Evaluation of a multiple-mini-interview protocol used as a selection tool for entry to an undergraduate nursing programme.

Whilst an individual's cognitive skills are essential for academic progress, the possession of non-cognitive skills, such as empathy and ethical judgement are attributes required and valued in those applying to join healthcare programmes and by the profession itself. Doubts have been expressed, however, whether final selection using traditional interviewing methods serve adequately to reveal these key competencies. Kingston University and St George's University of London, therefore, have employed the Multiple-Mini-Interview (MMI) system for those applying to their BSc Nursing Programme. The MMI comprises a series of interview 'stations' where candidates respond to scenarios and are assessed on their display of required skills/competences. 890 candidates and 82 interviewers completed a short questionnaire to gauge their reaction to the concept. There were positive responses from candidates with 65% replying that it was "a better experience" compared with traditional interviews. Unsolicited comment was generally found to refer to restrictions on opportunities to express enthusiasm for nursing. Interviewers likewise responded positively with 71% noting "a better experience." Unsolicited feedback indicated that some would have preferred to have had greater opportunity to discuss nursing issues, with their interviewees. It has been agreed that the MMI system of interviewing will be retained and further work will include the tracking of students through and into the workplace.

Fundamental failings show up the organisational culture of the NHS.

The inquest into the death from dehydration of hospital patient Kane Gorny in 2009 (news July 18) has again highlighted fundamental failings by nurses.

Lack of support from a mentor while on a placement is something that, unfortunately, many of us will recognise (reflections May 25).

The Nursing and Midwifery Council code of conduct requires all nurses to support learners and expects all nurses to aspire to be a mentor. While this is great in theory, not everyone makes a good mentor and many nurses who attend mentorship programmes openly admit that they are doing it to aid their career progression.

How skill mix affects quality of care.

While the media has reported failings in care as failures in nursing, it has not distinguished between care delivered by nurses and that delivered by unregistered healthcare assistants and other support staff. This article examines the role of nurses in an evolving healthcare climate.

Using care bundles to reduce in-hospital mortality: quantitative survey.

PROBLEM: To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. DESIGN: Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for the 13 diagnoses targeted by the intervention care bundles, 43 non-targeted diagnoses, and overall mortality for the 56 hospital standardised mortality ratio (HSMR) diagnoses covering 80% of hospital deaths. SETTING: Acute hospital trust in north west London. STRATEGIES FOR CHANGE: Use of clinical guidelines in care bundles in eight targeted clinical areas. INTERVENTIONS: Use of care bundles in treatment areas for the diagnoses leading to most deaths in the trust in 2006-7. KEY MEASURES FOR IMPROVEMENT: Change in adjusted mortality in targeted and non-targeted diagnostic groups; hospital standardised mortality ratio (HSMR) during the intervention year compared with the preceding year. Effect of the change The standardised mortality ratio (SMR) of the targeted diagnoses and the HSMR both showed significant reductions, and the non-targeted diagnoses showed a slight reduction. Cumulative sum charts showed significant reductions of SMRs in 11 of the 13 diagnoses targeted in the year of the quality improvements, compared with the preceding year The HSMR of the trust fell from 89.6 in 2006-7 to 71.1 in 2007-8 to become the lowest among acute trusts in England. 255 fewer deaths occurred in the trust (174 of these in the targeted diagnoses) in 2007-8 for the HSMR diagnoses than if the 2006-7 HSMR had been applicable. From 2006-7 to 2007-8 there was a 5.7% increase in admissions, 7.9% increase in expected deaths, and 14.5% decrease in actual deaths. LESSONS LEARNT: Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate.

It seems that the defining role of caring is no longer our domain.

NHS boards in Wales are to cut a number of staff at bands 5 and above (news February 17) and replace them with healthcare support workers (HCSWs). Strategic health authorities in England are cutting commissions for nursing students and receptionists are being trained by doctors in their surgeries to adopt nurse roles (news February 15).

Supernumerary status--an unrealised ideal.

Supernumerary status, for pre-registration student nurses, should have fundamentally changed the way they learn in practice. Research suggests, however, that for many students the apprenticeship model still exists and that supernumerary status has created new challenges for learning in practice. Common themes found in the literature on supernumerary status are: confusion over the meaning of supernumerary status, the effect of supernumerary status on becoming part of the team, importance of the mentor, power relationships and operationalising supernumerary status. These themes are explored further with reference to the international literature and recommendations made as to how nurse education can respond to the challenges posed in order to ensure the quality of student learning in practice.