Poo Free

No more poo:

Student nurses are rejecting essential elements of bedside care because they feel it is not a worthwhile learning experience, research published by Nursing Times has found.

The research found widespread conflict between student nurses and qualified staff over the tasks students should do on placement.

Tasks normally carried out by HCAs, such as making tea, washing patients and cleaning, were not seen as valuable learning opportunities for student nurses keen to gain experience with more technical roles like administering drugs.

As a result, many senior nurses feel that students are qualifying with significant gaps in their basic skills. One interview participant said: “I sometimes feel in despair that by the time students have qualified, they still haven’t gained some of the practicalities and common sense – things like time management, basic assessment skills – that we would have been doing on our first round.”

One student was reported to have told a staff nurse: “I keep being asked to do things which won’t help me learn – clear up poo, mop up blood, give patients tea and toast. I realised that I needed to more focused to learn, and I don’t do those sorts of things now. [The full study is here.]

I’m actually with the students on this. There are few things going on here. One is the perpetual nostalgia that nurses have for the good old days, when men were men and nurses were nurses, and we were trained by battle-axe old-school-types who flogged us students daily with used foley catheters before we walked home uphill in a blinding snowstorm to work all night on 45-page-long care plans. And that somehow produced wonderful, thoroughly trained nurses, unlike today’s crop of know-nothings. So say a lot of you, including many of my own colleagues.

Oh honey. I have a newsflash for you. We weren’t that good, or well trained, and we fumbled around just like today’s new grads. I know. I was one of you.

And then there is a notion that since we went through all that crap that Hilda Harridan RN made us do, the current generation needs to “pay its dues” too. Though it escapes me how making nursing student go through their paces like we did will make them better nurses.

From the times I walked the floor as a clinical educator, I spent a great of time defending my students from the sort of crazy, useless busywork that the ward staff seemed determined to make them do. Staff believed they were free, exploitable labour. The manager of one of units told me, “They will be great help for the nurses.” She grew shocked and angry when I suggested they weren’t peons or gophers, and accused me of not teaching the students proper “teamwork”. This in her eyes seemed to mean making the students do the pissy things no one else wanted to do. My students, in fact, were not there to fluff pillows, cart patients to x-ray, boil the kettle, organize the bedsides, take specimens to the lab or any of the innumerable trivial tasks that can consume your average med-surg floor.

They were there to learn.

And I still don’t see how making a cuppa for the dear in 6 or running that routine R&M downstairs will help nursing students in time management or pharmacology — which seems to be the prevailing attitude in clinical areas. Good nursing skills come from hours of doing patient assessments, developing advocacy skills and learning to think critically.

And frankly, I would much rather have a nurse at the bedside with amazing critical thinking and communication skills than one who can effectively wipe the poo from my bum.

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  1. #1 by maha on Wednesday 11 November 2009 - 1252

    How I wish I had this study when I was a nursing student. I always felt like I was a nuisance in the wards. I felt completely belittled when there was a great opportunity to learn a skill one of the nurses would redirect me to a patient who needed a thorough hose down. Helping patients keep clean is important but when one is trying to learn how to manage several patients at a time, I would much rather be exposed to the critical thinking and assessment process. Now that I orient new nurses to the unit, I try to get them to do all the initial and ongoing assessments, practicing blood work, IV placement, ECGs, blah blah blah instead of getting them to change diapers all day long. And as far as paying dues goes – everyone pays them, just not in the same way.

  2. #2 by wilomis on Wednesday 11 November 2009 - 1806

    I am a student nurse and here is my two cents. Give the bed bath (and I mean full, no half assing it), brush their dentures (put a towel in the sink to avoid shattering them), changes their incontinent briefs (roll this way now that way), get them dressed (is color coordination that hard?), feed them powder stirred honey thick water, and wipe their ass for crying out loud. But also administer the meds and insert the catheters. But all the while assess their condition and needs. It’s all relative. I don’t like giving bed baths and wiping nana’s rear end, but guess what I might get to learn what C Diff actually smells like and learn something along the way. I say if you feel you are only doing menial tasks, ask for more responsibility. Don’t go and hide in the lounge. Find something fun that’s going on like a tube feeding or something in wound care.

  3. #3 by wilomis on Wednesday 11 November 2009 - 1806

    PS I love being a student nurse and will one day love being a nurse!

  4. #4 by Kalanna on Wednesday 11 November 2009 - 1952

    while i agree nursing students shouldn’t be used as temporary janitorial staff, the menial tasks of wiping bums etc has for me – currently working as a PSW – done leaps and bounds for learning one on one patient skills… communication, behaviours, aggressiveness, building trust… not to mention turn this way and that is a really good way to start a head to toe assessment. after a round of bum changes, i usually have a list of concerns needing to be addressed.

  5. #5 by torontoemerg on Thursday 12 November 2009 - 1315

    Thanks guys for the responses. Don’t get me wrong — I’m not saying that students don’t need to do these things. Clearly they do, in the context of ongoing assessment and good nursing practice. There is nothing like a bed bath to really evaluate skin condition, for example. But really, how many bed baths do students need to do to become proficient?

    (I have to add, though, that after many years of Emerg nursing, I still can’t properly place an adult brief with it riding to high or too low.)

  6. #6 by kalanna on Thursday 12 November 2009 - 1558

    I’ll teach ya. It’s mostly what I do all shift. hehe

    thought about this all night long, wondering if i was simply trying to justify my own job. i think i was inadvertently reacting to an interview i recently heard on a podcast where a nursing student felt that she should NEVER be required to do these little tasks. i think she shouldn’t be in nursing. period.

    this was the beginning of nursing and it’s like our foundation. we need to know it but there is so much more to learn. to waste students time doing only baths would be just as bad as never doing baths. thanks for the food for thought!

  7. #7 by paedsnurse on Friday 13 November 2009 - 0046

    Oh I totally agree with this. I can remember when I was a student, I had so many placements where all the nurses treated the students like free labour. It was always someone who needed bathing, feeding, dressing, going for a test. And then when there’s an opportunity to do something (such as an IV medication instead of oral), suddenly another bum needs to be wiped clean with poo!

    I have to say that some nurses are really good about students and really take the time to sit down and try to teach. I had one nurse teach me about ECGs and some cardiac obstructions that are commonly seen on the unit. That was educational and I loved her for it. Some nurses were complete and total b*tches and would order us to do menial things all the time. Heck, one nurse even tried to blame her mistakes on me, claiming that it was the student who was causing a disruptance on the unit to the manager (that’s a whole other story but I have not forgotten it or her for that matter).

    All in all, menial tasks are also a part of skills that we all learn. Some nurses just need to realize that there is so much more than that. Would you rather a student who’s an expert in bed baths and diaper changes or a complete idiot when it comes to critical care and assessment? Argh, this has really riled me up!

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