10.14.06
Educating people in the NHS
I guess that many people might think that nurses, therapists and others working for an NHS organisation have little ongoing learning to do. They would be wrong. Our basic training teaches us a lot of things, but that learning then needs to continue for as long as they are working for us. First of all they need the statutory and mandatory training which addresses all those health, risk and safety issues that we need to be reminded of periodically. Things like fire training, moving and handling, infection control, record keeping, that kind of thing and then there are the skills that are directly related to peoples jobs. The theory of these can be taught in a class room, but most of the learning goes on within the work place, learning from each other, learning from doing; experiential learning.
I guess this will be where the myth of the 5 day course to teach someone to say deal with minor illnesses comes from. There are such courses available, but in order do embark on such a thing, you already need to have a reasonable level of knowledge and skill and you need to be working in an environment that you can continue to learn. It is the same as something like a leg ulcer course, you might do the academic learning one day a week for 3 months but the learning would continue within the work place as you apply that knowledge into practice with supervision from other nurses who already have that skill.
Then there are other things that need to be learned, skills and competencies to be developed, for example how to be a manager, how to lead others. The NHS is incredibly hierachical, and structured around particular systems and processes. For example as a district nurse you might be in charge of half a dozen or more other people, nurses and health care assistants. You will need to take part in interviewing for new positions, you will need to carry out regular meetings with staff and their appraisals. You will be expected to supervise their work, and don’t forget that you are not working in a ward so cannot see their practice without putting yourself out and doing a joint visit with them or by talking to them about what they have been doing. People don’t necessarily instinctively know how to do these things any more than they know how to take out some ones sutures the first time they do that.
Everyone also needs the time to discuss issues that have happened in their practice, to reflect and look at how they would do them in the future. Many people do this any way, I know that sitting in a traffic jam on the way home (an only too common occurrence) is a good time for me to reflect. But sometimes, people need a place where they can be encouraged to do just that, to compare their way of doing things with that of others, to learn from others.
In primary care we are being expected to change the way we work big time. We have had a vacancy freeze for a year due to the financial state we are in. OK so there are complex reasons why the trust is in this mess, but we have to play our part in managing it. It has made us ask whether we in fact needed all of the staff working in the way they were or if in fact we could work smarter, more efficiently? I have recently asked one of my team to do different things to take on a new role, and have had to ask her colleague to take on her work. It turns out that she has been able to absorb the work by working more efficiently, and she has admitted that perhaps this has been a good thing. This is not to say I am supporting the wholesale rationalisation of staffing in the NHS, but what I am saying is that we need to look at what we are doing, make sure we are doing it the best way for both ourselves and for our patients and that we need to continue to learn while we do it.
turnthetables said,
October 14, 2006 at 6:23 pm
Have district nurses always done those jobs?
Julie said,
October 14, 2006 at 8:54 pm
Yes, I was one and the job hasn’t changed significantly. As far as I can see more and more of health care will take place out of the acute hospital and in order to be able to do that, they will need to develop more skills and competencies.
Sorry about mis reading your comment earlier.
turnthetables said,
October 15, 2006 at 5:56 pm
No problem
Kim McAllister said,
October 18, 2006 at 4:53 pm
I would like to see more community health available in the US; our ERs are so impacted with things that could be handled differently.
Julie, would you be able to do a post about what exactly a Nurse Practitioner does in the NHS, the educational requirements? I often get confused in UK blogs because the title and function seem much different than they are here.
Julie said,
October 18, 2006 at 6:32 pm
Yes, I will do some research and post something, probably at the weekend.
I think that it was when I sat in our own A&E (ER) dept with my suspected fractured ankle (luckily only sprained) that I realised just how many people attend these places when they could be better dealt with elsewhere - even a building near to the A&E. Not only that, but there are people bouncing in and out of hospital who if better managed could be kept at home for longer.
Thanks Kim will give the NP thing some thought.
Change of Shift: Volume One, Number Nine // Emergiblog said,
October 19, 2006 at 1:27 am
[...] Our “other” Julie this week is our Julie from Life in the NHS who discusses the reasoning and some of the processes involved in Educating People In the NHS. Yes, there are issues, but until they are resolved there are patients to care for and work to do! Nice new look to the blog, too! Great job! [...]