Should nurse training go right back to basics? Low pay is not the only issue that worries nurses .

JUNE SAMPSON speaks to one nurse who says nurse training has lost its way.

Poor recruitment and low pay are NOT root causes of the current nursing crisis. There are more trainee nurses than ever before, and colleges are hard-pressed to give adequate tuition.

And though pay should be higher, it's not as dire as we've been led to believe.

This is the view of Anna, a 27-year-old staff nurse who lives in Kingston and commutes to one of London's major hospitals. Her comments are worth listening to because she's uniquely placed to know what she's talking about.

Nursing is in her blood. Most of her female relations, including her mother, made it their career, and at 19 she herself began auxiliary work in a local hospital during her university holidays.

In 1994 she began training as a nurse at the Nightingale School, formerly attached to London's St Thomas' Hospital. It was founded by Florence Nightingale in 1850 and renowned as the best of its kind in the world.

Anna entered in a transitional period.

Project 2000 had been launched in 1988 to revolutionise the nursing profession, but had yet to complete its clean sweep. So she got first-hand experience both of traditional training methods and their new replacements.

She found the contrasts appalling. Indeed, she sees Project 2000 as the main cause of today's nursing crisis.

Anne began training when the now-defunct Registered General Nurse (RGN) scheme was still operating in many hospitals.

"It was a three-year course, with most of the time spent learning on the wards," said Anna.

"Students also did classwork for blocks of eight weeks in the nursing schools attached to most big hospitals."

Now, said Anna, all those schools have gone and nurse training has been transferred to universities. The Nightingale School - renamed the Nightingale Institute - took its last intake in 1996. Now it's just the Nightingale Department at Kings College.

"They've kept the name, but not the tenets that went with it," said Anna.

She explained there are now two routes into nursing.

"One is Project 2000. You enter that with five GCSEs or, if you have no exam qualifications, sit a basic test. In practice, most people have A levels, and where I trained most had degrees.

There's hot competition to get into the better university colleges, so higher qualifications are an advantage.

"The second option is a full nursing degree course. You need A levels, and there's no bursary. This is for people with future promotion in mind. Many find they can't move on without a degree."

So what's wrong with the new system? Isn't it right to give nursing higher academic credentials?

Anna says no.

"The great drawback is that nursing has moved out of hospitals and into universities," she said. "When I started, training was still attached to the hospital, and I learned in the traditional way.

Only in my third year did I join the modern route. I was horrified to find that students don't even set foot in a ward until the end of their first year.

Then they get six-week placements in wards for the next 12 months, followed by longer spells later.

They don't do any night duties until their last year - and then only eight sessions. This isn't enough. For nurses, nights are a fact of life requiring different skills, so it's best to get used to it as early as possible."

She feels for today's students.

"They come in very keen to care for people, and it's disillusioning to be stuck in college, " she said. "For many it's a horrible shock after nine months to have their first experience of wards, and discover they can't cope with it.

That's the reason for many drop-outs. There were 200 people on my course when we started.

Eighteen months later, there were only 100."

As she points out, it's a bitter disappointment to spend a year studying for a profession which, when you eventually get to see the practical realities, is not at all what you thought. It's also a huge waste of funds, given that it costs £35,000 to train a nurse.

"ou need to be out there on the wards from the beginning, as was the case before Project 2000," she said. "Colleges aren't interested in teaching nursing skills. They teach things like sociology and nursing research . Basically it's how to deal with paperwork, not patients.

She was shocked to find that workshops on how to take blood pressure relied on pieces of paper - no equipment, no patients, just a list of instructions.

"There's so much theory, and so few of the practical skills taught in the past."

Thus even those who complete the course may not stay in the profession.

"People emerge as qualified staff nurses without the confidence to cope with life on the wards," she said. "Project 2000 has taught them an administrative role they're not going to do for years - if at all. The course is good at teaching you theories, but not what do when the emergency buzzer goes, and a patient stops breathing. After three years, a Project 2000 student has about as much practical knowledge as RGN students used to at the end of their first year."

Can't senior nurses do more to train newcomers?

"Students find senior staff aren't interested in all their theory. They want them to give a bed-bath or bedpan, but they don't know how to do it. Often they don't even know how to make a bed. Project 2000 tells students they're adults who don't need to be bossed about - reflective practice is the buzz-phrase. College tutors don't guide. They tell people to go on the wards and decide what they need to learn."

Another negative aspect is that nursing students have a very different agenda from their other university peers.

"They can't do what their friends are doing, like clubbing and socialising to the early hours, if they have an early shift. So some get fed up and drop out."

There were no such odious comparisons when student nurses learnt in training schools that were actually part of hospitals, and developed valuable camaraderie on equal terms. .

"They lived in good, subsidised accommodation and had all the benefits of staff status," said Anna. "They were paid salaries by the hospital throughout their training, and had all the benefits of staff status, such as pension rights and sick pay. It gave them more self-respect, and the drop-out rate was low."

She disagrees with the impression that the crisis is all about pay.

"I agree we deserve more. But we're not THAT poorly paid, and there are many more pressing reasons for discontent.

"Morale on the wards is low because we're fed up with lack of resources and staff. Before Project 2000 days there were competent students to give back-up. We're also fed up with insensitive management. I'm shocked by the lack of compassion. The public has an image of nurses as angels, but I've met some of the nastiest people of my life in nursing. I was ashamed of my profession when I read of the man who died on a hospital ward in his own excreta and vomit while nurses refused his pleas to be washed and changed. I see people with this lack of compassion. I know nurses who leave beds un-made, patients unwashed, and ignore bedpan calls because they consider it beneath them.

Anna says abolishing the traditional uniform has diminished nurses' pride in their profession, and the public's attitude towards them.

"Lack of uniform is demoralising. And if patients can't distinguish between a nurse and a fast-food worker, it doesn't help. Another aspect that's never mentioned is poor hygiene. When you put nurses into everyday clothes, like trousers, leggings and tee-shirts, they often don't bother to change when they go home. If they've been among sick people all day, those clothes pose a real threat of infection to fellow travellers."

She added that a survey conducted at her hospital showed that patients overwhelmingly preferred the traditional uniform because it instilled confidence.

She's appalled by the declining standards on wards.

"Many older nurses are leaving, or retiring, and skills are being lost. And wards are so dirty. In the past, sisters came round and read the riot act if patients weren't washed and comfortable, the beds neat and fresh and the room clean.

"Now people say it isn't a nurse's job to do these things. But it IS. Patient contact is what it's all about.

"I love nursing, and I'll never leave it. But I wouldn't recommend it to anyone who wasn't really determined. Vocation is a dirty word these days, but that's what nursing is."

The facts on nurses' pay

The media indiscriminately quotes a newly-qualified nurse's starting pay as £12,000.

In fact it's around £13,000 minimum in the provinces, and considerably more in the London area, where special supplements and weightings apply.

At Kingston Hospital, for example, a newly-qualified nurse (Grade D) starts at £15,831 while Grade H (the level to which most nurses aspire) can earn up to £26,932.

And all grades in all hospitals get guaranteed annual increments.

As Anna says: "It isn't brilliant, but it's not bad!"

Converted for the new archive on 30 June 2000.Some images and formatting may have been lost in the conversion.