The government’s plan to require potential student nurses to work as healthcare assistants for “up to a year” prior to embarking on undergraduate education will not reduce the likelihood of a repeat of the Mid Staffordshire scandal (Nurses to undertake hands-on care in NHS shakeup, 26 March). It appears this scheme is to act as a screening device to exclude those who do not demonstrate attributes of compassion from places on courses that lead to registration as a nurse. The more likely outcomes are: (1) the potential loss of high-calibre applicants who will no longer have the support of mentors and tutors during their first experiences of direct patient care; (2) an influx of inexperienced staff providing direct and less-regulated care to vulnerable patients; (3) early formation of work habits without peer and educational support to challenge poor practice; and (4) a decrease in the nurse-to-healthcare-assistant ratio, leading to a greater distance between the direct care of patients and the work of registered nurses.

What evidence there is suggests that higher care standards are associated with a better-educated nursing workforce. Nurses are a key and sizable proportion of the healthcare workforce, but their visibility makes them easy scapegoats for what is a systemic failing rather than one of any particular professional group. This is a populist and unworkable response to a complex problem.
Antony Arthur
Professor in nursing science, University of East Anglia

• Basic nursing care is not simply about hygiene; it provides the nurse with the opportunity to observe the patient thoroughly. The state of the skin, mouth, eyes and pressure areas indicate the condition of that patient, adding to the other observations that the nurse performs. The intimacy that develops during the time spent washing, combing hair etc is also part of understanding and assessing patients’ mood, allowing time for them to confide fears and worries to the carer. Likewise, while feeding, patients’ ability to swallow can be observed, appetite and hydration monitored and documented.

The “probationers” will expand the numbers of carers performing these tasks and so allow more time for them. The vocation of an aspiring nurse who does not value this aspect of nursing (or finds it demeaning) will be tested and attrition rates reduced at an earlier, and less expensive, stage. As graduate nurses with this background in basic nursing care they will be the supervisors and monitors of standards of nursing care on their wards. It is a shame that this proposal comes from ministers and not from the NMC or the RCN, the public voices of the profession.
Gránia Fine
Bridford, Devon

• There are two aspects of current nursing conditions which Jeremy Hunt‘s pronouncements on training reform fail to address. The first is the fact that a large number of our hospital nurses have not been trained in this country. As it is unlikely that Hunt will reverse the Thatcher government’s closure of many of our hospital training schools, this situation is likely to remain unchanged, and Hunt’s proposals will remain irrelevant and inapplicable.

The second is that, again thanks to Thatcher, the control of the patient environment – a crucial element in the nursing process – has been withdrawn from nursing staff. In-house hospital cleaners, who rightly considered themselves an arm of patient care, were abolished. Their place was taken by contracted-out services, responsible to non-clinical managers. A nurse who could see that a ward, or its toilets, needed cleaning could do nothing about it. If you know you can’t remedy an abuse or a deficiency, you soon cease to notice it. The rot set in then, and has been spreading ever since.
Anne Summers
Honorary research fellow in history, Birkbeck, University of London

• Your article says “nurses will have to spend up to a year helping patients to eat, wash and get dressed”; readers might think that this is something new and praiseworthy. Not so. I started my RGN training in 1987 and this was an integral part of it. The difference was that we were a part of the staff numbers on the ward, we were paid and we were learning as we progressed in our training. Ward sisters were a part of the same team of staff members and were there to guide and teach as well as manage the ward. I always thought that if I wanted to have a university degree, I would have chosen a different area. Nursing is a hands-on job, underpinned by theory.

Helena Johnson

• In the 1970s I knew conscientious girls in their teens who were never going to get a superb degree but who became superb nurses through SEN (I never knew any male nurses) and who converted in time through dedication and training to SRN and on to the highest levels of nursing work, such as intensive care. The current university-only route is overlong, expensive and inefficient and denies some of the best potential nurses a place in this most vital profession, drawing instead only on graduates, some of whom clearly have the wrong training and mindset.

Mark Lewinski
Swaffham Prior, Cambridgeshire

• So, as the government announces that nurses will have to spend a year cleaning and bottom-wiping, apparently so they can learn compassion, they also inform us of new measures that will have a devastating effect on thousands of disabled people (Report, 27 March). Maybe ministers should be required to spend a year living as the poorest and most disadvantaged do before they sit in government. They might then begin to show compassion themselves, rather than merely demand it from overworked nurses.

Ned Reiter
Glastonbury, Somerset

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