In the UK there are 20,000 nursing students a year largely funded by the government (Campbell 2013 ). Many of those leave ( Kendall -Raynor 2012 ) or fail to work as nurses afterwards, or cannot get jobs in the UK , or work abroad (figs unknown). Furthermore, many nursing students may work within the private sector. Are they prepared for doing so? This article will highlight some of the key differences between the statutory and the private sector, with a recommendation to address the private sector to a greater extent within nurse education.
Care within the private sector which includes hospitals, clinics, care homes and prisons for example, is increasing. This is likely to continue with the commencement of Foundation Trusts (Dimon 2013 wideshut). Then why do care homes need to recruit nurses from overseas, because UK nurses will not apply for the posts? Overseas nurses do not necessarily receive the equivalent training to UK nurses. Consider , how can they be aware of different regulations such as the Human Rights Act 1988 and the Deprivation of Liberty safeguards? There are also cultural differences to address (Dimon 2013 ). Yet the NMC declare that any adaptation training given, is based on the assessment of the individuals needs. Although a test is proposed ( NMC 2013 ).
The private sector does differ largely from the NHS sector. Let’s also remember the voluntary sector here . Awareness of these differences can only be gained from vast experience and research within these areas. Even different private establishments differ so it is not enough to have worked in only one of them.
Here are some of the differences;
Mrs Smith walks with a frame and is not confused. She wants to go out alone. What do you do?
Mr Downs wants to die alone outside. What do you do?
It is midnight, you need to consider the Deprivation of Liberty safeguards and place bedsides on Mrs Smith’s bed. What do you do?
Three residents have diarrhoea and 2 members of staff. What do you do? Are you aware of regulations requiring you to contact environmental health immediately and how to do this out of hours?
The care assistants often have a huge turnover and a very different approach to health care assistants within a hospital. Motivating staff and dealing with stress are essential skills within this sector.
You may find huge restrictions on resources and staff levels. There may well be within hospitals. Yet within a care home, you are alone on your shift. What do you do in these situations?
The complaints procedure for residents and staff is totally different to within hospitals (Dimon 2014), it very much depends what the issue is and how the care of the resident is funded. Are you aware of Contracts Compliance for example ?
Policies are totally different. Yes CQC standards apply and the same regulations but there are additional guidelines to the Health and Safety Regulations for example .
When do hospital nurses have to think about PAT testing or lift inspections? Recall the manager of a care home is actually registered- unlike a ward manager. This means the manger is responsible, even if he or she has a regional manager above him or her.
Medicine management differs- you cannot routinely keep oxygen in care homes (unless prescribed for a specific resident) unless you pay for it and you need specific homely remedy policies signed by each GP for each patient and agreed by the care home inspector. .
Even salaries differ. Agenda For Change pay scales which apply to the majority of staff within the NHS, do not apply to the private sector- nor are they required to apply to Foundation Trusts. Indeed, many staff within the private sector are paid less than within the NHS and may also have less terms and conditions (Dimon 2013 in print). Yes there are Unions but not all staff are members of Unions- which in some cases are ineffective (Francis Report 2013). Not many staff are however, aware that they can obtain free employment advice from ACAS,
The list may go on. There are further differences within private hospitals.
When I hear lecturers and nurses announce the private sector is the same as the NHS, I begin to realise why problems occur. We are not preparing the student nurses adequately. The NMC do state that the private sector must be addressed within the standards for education. Yet this needs to be more specific. When lecturing students , all topics need to be applied to the private sector as well as NHS. For example, medication or nutrition. It is so easy to inform students to refer to the dietician but they need to know how to do this in the private sector when there is a shortage of such services (BBCnews 2012). There are also prisons to consider, which are totally different again.
Many students work in care homes as a last resort. They need to regard it as the challenge and specialist area that it is. This will only occur if Universities realise the potential of employing lecturers who are specialist in this field. Students fear that working in care homes will bar them from ever returning to hospitals. Hospital staff need to recognise the high level of skills involved within care homes. No longer is it appropriate to continue to employ solely clinical hospital nurses as lecturers. Students need a case study approach discussing actual situations within care homes and how to deal with them. Providing students with theory is nowhere near enough. Students can read theory for themselves. The skill is how to apply it. You only know how to apply theory if you are experienced within that field. Such case studies need to address good as well as bad practice. We ought not to keep rose coloured spectacles on ourselves and our students. They need preparing so they need the truth. 50% of nurse education is required by the NMC to be placements. Usually this involves care homes for students, depending where Universities can obtain placements- and on the students’ interests in some cases. We need to prepare students for this.
Universities- you can accept the challenge and prepare students for the private sector or you can await the demise of the role of the nurse certainly within the care home sector. Already we have debates considering the feasibility of employing nurses in nursing homes . Or is the issue- a full three year degree is inappropriate when nurses know exactly which area to work in? Already many overseas courses include for example, 6 months in theatre to be a theatre nurse. Could we consider, six months to be a nursing home nurse or a nurse within another specific field ? Let’s look at reality.
There are differences between working within the private sector and the statutory sector.
Nursing students need preparing to a greater degree to work within the private sector.
Lecturers need to be more aware of these differences.
Lecturers who are experienced within the private sector need to be employed.
Working in care homes, ought not to be regarded as a last resort
BBC news (2012)
Care Home Residents Lack NHS Services- CQC Survey
Campbell D (2013)
Nurses Must Spend a Year on Basic Care
The Guardian 26.3
Dimon C (2003)
The Commodity of Care
Francis R (2013)
Public Inquiry Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry
The Stationary Office
Kendall-Raynor P (2011)
Nationwide Initiative To Reduce Student Dropout Rates Revealed
Nursing Standard p14 Sept 21 v20n3
Adaptation and Aptitude Test (6.2)