We hold Dr. Ann Bradshaw in the highest esteem. Her long and distinguished career in university nursing have left their mark, especially on the history of the various changes that have taken place in the last century and the way nursing education is delivered. One of us reviewed her book The Project 2000 Nurse for Journal of Advanced Nursing in 2003, saying that it “deserves to be read widely and will serve as a ‘gold standard’ in the history of nurse education”.
Views were exchanged before on the value of graduate nursing following a previous article she wrote in the Daily Sceptic. Her work has also been referred to in TCW Defending Freedom where criticism of university educated nurses is lapped up by a readership largely ignorant of the evidence in favour of graduate nurses and unwilling to consider it.
Dr. Bradshaw surely cannot be unaware of the evidence on the value of a graduate workforce in nursing and also the fact that nursing students in university spend 50% of their time in practice. We wish to offer a rejoinder to her recent piece on fixing social care in the Daily Sceptic. Here the usual tropes about how nursing has gone to hell in the proverbial hand cart are rolled out, and all because nurses now go to university. In support she cites Left of centre journalist David Goodhart and one article in the Daily Telegraph reporting a case of sepsis allegedly contracted as graduate nurse did not swab an injection site prior to administering an injection.
Dr. Bradshaw is, we presume, aware, as described in a Cochrane Library review of 2018 that “there has been no clinical impact of using or not using alcohol swabs on infections and infection symptoms calling into question the practice of using it prior to all injections”. The link between what the Telegraph – another bastion of graduate nurse criticism – reckons and the purported outcome is a spurious one.
Claims linking poor nursing care with the development of graduate nursing education have a long history. Sadly, for the detractors of university level education for nursing students, this has not been an evidence-based approach. The first Willis Commission of 2012 searched in vain for such evidence.
On the contrary, copious evidence is available for the effectiveness of graduate nursing education. A long line of work at the University of Pennsylvania led by Professor Linda Aiken provided evidence so convincing that the Institute of Medicine in the United States recommended increasing the number of graduate nurses in 2011.
Aiken’s work is not confined to the United States. The RN4CAST project showed in 2014 in a study of 300 hospitals, 26,516 nurses and 422,730 patients in nine European countries that every 10% increase in bachelor’s degree nurses was associated with a decrease in the likelihood of an inpatient dying by 7%.
Work from a different team from Qatar has shown a direct and positive link between graduate nurses and patient outcomes. Whereas the link between nurses and outcomes in Aiken’s work is indirect, in the Qatar study the link was direct and made possible due to the unique electronic records system available in the organisation studied. The study, originally published in Journal of Advanced Nursing, was summarised in the Conversation. In short, it shows that greater exposure to graduate nurses during a patient stay in hospital leads to a greater likelihood of survival.
The effect of the admitting nurse was controlled for in another study published by the same group in International Nursing Review. It mattered not whether the admitting nurse was a graduate or non-graduate, demonstrating that the effect on survival was not the patient pathway, and further demonstrating that it was the subsequent exposure to graduate nurses which positively influenced patient survival.
We do not claim that all is perfect currently with nursing. One of us wrote about our own brush with the NHS earlier this year, after collapsing at home, in TCW Defending Freedom and the Catholic Herald. The ambulance staff were great, the consultant was as caring and competent as any medical professional could be. But the nurses were truly shocking. Much is wrong, but we have never understood and can find no systematic evidence that this is because of nurses being educated in university.
We are not graduate nurses; we are of the old school. But we recall shocking examples of care when we were student nurses: patients tied to chairs with blankets; tea, milk and sugar in the same pot being given to patients with learning disabilities; pressure sores that you could put your fist into and some incidences of terrible patient abuse.
It is so easy to look back on the good old days of nursing through rose tinted spectacles. It is also so easy, as demonstrated above, to make spurious links between every incidence of poor care these days to the fact that all nurses are graduates. The crucial point is whether we are going to make such comparisons based on evidence or prejudice. We conclude with a question to Dr. Bradshaw: in light of the link between graduate nurses and inpatient survival, would she rather, when ill, be admitted to a hospital with high proportion of graduate nurses or a low one?
Dr. Roger Watson is Academic Dean of Nursing at Southwest Medical University, China. He has a PhD in biochemistry. He writes in a personal capacity.
Professor Mark Hayter is Head of Nursing at Manchester Metropolitan University. He writes in a personal capacity.
Dr. Ann Bradshaw responds:
Thank you to Professor Watson and Professor Hayter for responding to my article. I fear they may have missed my point (or I was not clear?) in that I was writing about the crisis in social care and offering a solution.
In response to his defence of degree nursing (which is neuralgic to the nursing establishment), as I argued in Times Higher Education, the North American study he refers to does not define what is included in the nursing ‘degree’ in any country, so is irrelevant to survival rates. ‘Degree’ is just a label. In the U.K. the nursing degree is not a medical degree and is not standardised. Professor Watson has admitted to me in the past his regret that there is a lack of anatomy and physiology taught generally in U.K. university nursing departments. Also, unpaid supernumerary placements are not the same as paid full-time apprenticeship training.
In response to the authors’ last question, as to whether I would like to be nursed by a degree level nurse or not, I will give my story. Several years ago, while working on my allotment, I developed severe abdominal pain. My husband took me to our local teaching hospital emergency department, where I lay on the floor in pain until my turn came. The degree level trained nurse came with her paperwork, looked at my drip (not at me), inserted pain relieving suppositories into my rectum and left. I vomited, no nurse present, my husband found me a vomit bowl. I passed out the contents of my rectum on to the couch I lay on. No nurse came. My husband cleaned me up. The nurse came and reluctantly changed the sheet, as if it was below her station, but left me in the soiled hospital gown and with soiling on my skin. I was wheeled to X-ray in the gown and felt very humiliated. When I told this story to a Royal College of Nursing conference, the degree level trained nursing delegates did not want to hear it.
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I’ve put a large cardboard box out two weeks running, which they’ve refused to take; presumably because there’s a couple of tiny polystyrene balls at the bottom. I’ve now burnt box at back of garden and will no longer play their silly game of separating the trash. I’m surprised it’s taken me so long to stop playing.
Time to haul out another idiot politician to pay for the sins of our tyrannical bureaucrats.
It’s getting a very long list of them isn’t it?
I once put some rubbish in a rubbish bin, too.
I know, it’s a good job Marcus Aurelius knew isn’t my real name!
Good Lord!
Oh, not that either?
You’re a monster.
Now you tell us, Marcus!
As the saying goes “no good deed goes unpunished”. I would always recommend not binning anything with your intact name or address on it in case the garbage stasi want to trace it back to you. An indelible marker pen or shredding should do the trick.
At least, through incidents like these, people are starting to see how unhinged the environment movement has become.
Been doing that for years. Didn’t think I’d be worrying about the bin police though.
That said, this news should also be used to emphasise the risk of ID theft. Not only could someone go through the bins to identify you – this shows that someone actually did.
I went round, under the cover of darkness, covertly dumping bin bags full of stripped wallpaper in the neighbours’ bins in the street, the night before bin collection.
It’s when we first moved in and the previous owners were obviously fans of the ‘multi-layer’ approach to wallpapering over the decades. We ended up with our garden shed crammed full of these bags.
You’re meant to take it to the tip but we didn’t own a car then and we’d have had to pay through the nose for the council to take it away. It took several weeks but I got shot of it all. ‘Off-territory’ dumping for the win! Fortunately my neighbours are all very chill and helpful, one even suggested I do that, but god knows how much I’d have been fined in Brighton.
I am a master. I’ve got rid of TONS of waste like this. The council employee at the tip told me to do it when I looked aghast at the prospect of having to pay AGAIN for the council to take a few old bricks. Thing is, my neighbours don’t know about this… arrangement… so like you say, darkness and stealth are key
We put an old car engine in a wheelie bin once, back in the 1990s the bins were much bigger. Council truck groaned a bit when it compacted it but there it was, gone..
When wheelie bins were first introduced, as long as it fitted in the bin, you could put it in. True, dat. That was the whole point of them. The only time one wasn’t emptied was when I filled it with garden rubble…it was so heavy it was almost impossible to wheel the bin, so had to take some out and spread it out over a few weeks!
Well I just call it using your initiative. I feel like as the years go by there seems to be more and more rules for us to abide by. The vast majority being totally pointless.
We’ve got some used beer bottles that aren’t made of glass so can’t be recycled. They’re mega heavy and appear to be made from stone or granite. They’ll be getting off-loaded 2 or 3 at a time down at the bins in the car park at the top of the street.
I figure that as long as I don’t do a secretive dump in the dog poo bin I’m not actually doing anything wrong..
There is actually a bin for dog poo———–It’s called a politicians mouth.
I got rid of a bath by chopping it up and putting a bagfull of it in my bin for each collection. Eventually got rid of it over many weeks. This between the time that councils started charging for DIY domestic waste (by claiming it wasn’t domestic’) and the recent change which stops them imposing these charges.
This has turned into quite the “Dumpers Anonymous Confessional”, hasn’t it? You bloody axe maniac you! Or were you more of a Leatherface, in your weapon of destruction choice?
I am pretty sure that they don’t recycle anything like what they claim. I suspect most ends up in landfill. So they have us jumping through all these hoops for nothing. GREEN has to be the most insidious and disgusting political ideology ever imposed on an easily manipulated public, who thought they were living in a free country. —–Once their gas central heating is ripped out and they have 10 plastic bins in their garden some people might actually wake up one day and say “Eh, what is going on here exactly”?
I find the last part of this story particularly vexing. £400 fine for litter picking. My wife does at least an hours litter picking most days. She has early onset AD. If she is fined for putting something in the wrong bin there will be hell to pay.
#excited is trending in the legal community.
My solution is to dig holes and bury it. Keeps you fit digging and yields topsoil to go in raised beds.
I am jusy continuing the practice of the former owner of my home, who was a haulage contractor for a large nearby chemical company. They paid him to take it away and he tipped a lot of the useful bits and pieces in the back garden. For the last three decades it has yielded much useful stuff for an enterprising cheapskate like me.
For a fist full of rubble?
We found an old coal fire back boiler buried in our garden – didn’t know what it was at first.
Hunger games type behaviour, may the odds always be in yr favour.
In Essex visits to waste disposal sites (“recycling centres” in swamp language) requires prior reservation giving phone number, email addreess and vehicle registration number. I have found the staff who check admission allow some leeway on time which is just as well because local roads are often choaked.
Staff in the centre are very interested in metal waste, so much so I wonder if they sell it privately. There is no assistance available for heavy items.
This seems to me just another way of monitoring the public.
Council waste tips have always been obliged to take metal. Yes, I strongly suspect that the staff scavenge and sell-off the good bits. I’m a bit of a car renovation nut – the local guys have got used to me dumping old driveshafts and suchlike.
This level of micro surveillance and stupidity has not yet reached Scotland, as far as I am aware. The response from the typical Jock would likely be far more colourful than awa’ and bile yer heid….
It is sad then that the typical Jock could not manage “awa’ and bile yer heid….” when the Scamdemic and associated nonsense were being rolled out.
No personal criticism intended.
It’s high time everyone told their councils to F themselves. This is rule without consent.
The level of the fine constitutes a cruel and unusual punishment, totally out of order.
How can it even be a crime to put waste in a bin, it’s not industrial quantities of waste, it was one piece of cardboard.
The Highland Council (SNP) is similarly anal about street litter bins, all sorts of threats and incitement to snitch, horrible notices.
Could the FSU help to challenge this or help organise an appeal for funds.
“You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.”
Thomas Sowell
With respect, the people of Brighton shouldn’t complain.
They voted for the greenists.
PS maybe try some direct democracy and sneak out at night and plant some cardboard boxes in the greeny’s bins?
We will soon have a bin that goes out once a year for toe nail clippings. Try not to put it out on the wrong day though or the toe nail wardens will slap you with a heavy fine.
One for the left foot and one for the right.
Years ago (before I retired) after each meal in the company’s dining room we meticulously separated out plastic and polystyrene cups placing them in special containers. One day I happened to be in the service yard where I witnessed the two separate containers being emptied into the back of the same dust cart! After that I made a point of placing plastic cups in the polystyrene container and vice versa.
Simple solution: don’t pay the fine. Inundate the council for evidence of any contract and shower them with FOI requests. Basically, tie them up in legal knots. They’re just out to rob you after all.