Sunday, 24 May 2015

Why do helicopters eat their young and other tales of nurse education

The wonderful blogger Paul Millard, pilot, motorbike enthusiast and general nurse, working in the US wrote a blog back in 2012 that asked the question as to 'why do nurses eat their young'. Unlike bears, lions, bottlenose dolphins and rabbits who will sometimes eat their young for understandable reproductive and survivability reasons, the term in nursing refers most frequently to the way some qualified nurses treat their student nurses and the newly qualified nurse – which can be poorly and often without compassion.

It is also a term used to suggest that nurses themselves can do the most damage to their profession through publicly undermining the confidence society might have in them.  Despite the evidence clearly supporting the fact that higher numbers of nurses with a degree have reduced by 7%, the risk of death following surgery, in recent years much media focus has coalesced around the notion of nurses being 'too posh to wash'. This proposition argues that since nurse education adopted an all graduate approach to the preparation of nurses, today's nurses don't want to get involved with any element of basic care. Despite a number of high profile reviews and reports that said there was no evidence of this, the myth has persisted.

The comprehensive 'Too Posh to Wash' report produced by the excellent 2020Health is a great example of the high quality, evidence based approach to challenging such notions. 2020health is an independent think tank, whose aim is to improve the health of individuals, and create the conditions for a health society, through research, evaluation and campaigning and relationships.  Published in 2013, the report is still a relevant and important read. Unlike, I would suggest, the opinion piece posted on the RCNi web site (part of the Royal College of Nursing Group) last week by one Tony Stein.

Tony works for Health Care Management Solutions (HCMS). He is one of the 5 senior team, 3 of which, including Tony are accountants. It’s difficult to tell from their web site as to whether any of the senior team are nurses or nurse educationalists. HCMS provide Care Home providers, owners and investors with 'one-stop' solutions to the care home sector.

He set out to explore the current nursing shortages being experienced by many NHS Trust's. The account appeared to be ill informed and not particularly evidence based. One reading of his argument might be that following the decision to make the threshold for nurse registration a graduate education, those who might have a genuine desire to become a nurse but who may not have been able to meet the academic requirements, particularly mature applicants, were unnecessarily excluded from the opportunity to train, and this has had a negataive impact on the numbers of nurses in the workforce.

Clearly the evidence refutes this. Those nurses graduating this year are those that started their education programmes back in 2012. In England, the number of commissioned student nurse places has steadily fallen between the years of 2004 – 2012. It’s therefore perhaps not surprising that there is a current shortage of nurses entering the workforce. Whether they have a degree or not is not particularly relevant. In our School we have high rates of retention, currently the best in the University, and high levels of newly qualified nurses entering the local health economy. Of course the local health care economy includes care homes, who currently do not contribute to the cost of educating the nurses they employ.

Despite Tony Steins appearing to advocate a return to a previous era of two tier nursing qualifications to resolve the present workforce shortage, there are no quick fixes to the current situation. Having spent two days last week with 120 colleagues from across the 4 nations of the UK, all of whom were intent on contributing to improving the education of health care professions in order to create the best possible future workforce, I found the RCNi and Tony Stein’s contribution to the wider debate really unhelpful and unnecessary. 

Maybe both could learn something from Paul Millard. He was working in an Emergency Care Department when he overheard a conversation between a doctor assessing a patient with an alcohol problem to see if he was confabulating. The doctor asked the question, 'why do helicopters eat their young?' – the patient apparently confidently responded that he couldn't answer due to the issue being a matter of national security – to  answer the questions would incur the death penalty. The patient continued in this vein for a few minutes before saying 'besides, they’re more tender when they are young'

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