Friday, September 14, 2007

Train Nurses in Hospitals? You Must Be Joking!

John Howard and Tony Abbott have come up with an amazing idea... perhaps we should start training nurses in hospitals?

The Australian: Nursing to lead PM's fightback
Dennis Shanahan and Patricia Karvelas | September 14, 2007

... The new nursing schools will be modelled on the Government's 24 Australian Vocational Training Colleges, built by the commonwealth but run by community groups working with employers. The trainee nurses will provide immediate relief to hospitals suffering staff shortages.

The courses will run for three years and students will emerge with a nationally recognised TAFE qualification - equivalent to university-based study.

While they study, the commonwealth will subsidise their wages and also pay bonuses in the middle of their courses and at the end of their studies, to encourage their completion.

Doctors, hospital administrators and private hospital employers will have input into the training programs to ensure the nurses emerge with skills sought by their industry.

According to a 2004 Australian Health Workforce Advisory Committee report, Australia will need up to 13,500 new registered nurses each year to meet the demand for nursing services over the next 10 years. In 2004 only 5631 nurses completed their training. Despite the shortfall, 2408 eligible applicants were turned away from university nursing courses last year because there were not enough places.

The Government's move is likely to be welcomed by the medical community because university training is often criticised as producing book-trained nurses with inadequate practical experience. The Government has already raised the plans with some hospitals and its announcement will come as the Australian Nursing Federation launches phase two of a four-week TV advertising campaign outlining the negative impact of the Howard Government's industrial relations laws on nurses working in aged care. ...

Hospital doctors and nurses have been saying this for years. The lack of clinical experience and focus in University-based nurse training has led to a major shift in the focus of nursing graduates. Actually looking after a patient's physical needs, helping them get out of bed or go to the toilet, changing dressings, washing and showering, administering medication, physically checking for pressure sores - these have become non-core duties which are beneath that of nursing staff.

Nurses have now become managers, psychosocial carers, patient advocates and protocol pushers. I find that often the job of nursing has been delegated to Ward Assistants, and Orderlies. In fact, a whole new profession has sprung up called Patient Care Assistants or Patient Services Assistants. I think that perhaps we should give all the PCAs / PSAs badges that say "I am really your nurse today".

I am not alone. Kim from Emergiblog and the vast majority of hands-on hospital-trained nurses would wholeheartedly agree that we need a return to fundamental nursing. Moving nursing training out of the wards and into the Universities has been a disaster for patient care. It has produced a generation of "nurses" who do not want to nurse patients. They don't want to train to become doctors, so they have created a new job - the "Nurse Practitioner".

Perhaps the most revealing part of the current state-of-play is that the most vocal opponent to a return to hospital-based, apprenticeship-style on-the-job training for nurses is the Australian Nursing Federation.

Govt announces hospital training plan for nurses
AM - Friday, 14 September , 2007 08:11:00
Reporter: Peta Donald

PETER CAVE: The Federal Government will be hoping to put the leadership turmoil of the past week behind it today, with an announcement about a return to hospital-based training for nurses.

The Prime Minister will announce the new system in Sydney. It will see an extra 500 nurses a year trained in hospitals, rather than universities, as part of back to basics approach.

From Canberra, Peta Donald reports.

PETA DONALD: If the Federal Government wins the election, nurse training will be done in hospitals again, not just in universities. Twenty-five privately operated nursing schools would be built in hospitals around the country, as part of the $170-million plan.

Five hundred extra nurses would be trained each year, according to the Health Minister Tony Abbott.

TONY ABBOTT: It will be based on hospital training in the old style, because one of the real problems with nurse training in recent years is that too much of it has been the classroom, not enough of it has been in hospitals, and it's important that nurses come out of their training program understanding patients and ready to help from day one.

PETA DONALD: Well, they already have a clinical element to their university training, and in the '90s, it was thought to be the way to go to train nurses in universities.

TONY ABBOTT: Mmm. Yes well, I think that we're a little wiser now than we were then, and I think that the pendulum's swung a bit too far and this will be an additional nursing pathway, which will be entirely hospital-based.

Now, it doesn't mean that they won't be doing their classes, but the classes will be in hospitals, the training will be in hospitals and when they come out of their training, they will be absolutely, thoroughly familiar and acclimatised to work in hospitals.

PETA DONALD: But the Australian Nursing Federation is not impressed. It hasn't been consulted about the plan, and believes it's a big step backwards for the profession.

Lisa Fitzpatrick is the State Secretary of the Federation's Victorian Branch, and she remembers what it was like to be trained in a hospital.

LISA FITZPATRICK: Look, it was a wonderful experience, but it was very difficult trying to study and to work full-time, and you did make up the workforce and it was an apprenticeship scheme. Nursing and the skills required for nursing nowadays has changed since the 1980s when we had hospital-based training.

The acuity of the patients is much greater, the skills and the expertise that is required by nurses, their assessment skills, their understanding, their work with inter, ah, other professions is much greater than back in '80s and I do really think that this is very disappointing that the Prime Minister is attempting to take nursing back into the last century.

PETA DONALD: Well, what is the advantage of university-based training for nurses then?

LISA FITZPATRICK: It is a very good preparation for them to work in any health (inaudible) not just a hospital setting. Nurses aren't just found in hospitals. And it's important because it exposes nurses to research, for example, a research culture so that they can improve the practice of nurses into the future.

To take nurses away from the university sector and go back to the days where doctors and hospital administrators and employers were conducting and had input to their training programs is a huge setback for nursing, and one that won't be accepted by the profession at all.

PETER CAVE: Lisa Fitzpatrick from the Australian Nursing Federation.

That's right, Lisa - the nursing landscape has changed a lot since the 1980s... for the worse! But your agenda finally becomes clear:

To take nurses away from the university sector and go back to the days where doctors and hospital administrators and employers were conducting and had input to their training programs is a huge setback for nursing, and one that won't be accepted by the profession at all.

This is not about quality of patient care - it is about a bunch of power-hungry ANF officials keeping other stakeholders out of improving the quality of nursing. These "nurses" don't want to be part of a team... they just want to run the team. Perhaps when they start wearing the moral, legal and financial responsibility of doing so, they will change their minds.


Milk and Two Sugars said...

I am aquiver with excitement that nurses might be allowed to learn their profession in hospitals once more. Seriously! The health system has lost many excellent nurses to the university-based training system. I only hope this actually comes about.

Anonymous said...

It's *amazing* how much of a furore the idea of bringing hospital training back caused amongst the new grads and uni trained nurses at work! Whilst they were all huffing and puffing about what an "outrage" it was, and how it was just another example of doctors running nasty agendas against nurses, the hospital trained nurses just sat there, quietly smiling to themselves.

The Girl said...

So they get paid while they learn, as well? Fantastic! That would HAVE to attract some people.