Posted by: Witch Doctor | November 17, 2009

The problem with bananas


The fact that all nurses will now require to have degrees, indicates that the major restructuring of staff planned within the NHS for some years now, is imminent.

Almost simultaneously it has been leaked that the Department of Health have proposed to cut central funding to hospitals to cover the salaries of junior doctors. Coincidence? Not on your life! They say it is to free up funding for nurse training. These proposals would have been made in the full knowledge of the likely outcome – that Trusts will cut the number of medical training posts.

The Witch Doctor’s interpretation of what is happening just now is very simple. Nurses NEED to have degrees so that The Skills Escalator becomes what it was always intended to be – a brutal cut in the numbers of expensive professionals (e.g. fully trained doctors and nurses), perched side by side, on the narrow upper echelons of The Skills Escalator, and a broad, broad base for a large workforce each of whom has clocked up a few simple competencies.

Those who have grabbed a fistful of “skills” will earn a place on the first few rungs of The Skills Escalator and most will go no further. This means, though, that the workforce will be “skilled.” It stands to reason. Hopefully patients will not know the difference between a professional worker and a skilled one. They certainly won’t know who is standing on each rung of The Skills Escalator. Eventually the skilled workers will regard themselves as “professionals” and The Skills Escalator will have done its job as one of societies‘ Great Levelers. Dumbing down will then be complete.

The Witch Doctor was made aware a couple of years back of a course being planned where a dietitian was to train staff in certain aspects of patient nutrition. Fair enough. Rightly, there was concern that patients were not eating their meals. The course was not really about nutrition at all. It was absurd. In one of the “modules” a banana featured. The skill required was to consider whether a patient was, or was not, able to peel a banana for herself. If the conclusion was that the patient was confused, had arthritis or couldn’t see etc, then that banana had to be peeled by the skilled worker and placed in an appropriate place that the patient could reach.

Who knows, maybe there was a “banana box” to be ticked on a clipboard. However, it was The Witch Doctor’s view that if members of staff did not have the powers of observation or wit to work this out, then they were a liability and should not be allowed near patients at all.

Not everyone will agree with The Witch Doctor, but she is of the view that “dumbing down” does not save money. Indeed, from what she has seen it can be a pretty expensive exercise. For example, a trained nurse while peeling a patient’s banana will ask, “why am I having to peel this banana today for this patient when I didn’t need to yesterday?” Nurses will want to know why there has been a deterioration. They will ask about pain and discomfort. They will look for vital signs. They will check the drug cardex. In fact, they are multitasking while they peel the banana. A professional, multi-tasking while doing mundane jobs, saves money, time and lives. Similarly, as a junior, The Witch Doctor used to pick up many important problems about patients and dealt with them, while she multi-tasked during her “blood round” early every morning. Incidentally, this also taught her how to get blood out of a stone and put up difficult drips at amazing speed! It also primed her for the following year when she had to tackle tiny scalp veins on dehydrated babies as a matter of urgency. Nowadays, she would not acquire these “skills” so easily. Phlebotomists were a great blessing in many ways, but they were also one of the earliest symptoms of “dumbing down.”

The Witch Doctor could go on, and on, about her views on The Skills Escalator and how “dumbing down” is the expensive alternative. But won’t. Instead, the question she is asking herself is this:

How can dumbing down save money? Lots and lots of money…….

She thinks she knows the answer to this.

She might be wrong, of course.

But the signs are all there that she is correct.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





© Dlundin |

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