While wondering what I would write about this time I thought I would have a quick look at previous contributions to My Week. I was struck by Donna Davenport's recent comments on communication skills, as it is a topic I am very passionate about in my work. It sometimes feels to me that if we concentrate too much on academic work in nursing we might lose sight of the essential ingredients of good nursing and what makes someone a good nurse.
I was delivering my lecture on the nursing identity (again) last week and it struck me how far I have come since I started nearly 30 years ago. Also during a session on skills for assessment with the first years I realised how much we can take it for granted that a willingness to enter the nursing profession equals an inherent ability to communicate and understand someone else's situation. We need to address and discuss frankly the importance of effective communication with our students and the consequences for people psychologically, emotionally and physically, if we don't provide people with information and check out how they are experiencing the care we are delivering.
Another session I was teaching last week was around patient safety and the issues that arise when trying to design services to avoid harm to our patients, families and carers. Communication is the cornerstone to the issues and by year three of their course most healthcare professionals have grasped. However, the allure of technology and higher levels skills often result in students dismissing communication skills as an optional extra.
This brings me on to where these skills should be taught (or can they?). It is a bit like the debate I keep reading about whether creative writing can be taught. The answer to both questions is yes and no. Clearly the student needs to be actively engaged with the topic and some inherent ability ought to be being developed and nurtured. However, one of the challenges nursing students face is their experiences out in placement. We can deliver lectures on good communication skills, assessment skills, theory about nursing and what research has taught us about people's experience of nursing, BUT, and this is a big BUT, if their experience in practice does not reflect this, then they are going to feel confused and stressed.
Research has shown that nursing students often find that their ideals for practice are not met and their expectations not matched by their experience (this also continues when they qualify).(1) They feel pressurised to conform to the norms around them and the power of socialisation overrides any other in their bid to fit in and survive their placements.(2)
This may paint a very negative picture, but we must remember that these students are the nurses of the future and we need to ensure that they stay in the profession and become excellent and committed practitioners. I believe that this can be done, but not without a lot of hard work and support to those facilitating learning out in practice. Having the double responsibility of doing your job well and having a student beside you is a difficult balancing act.
As healthcare delivery changes and the pressure for a wider range of placements increases then more of you in primary care will be asked to take students. This will add to your anxieties unless you are adequately prepared. Make sure you attend a course on mentoring in practice and develop good working relationships with the key people around you responsible for students learning.
If any of you have recent experiences to share then please do. I intend to write an articles (or articles) about facilitating learning in practice and any issues you would like highlighted will help to make the article relevant to you out in primary care.
1. Maben J, Latter S, Macleod Clark J. The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal study. Nursing Inquiry 2007;14:99-113
2. Mooney M. Professional socialisation: the key to survival as a newly qualified nurse. International Journal of Nursing Practice 2007;13:75-80.
RCN (2007) Guidance for mentors of nursing students and midwives. London RCN
RCN (2007) Helping students get the best from their practice placements. London, RCN
Both available from www.rcn.org.uk/publications
Your comments: (Terms and conditions apply)
"As a student nurse I can agree with the pressure to conform whilst on placement. Despite the fact that we have been taught the new ways to do certain tasks, for example, moving and handling, it is very easy to forget the theory taught at university and simply do what the other nurses on the ward are doing, even if it could be potentially dangerous to yourself or the patient. It is far harder than I anticipated saying 'Could I practise the way I've been taught at university?' Lecturers say to do this but I wonder how many of them would have done this if the role was reversed? However, I will say that I felt I got far more valuable experience on placement than I did sitting in a lecture being taught about communication. You can read about theory after theory on communicating with patients but the only way to really develop your communication skills
is by actually communicating." - Adele White, Northumbria
"Even when I was student nurse, 20 years ago, there was a huge gulf between what we were taught in the classroom and 'real life' on the wards and in the community. Tutors and lecturers were seen as living in ivory towers, out of touch with the practicalities of putting their nice neat theories into action. I imagine that things are far worse now, what with staff shortages, bank staff (foreign & British), financial cut-backs and qualified nurses taking on traditional medical roles and delegating the 'basic' nursing care to unqualified staff. May I respectfully suggest that as well as theoretical research, practical, hands-on, working 'out there' in practice would prove very enlightening to today's nursing teachers and lecturers if they aren't already involved in such activity?" - C King, Derbyshire
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