'Education distant from practice undermines a caring culture'

Nursing education, once a powerful influence on the development of nursing theory and practice, has been increasingly accused of contributing to falling standards of care.

The media in particular has been vociferous in this regard. It has assumed that if the “right kind” of people are selected for nurse training, on the grounds of their positive attitudes, compassion and honesty, nurse training would provide the context in which skills, values and professionalism could be instilled and flourish.

Two decades ago, Project 2000 was hailed as a significant sign of professional maturation. The move to university education was a momentous step towards nursing becoming an all-graduate entry profession and thereby gaining parity of esteem with other academic disciplines and professions.

Nursing lecturers were expected to become competent in securing research grants, undertaking research, publishing papers, servicing committees and collaborating with a wide range of service providers. These activities, once seen as a means to an end, became an end in themselves and the lecturers, who ought to have been role models, supervisors and culture-carriers, became distanced from the very thing they were meant to be teaching.

The Mid Staffordshire Foundation Trust Public Inquiry heard diverse observations on current nursing practice. Some who were called to give evidence saw nursing as a profession in danger of losing its core values; others saw it as being strangled by red tape and sinking under the pressure of dwindling resources.

In defence of nursing, one witness told inquiry chair Mr Robert Francis QC that a recent Royal College of Nursing survey had found that 85% of care delivered by nurses had been deemed satisfactory. His response was that a 15% level of poor care was far from impressive and this required immediate and drastic attention.

‘The failure of students to complain suggests that they were being socialised to accept a culture of indifference where poor standards were the norm’

Witnesses responsible for medical and nursing education felt that the recent reorganisation of services had led to education and training at pre- and post-registration levels being sidelined and under-resourced, and considered low priority. Some clinical areas where students were placed were barely fit for purpose. Many students viewed their training as no more than a means of securing a qualification. Curriculum content had become fragmented. Supervision of students had been reduced to a cursory telephone chat, and academic staff were hardly ever involved in monitoring standards of care.

The inquiry heard that the requirements and processes for the accreditation of wards were unclear, with the ratio of trained to untrained staff not being specified, objectives for student nurses not being taken seriously and competencies of supervisors rarely assessed.

Following the dismissal of nearly 140 staff at Mid Staffs so it could secure foundation status, students continued to be allocated to areas where there was a dire deficit of basic care. The failure of students to complain suggests that they were being socialised to accept a culture of indifference where poor standards were the norm.

Nurse education is not consistent across the country. There is insufficient hands-on experience, and practice settings vary considerably in staffing levels, skill mix and the extent to which a caring culture is ingrained. Nurses appear to have little say in the content of the curriculum or over which students qualify.

The bureaucratisation of health poses a threat that nurses could become more focused on the dictates of commissioners, regulators, monitors and auditors than on the needs of patients.

The public has every right to be concerned about standards of care in the NHS - after all, it is tax funded. There are now many healthcare assistants working for it and it is not necessarily clear to patients who is a nurse and who is not.

The distancing of education from practice, the downgrading of the curriculum and the lack of hands-on experience are matters that every nurse should find disturbing because they undermine the caring culture that is central to the patient experience.

Peter Nolan is professor of mental health nursing (emeritus)

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