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Every potential student nurse to face aptitude test

Every potential student nurse or qualified healthcare worker entering training will in future be interviewed and tested to make sure they have the right values and skills to provide good care, HSJ can reveal.

The plans are being drawn up by Health Education England in response to Robert Francis QC’s report into care failings at Mid Staffordshire Foundation Trust. HEE is the national body set up in June last year to ensure high quality NHS education, training, and workforce development.

Its chief executive Ian Cumming told HSJ he accepted that testing every course applicant would pose a challenge.

“It’s not something that can happen overnight but I want to see anyone who is entering training – whether it be for nursing, medical or whatever it may be – to show they have the right skills to work in healthcare,” he said.

“If people can’t demonstrate the right values and behaviours they should not get jobs in our NHS. It is as simple as that.”

Professor Cumming said there were a number of ways to test applicants and that HEE would not seek “dictate” to universities which method to use.

But he said HEE would work with NHS Employers and others to develop a “series of tools” to test aptitude and behaviours – suggesting universities will be encouraged to use a set of standard national tests.

Mr Francis’ report recommended the widespread adoption of aptitude tests for qualified staff seeking employment in the NHS. They are already used by some NHS organisations, especially in the mental health sector.

The report also said students should be barred from nursing courses unless they had spent a minimum of three months working on the direct care of patients under the supervision of a registered nurse.

In addition, it urged the Nursing and Midwifery Council to introduce a system of revalidation for nurses similar to that launched for doctors in December by the General Medical Council.

The nursing regulator already has plans to bring in revalidation by 2015. But the report suggested the NMC should lead on developing an annual appraisal system to be implemented before the full system of revalidation is implemented.

Mr Francis suggested the annual performance appraisal – in which nurses have to show evidence of learning and skills in key areas – should be signed off by senior nurses and include feedback from patients and families.

One of the largest areas of workforce change proposed by the report is the regulation of healthcare assistants by the NMC.

Mr Francis told HSJ it was vital to protect the public that an HCA register was created and that staff be barred from providing care unless they were included on the list. He also backed the creation of a national code of conduct for HCAs, and consistent training and standards – both of which are already under development.

But the government was lukewarm last week in its response to the idea of mandatory HCA regulation and has resisted similar calls in the past. The NMC also said there were difficulties with implementing the idea.

NMC chief executive Jackie Smith said it was unclear how many HCAs there were and that regulation would require a change in the law. She said: “The regulation of HCAs is for the government. We need to consider the recommendation and we can’t do that in isolation.”

Mr Francis’s report also called on the government to “consider urgently” the introduction of a common “requirement of proficiency in communication in the English language” for healthcare staff.

Readers' comments (12)

  • I have yet to come across a newly qualified nurse who did not have the right values and attitude to work in the NHS. What seems to change them, however, is the culture of the NHS as a whole and the organisations where they work, which encourages a prioritisation of other aspects of their workload. Surely tackling this would provide far greater return on investment than a potentially off-putting written examination (which are notoriously bad at detecting 'soft' traits such as compassion and caring)? Also, this will only apply to those nurses who have not yet qualified - what about whether the ones currently on our wards have the right attitude and values?

    I would be interested to hear whether any nurses feel that they would have been put off from applying as a result of these new measures.

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  • How do you get a job that allows you to spend three months working before starting training? Can this be explained? Does it mean that unless someone can pull strings and get you a post as a school-leaver you can't come into the system? Or will every course start with 3 months practical work?

    The usual well-meaning suggestions being made by those who won't have to bother themselves with the realities of delivering them.

    All of the issues that have been raised could be addressed using existing laws, processes, policies and plain old common sense. We are just very bad at applying these in the NHS...

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  • I agree Ananymous above. The report's proposal that 'students should be barred from nursing courses unless they had spent a minimum of three months working on the direct care of patients under the supervision of a registered nurse' seems bizarre. It means that there would be even more inexperienced unqualified staff working on wards simply to get work experience. It would also mean that those with parents with exsitng NHS connections have a better chance of getting on courses as they could pull strings to get thier children the work experience. It would be a retrograde step by inhibiting access for people from disadvantaged backgrounds into nursing.

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  • Values and attitudes upon entry are not the issue. It is the change in the attitudes and erosion of values over time that is the main cause of the ills of the NHS.
    We are checking up on nurses, what about the doctors? managers? other healthcare professionals?

    Or is the provision of good quality healthcare the sole responsibility of nurses?

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  • Agree with all of the above. Would you want a well meaning but hapless work experience person caring for your parent just to see if they are compassionate enough to train as a nurse. It is the culture of the bottom line being more important than the patient that corrupts. Regulating HCAs is just enrolled nurse history threatening to repeat itself. How about politicians complete an aptitude test to show they are decent and honest and only want the job for altruistic reasons?

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  • Complete piece of idealist, public pandering nonsense. It is the huge number of nurses already in practice with poor values and practice that should be the focus of concern. I doubt any of the 40 nurses being explored by the NMC re Mid Staffs were newly qualified.

    That said, Social workers are often required to demonstrate some practical experience in social or health care before undertaking their degree.

    Registered Nurses operate across sectors - the independent sector could provide any number of opportunities for supervision for 3 months by an RN. This isnt just about NHS hospitals.

    The education of nurses is a University function - not an NHS function. Not all RN's who qualify go on to work in the NHS and plurality of provision and AQP will mean that is increasingly true going forward.

    It is the regulation of healthcare assistants which is most crucial.

    With regard to Enrolled Nurse history - if we learn from the history of nursing, a type of enrolled nurse role has a role to play. Not everybody wants to run a ward or a community team, there are perople who are happy to deliver bedside care. The role has come and gone several times and is still alive and active as Licenced Practical Nurses in the USA. What will be important is providing a career pathway for registered HCA's who wish to, and are able, progress.

    The true tragedy here is that, already, Francis recomendations are being diluted or ignored. The more things change, themore they stay the same.

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  • Steven Burnell

    I don't think the "Care and Compassion" of young people are in doubt.
    What is seriously in doubt is the destructive fighting between NHS Direcrorates (from Whitehall), NHS Management(Primary/Secondardy/Tertiary), Local BMA and Local RCN.

    Pretty good time to put patients first

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  • I don't think the "Care and Compassion" of young people are in doubt.
    What is seriously in doubt is the destructive fighting between NHS Direcrorates (from Whitehall), NHS Management(Primary/Secondardy/Tertiary), Local BMA and Local RCN.

    Pretty good time to put patients first

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  • Virtually no nurses go into the profession being uncaring. What happens is that the system grinds them down - all the more so now with patients being more acutely unwell; job cuts on wards; and great inefficient support and bureaucracy. What you then get is classic burnout (hopeless, helpless, then ultimately heartless). We need to therefore (just like troops in fighting situations) rotate nurses out of " the front line" from time to time so that they are both refreshed, and they rediscover their humanity and their passion for caring..

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  • Aptitude test? If it's the right values that are being explored, shouldn't that be an attitiude test?

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  • I work in the NHS as an HCA, in mental health. I had no previous experience, other than as a user (in-patient and community). I will happily take any aptitute test (and register depending on the charge) so long as Sir David Nicholson takes a similar test. I agree with many of the comments above. I have worked with some fantastic students, full of enthusiasm and compassion - but as for some of the management...

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  • I think there is concern that some students may see nursing as a 'free' degree and have little intention of practising once qualified. Particularly students who enter training via clearing.

    Employers have a nettle to grasp here too if they are serious about investing in the future workforce.

    Finally anonymous 8.47 I too used to work as an HCA - from that perspective it was easy to picture managers swilling tea in the office and driving off to meetings that in all probability would have little to do with the coal face. Yet almost without exception these were qualified staff with many years of experience, no doubt once 'full of enthusiasm and compassion'. How does this gap develop ?

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