am, 1 Jan 10 (“Dear God, OSB, you’ve plumbed new depths…”). The second I replied to 3.27pm, 31 Dec 09. I don’t want to reopen the debate here, the Forum’s the place for it if anyone really wants to, which I don’t.