Letters extra - April 2012

RMNs: ‘no clinical skills’

Following from Mark Marsh’s letter (Letters and emails, March); it has become increasingly worrying for me as a mental health nursing student that during the course of their degree, regardless of their chosen field, student nurses are not being taught what some people would consider to be some of the most fundamental of nursing skills. Surely every newly qualified nurse should be able to take bloods and insert a cannula. Yes, doing observations correctly is important and yes, completing paperwork is also important. But, in my humble opinion, I won’t consider myself to be a ‘proper’ nurse until I am capable of competently and efficiently taking bloods or inserting a cannula where necessary.
Maybe some students feel differently about this and would not be interested in learning these kinds of skills - especially mental health students - but it should be down to personal choice. We should at least be given the opportunity to opt in to learning these practical skills if we want to.
It shouldn’t matter what letter you have in between the R and the N in your title, phlebotomy and cannulation should be a requisite of the basic skills of any nurse from day one on the ward or in the community. Dare I think that not teaching us such competencies could be down to insurance or litigation concerns?

Simon Nielson
Nursing Student
Liverpool John Moores University

I agree with Mark Marsh (Letters and emails, March). There is a big issue and dilemma in care of the elderly especially in care homes with dementia. I personally point it down to the nurse training system in force at the moment. I am an overseas-trained general nurse and lucky to be a multi-specialist nurse in UK.
I trained in Zimbabwe as a general nurse and worked there for four years in different specialities. I came to England abd worked in adult medicine in NHS.
I did a dementia course and worked in a dementia unit for four years before I joined a hospice for two years and currently work as a specialist TB nurse after completing my MSc in infectious diseases in 2010.
People in dementia units or any mental health institution also have more physical and clinical needs and nurses should be able to give a holistic approach to care, especially in this aspect of care.
I feel worried professionally if an RMN in a dementia unit 'cannot identify a grade-three pressure sore' and needs a an RGN to do that.
I remember an RMN who was doing bank night duties where I used to work not able to change a stoma bag and not alone knowing its use.
Ashamed to ask,he put a new stoma bag on the other side of the abdomen where there was no stoma and handed over to us in the morning saying "stoma bag changed to a clean side overnight", which left everyone shocked. This case may be a simple one over many horrible cases but is a good example of diminished simple clinical skills expected of a nurse or a health care assistant.
With staff shortages affecting both the private sector and NHS, how many nursing homes can afford this luxury in staffing - always having an RGN and an RMN - when they are cutting back?
If this disparity is not addressed as a training system change or a simple curriculum change in the UK, the negative cases reported by the Care Quality Commission will continue to surface and paint a very bad picture to the caring nursing staff in UK.
As RMNs are taking duties/jobs in nursing dementia units where clinical skills are also a high priority as well, an immediate plan to equip them with these skills is a necessity for patient/clients' safety awaiting some possible nurse training changes to reflect current needs.