This year’s the 50th anniversary of me starting my nursing training.
It feels time to reflect on how nursing has changed and how it has effected the NHS.
I trained at Chester School of Nursing, in 1975, there were 6 intakes a year:
3 X STATE ENROLLED NURSE and 3 X STATE REGISTERED NURSE.
Each intake had 20 – 30 pupils, so on average there was probably 150 qualified nurses joining the NHS from Chester, each year.
What was the difference between the 2 qualifications:
SEN (State Enrolled Nurse)
The entry qualification was a basic Math and English test, interview etc.
These Nurses were practical and hands on in nature.
The training took 2 years, based in the classroom but mainly on the wards, working side by side with experienced nurses. They were trained on the job.
When qualified the SEN could do everything the SRN could do, even take charge of the ward for short periods. However, they could not move up the promotion ladder; unless they did additional training to become a SRN.
Throughout this training they were paid, which encouraged people to take up a Nursing career.
SRN ( State Registered Nurse)
The entry qualification was 5 GCSE, interview etc.
This training took 3 years and was the equivalent to the
RN ( Registered Nurse) training today.
This training again, was classroom based, with the majority taught on the wards by other qualified nurses.
Again this training was paid and not grant based.
Introduction of Project 2000
When PROJECT 2000 was introduced; it took the Student Nurses away from the wards and put them into University. The SEN level of nurse was abolished and Student Nurses were initially given grants but eventually ended up with Student Loans.
Up until this point STUDENT NURSES TYPICALLY MADE UP TO HALF THE WORK FORCE ON THE WARDS !!!
The Project 2000 effect was to
- To cut the amount of nurses , possibly by half, on the majority of wards.
- It turned a very practical and caring job, into a University writing and referencing exercise.
- Took Nursing away from the patients and put it in front of computer screens.
- Reduced the number of people wanting to take up nursing due to the entry qualification levels and the cost of training.
Nurse Practioner
I fully respect the modern RN and the hard work they put in to qualify; they are excellent nurses.
We must look into a new Nurse training to encourage people into Nursing, whilst nor forgetting , nursing is a practical skill backed up with knowledge.
Would the answer be to reintroduce a return to the old Hospital based training, an example would be.
A 3 Level Entry System
LEVEL 1 – THE PRACTICAL NURSE (PN) a revival of the SEN.
Qualifications = a simple math and English test, screening and interview.
2 year PAID training based initially and periodically in the classroom, but mainly on the wards.
These Nurses would have all the practical assets of a RN. However, they would not be able to move up the promotion ladder, without taking further qualifications.
The experience they already have would cut their RN training down to 18 months.
This basic level of Nurse training would encourage people to become Nurses and enable them to move up the ladder if they desired.
LEVEL 2 the REGISTERED NURSE
Qualifications = 5 GCSE including Maths and English.
3 year PAID training based initially and periodically in the classroom but mainly on the wards.
These Nurses would have all the abilities that a RN does now and could move up the promotion ladder.
LEVEL 3 the NURSE PRACTIONER
Qualifications = must be a RN and have 5 GCSE, including Maths and English + 3 A Levels
This would be a 1 – 2 year University based course, enabling them to be almost a junior Doctor.
Why are we recruiting Nurses from abroad when an easy to enter and salaried method of training nurses would mean we could train our own.
Shift Patterns In Nursing
The majority of Hospitals work on a 12 hour shift pattern, 8am till 8pm. This results in a fulltime nurse only works 3 days a week.
This results in the Ward Sisters and all Staff nurses being only present on the ward 3 days a week. How can you run a ward effectively, when you’re only there less than half a working week?
These long shift patterns; have caused increased sickness. 12 hours on a physically and mentally challenging ward is exhausting. Often after these shifts, the thought of repeating the same 12 hours the next day is shattering; leading to a rise in sick leave.
Research needs to be done into these shift patterns; their effect on sickness levels, efficiency and patient continuity of care.
Hospitals Only Run 5 Days Out Of 7
Why is it that if you’re an inpatient in a Hospital; that everything stops on the weekend. The waiting lists are endless, we have bed shortages yet apart from A&E, the NHS just drifts along over the weekend as Doctors and other staff only work Monday – Friday.
Departments for investigations, Scans etc are closed over the weekend.
This also needs to be investigated.
Ward Sisters are now rarely seen in the wards, usually they only work their 3 days shifts They attend endless meetings about bed allocation etc. It used to be 1 Sisters meeting a week. These shift patterns and endless meetings need to be looked into.
The creation of Bed Manager jobs for a band 6 RN, has got out of control. These jobs did not exist before; the Nursing Officer / Matron sorted out the bed situation.
Separate Hands On Nurses From Managers
Basic nurses and carers in the NHS, are the hands on, caring people we meet ; if ever we are admitted to hospital. They deserve higher wages and respect for the hard work they do.
Pay grades 1 – 6 and 7 ( Nurse Practioners only ) deserve a pay rise and should be on a separate pay scale from Nurse managers (grades 7 and above).
Grade 7 and above Nurses , have walked away from practical nursing and become administrators. Their pay scale and pay rises and budgets should be separated from practical Nurses.
These managers have power over Nursing Budgets. They frequently create highly paid Nurse Administration jobs Bands 7. 8abcd& 9 ( £46,000 – £105,385 salaries), creating layers and layers of Nurse Managers. Protect the ‘Hands on’ Nursing Budget by separating it from the Nurse Management budget, so these ‘Hands on’ Nurses cannot be replaced by Managers.
I have seen this occurring myself, with no proper justification, managers creating ‘jobs for the boys!’ – so to speak. Whilst around the corner; the always at capacity and very demanding Care of the Elderly ward struggled on – understaffed, patients dying and suffering, due to shortage of hands on Nurses
If the ‘hands on’ Nursing [ Bands 1 – 6] financial budgets were separated from the Administration Budget, they couldn’t create these extra Band 7, 8abcd & 9 – ‘lanyard swinging’ posts ! – thereby cutting down on Nurse Administration roles and securing a safe level of ‘hands on’ Nurses and carers.
Thank you for reading this, sorry, I am very passionate about the basic care of patients and so very respectful of the work of our fantastic basic paid Nurses and Carers, who deserve so much more.
Gillian Parry RN RM DN