A REVOLUTION GONE WRONG Hospitals are warnedmake no hasty nurse-training changes

Press, 28 August 1979, Page 17

A REVOLUTION GONE WRONG Hospitals are warned—make no hasty nurse-training changes

By

TUI THOMAS

Three months’ observation in overseas hospitals has re-affirmed Miss Brenda Brankin’s conviction that any changes in nurse-train-ing methods and administration in New Zealand should be introduced cautiously.

“We must not be carried away by overseas trends because they are the ‘in thing’ until we see that they function satisfactorily,” says Miss Brankin, the chief nursing officer for the North Canterbury Hospital Board, on her return.

Brenda Brankin visited hospitals in England. Scotland, Canada, and the United States under a Health Department study award to look at nursing administration, management, and education. She found that some of the new systems expounded in overseas nursing journals were not always effective in reality, even those which seemed ideal on paper. Many nursing administrators she met regretted having introduced some of the new schemes, such as phasing out charge nurses, and would like to put the clock back. Some have already reinstated charge nurses on thpir staffs. The North American system of nurse-training at university level — hailed as revolutionary when started — is not one Miss Brankin would like to see introduced in New Zealand.

“It is producing nurses who are highly qualified academically but completely lacking in clinical experience when they graduate,” she says. “Efforts are now being made to give them orientation courses in hospital wards, but they have proved costly and time-con-suming.” The university-trained nurses are well informed theorecticaliy but see their professional roles in research or as teachers and are very apprehensive about working in hospitals. In short, they are trained for nursing rather than to nurse in hospitals and are ill-prepared for clinical duties. They are not able (or willing) to do shift work, Miss Brankin says.

Because of the over-em-phasis on the academic side of training, patient care is being carried out in some American hospitals by nurses comparable only to New Zealand’s enrolled (community) nurses. In the United States, academic and service personnel are very wide apart in their thinking about nurses of the future and Miss Brankin believes that with

the recommended policy of training all nurses at the university level gap will widen further.

In Canada, she found the problems similar but believes that the academic and service nurses are coming closer together there in their views on what a nurse should be. Canada is one country of the four she visited that has at least a temporary surplus of nurses, brought about by a doubling' of intakes of trainees before the phasing out of hospital-based programmes.

“Britain has no intention, at the present time, of phasing out its apprenticetype of training for student nurses,” she says. “But it has experimental programmes under review for preparing nurses.” Having observed the difficulties which have followed in the wake of the North American system, Miss Brankin believes that New Zealand’s comprehensive, three-year training course of half theory and half practical work makes a much better balanced programme for

meeting the needs of our society. “And I still see the merit and the logic of maintaining schools of nursing already attached to hospitals, where nurse-trainees are given full student status,” she said. She does not feel, however, that hospitals should have to depend- on student nurses to give patient care. “But, until we can be assured of an adequate supply of registered and enrolled nurses, a chief nursing officer would be irresponsible to phase out the present system of using students in the wards. “This view was very firmly reinforced by my visits ,to hospitals in Canada and the United States, which have been forced to use unskilled personnel to give patient care, supervised by academically-trained nurses who lack service experience themselves.” The shortage of qualified nurses is world-wide (apart from the temporary

situation in Canada) for varying reasons, but not because girls are becoming disenchanted with the idea of nursing as a profession even though much wider career opportunities are now opening up for women, Miss Brankin says. The main cause of the dearth is that qualified nurses today are not willing or able, if they have home responsibilities, to work shifts or week-end duties in hospitals anywhere.

“At Christchurch Hospital we had some 500 applicants for this year’s intakes, but we could accept only about 140,” Miss Brankin says. “We were forced to reduce the number of new student nurses because of the lack of clinical materials and experienced personnel available for the present curriculum.” The assumption that registered nurses out in the community would be readily available to meet the hospital’s needs did not eventuate as expected, she adds.

The shortage in England exists only in some areas as nurses are remaining on hospital staffs since salaries have been increased and improvements made in hospital conditions. Such is the enthusiasm f.or nursing in the Warwick Health Region in England that 2000 girls recently applied for 200 nurse-training vacancies. In the United States an acute shortage of nurses is attributed to the fact that so many of the academically qualified women do not wish to face up to ward work, and leave the profession before gaining clinical experience, to teach, go into research or take up some entirely different career.

On the more positive side of her observations, Miss Brankin was greatly impressed by some of the post-basic clinical courses for nurses in England, planned for the sophisticated specialised nursing that has arisen. She mentions in particular a move by hospital administrators to up-grade the care of geriatric and psychogeriatric patients. “Some very worthwhile programmes are being carried out in Britain to prevent the .onslaught of mental disturbance in the elderly. I would like to see similar programmes in New Zealand,” Miss Brankin said.