Beware of bad habits
My daughter's friend has just failed his driving test for the third time. Prior to his seventeenth birthday he had been driving alone, from the age of eleven, on his parents farm.
So, he knew how to make the car go. But, because he had never been taught by an expert, he didn't have the correct techniques. He failed hs test three times because his examiner believed the couldn't demonstrate that he knew how to handle a car safely on a public road where anticipating other drivers, and making your own intentions clear, is a vital part of road safety.
It has now been suggested that getting prospective nurses to work for a year as healthcare assistants on the wards prior to embarking on their training will ultimately improve nursing care across the NHS and beyond. In theory, it might also improve the standard of healthcare assistants as a greater percentage will be people who are aspiring to be nursing leaders.
But, I believe that unless this initiative is instigated with enormous care, working for a year on the wards purely to wash, feed and toilet patients undermines the great nursing skills that should accompany to any of those processes.
I learned to wash, change and feed patients at the very start of my nurse training. We learned not only how to do it, but also how much we could learn about our patients in the process. Washing someone is a very intimate process. Respecting someone's dignity is at its the core. But there is far more to it than that.
Alongside learning the basic technique, I was also taught how to observe the patient without them realising. Examining the quality of their skin for rashes, bruising, dryness are all clues to other conditions. Noticing how one side of the body may move less freely than the other, that finger and toe nails are showing signs of infection or other diseases, or that the they are not hearing or understanding instructions as well as they were, observing that their false teeth are not fitting properly which can hugely inhibit speech and feeding, or sensing that they are becoming increasingly withdrawn and disinterested in their surroundings, or themselves, are all clues to physiological and psychological changes in that patient.
Communicating with a patient in a way, without sounding obviously intrusive, can encourages them to open up and talk about issues that are bothering them. But it takes intuition and skill to maximise that opportunity.
So, insisting that all prospective nurses get some basic ward experience before they undertake their full training is fine if you need to be certain that they understand some of the implications of the job they are taking on. But, their time on the ward needs to be heavily supervised by more senior nurses who have the time to explain why the jobs they are doing are such a vital part of nursing care.