OPINION

'Degrees will build in values to underpin and ensure good care'

19 April, 2011

‘Let’s stop debating whether an all-graduate profession is necessary and embrace the opportunity to address the challenges ahead’

I was proud to announce that the University of Southampton was the first to have its degree programmes approved by the Nursing and Midwifery Council. We will become “all graduate” from September, two years ahead of the deadline. We were closely followed by York and all other universities will soon follow suit.

This is a historic moment and one that we should rightly mark with celebration. But we still have many sceptics to convince that this is right and necessary for nursing.

We have called for this change over decades. Even though we are the birthplace of modern, evidence-based and data-informed nursing, England has lagged behind Scotland, Wales and many other countries, despite there being strong evidence to indicate that nurses prepared to degree level enhance the quality of care and are associated with better outcomes.

All other health professions study to degree level, but with nurses there is deep ambivalence over accepting that managing care and providing treatment in modern health systems requires extensive knowledge and skills. Nurses today do many of the tasks doctors performed 25 years ago when I was training to be a nurse.

The Health Service Ombudsman’s report that revealed shocking stories of neglect and poor care by nurses and other staff came close on the heels of reports from the Mid Staffordshire inquiry; these are an indictment of some nursing care in the NHS. It feels as if there may be a crisis in confidence over the quality of care provided by nurses in acute hospitals. We have heard a range of explanations into why such poor care is happening, what has gone wrong and what we should do. We have heard a lot about whether we should train nurses differently, concentrate on the basics of care or stop nursing becoming too academic.

This is precisely the wrong approach.

What we need are high-calibre, highly trained nurses who are supported and well prepared to uphold person-centred care, attending to the basics of what people need when they are ill, especially those who are vulnerable, such as frail older people.
We need to detail the science behind what creates the circumstances to get care right - leadership, organisational climate and context, a skill mix that includes expert clinical leaders and effective teams, and adequate staffing levels. Critical is an organisational culture that upholds and supports the delivery of such care.

Our degree curriculum is designed to inculcate clear values from day one. Values-based enquiry is core. Students will be supported to develop care and compassion, which will be underpinned by evidence-based knowledge and the confidence to recognise and speak out against situations where care is not of an acceptable quality.

We believe, in developing the Southampton values-based curriculum, that we have a response to some fundamental issues relating to the quality of care in the NHS and are passionate about instilling the values that are fundamental to putting poor care right. This involves working closely with local hospital and community trusts, auditing clinical placements, participating in quality monitoring, supporting students to speak out when they see unacceptable practice and developing students to have the expertise, skills and values to uphold and deliver high-quality care.

So, let’s stop debating whether an all-graduate profession is necessary and embrace the opportunity to work collectively to address the challenges that currently face the profession and ensure that system failure in delivering quality care is an unheard of, rather than a trend towards the norm.

Jessica Corner is dean of Faculty of Health Sciences, University of Southampton

Readers' comments (36)

mike | 19-Apr-2011 4:36 pm
Well said!!!
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Natasha | 19-Apr-2011 10:49 pm
I second mike! I just can't understand how anyone can disagree with it?! Knowledge is power and demands more respect, we nurses should therefore be embracing this change. Care and compassion will always remain in focus.
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Adrian Bolt | 20-Apr-2011 8:11 am
"Let’s stop debating whether an all-graduate profession is necessary and embrace the opportunity to address the challenges ahead"

Oh fine, well that’s that decided then, no need for any debate. Anything else we don't need to discuss, the war in Afghanistan, public service cuts, the perennial problem of does ones’ chewing gum loose its flavour on the bed post overnight? All we need is Dean Jessica to tell us all what to think, so much easier than working it out for ourselves.
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Lorraine Scaife | 20-Apr-2011 12:10 pm
I get tired of hearing this argument!

As someone who did the "old nurse training" and who does not have a degree, I begin to wonder if my last 33 yrs in the job been a waste of time as I am obviously not as good as a degree level nurse being trained today!

I feel that nurses I trained with were "high-calibre, highly trained nurses" as stated above as a requirement for todays nurses.

On my first day on the ward as a newly qualified nurse I "supported and well prepared to uphold person-centred care, attending to the basics of what people need when they are ill, especially those who are vulnerable, such as frail older people. Although I new that I still had a lot to learn.

I may not be a "graduate" nurse but I consider that my learning has continued my whole career, its been a "graduated" process over time.

If degree level nursing produces such great nurses, I wonder if degree nurse training is so good why do we still hear stories of patients developing bed sores, not being mal-nourised in hospital, left unwashed etc etc.

I am not saying that nurses should not be educated, of course we do, however I would ask how has this "education really benefited us?

Are we better paid? Do we really get the respect from our government we deserve? Are we valued by our employers? Do we really do a better job at caring for our patients?

Education is necessary but lets loose site of the fact that we also need to ensure patients receive good basic nursing care in our care and on the whole where its possible leave hospital fitter and healthier than they came in.

Whether degree educated or not, all nurses know how bad it feels when you get home wishing you could only have done more for our patients.
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Lorraine Scaife | 20-Apr-2011 12:14 pm
Lorraine Scaife | 20-Apr-2011 12:10 pm

I get tired of hearing this argument!

As someone who did the "old nurse training" and who does not have a degree, I begin to wonder if my last 33 yrs in the job been a waste of time as I am obviously not as good as a degree level nurse being trained today!

I feel that nurses I trained with were "high-calibre, highly trained nurses" as stated above as a requirement for todays nurses.

On my first day on the ward as a newly qualified nurse I "supported and well prepared to uphold person-centred care, attending to the basics of what people need when they are ill, especially those who are vulnerable, such as frail older people. Although I knew that I still had a lot to learn.

I may not be a "graduate" nurse but I consider that my learning has continued my whole career, its been a "graduated" process over time.

If degree level nursing produces such great nurses, I wonder if degree nurse training is so good why do we still hear stories of patients developing bed sores, not being fed and watered and ending up mal-nourised in hospital, left unwashed etc etc.

I am not saying that nurses should not be educated, of course we do, however I would ask how has this "education really benefited us?

Are we better paid? Do we really get the respect from our government we deserve? Are we valued by our employers? Do we really do a better job at caring for our patients?

Education is necessary but lets loose site of the fact that we also need to ensure patients receive good basic nursing care in our care and on the whole where its possible leave hospital fitter and healthier than they came in.

Whether degree educated or not, all nurses know how bad it feels when you get home wishing you could only have done more for our patients.

sorry, added again with correction.
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Adrian Bolt | 20-Apr-2011 2:44 pm
Lorraine have you not been listening, the debate is over, closed, finished. Your nursing certificate and 33 years experience count for nothing when placed against these shiny new graduates with their shiny new degrees. You are a dinosaur and soon to go the way of all dinosaurs (? early retirement) shape up or ship out!
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mike | 20-Apr-2011 4:22 pm
Edwin, the only thing you are right on is the fact the argument is over, Degrees are here and they are here to stay. Simple as that. On everything else, yet again, you are wrong.

Lorraine, it is not about 'us' and 'them', it is not about 'new nurses' with Degrees and the 'old guard'.

As I have said before, and I think this is the crux of the article above me, it is time to move past arguments like that.

All my practical training as a student was done with 'old trained Nurses' as you say. Their experience was, and still is, invaluable. No one is saying that it isn't. Your (and your colleagues) wealth of experience is still used to great effect in caring for patients, and will be passed down to the Nurses coming through the system with degrees now, who can learn from that experience as we move along our career paths and gain our own. But we can ALSO use our degrees to academically validate that wealth of experience, to compete on a level playing field with other health care professionals (who after all are ALL degree educated at least) and advance our profession even further. You ask 'Are we better paid? Do we really get the respect from our government we deserve? Are we valued by our employers?' At the moment no, but we will never have that until we are a Degree educated profession, which we are becoming. THAT is the power the degree brings, it by no means devalues the experience and knowledge of older Nurses, but it does ensure we can become a more powerful profession, one that can more easily stand up for itself, and its patients.

And one final thing, you also ask 'If degree level nursing produces such great nurses, I wonder if degree nurse training is so good why do we still hear stories of patients developing bed sores, not being fed and watered and ending up mal-nourised in hospital, left unwashed etc etc.' Are you really suggesting that Degree level Nurses are any worse at caring from our patients than 'older Nurses'?? I hope not. Because I strongly believe that these things happen not because of a lack of care within individual Nurses (regardless of Degree education or not) but more often than not, the working conditions that are imposed on us by management/government/ targets/etc. Especially staffing levels for example. I strongly believe that the vast majority of Staff Nurses, both Degree educated and not, are killing themselves trying to give the best care they can, and not always succeeding because their aren't enough staff, or the right equipment/drug/service isn't there, or ... you get my point. But this will only change once our profession starts standing up and taking charge, and part of that, is becoming a Degree educated profession.
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Adrian Bolt | 20-Apr-2011 5:17 pm
@ Mike

But we can ALSO use our degrees to......... compete on a level playing field with other health care professionals.

How exactly does a degree in nursing help anyone "compete" with a Doctor, physiotherapist or pharmacist when these are completely different disciplines to ours?

"Are we valued by our employers?"

and you think having a degree certificate to wave at them will change that?

"Are you really suggesting that Degree level Nurses are any worse at caring from our patients than 'older Nurses"

Go and read 60 seconds with Sara Owen

http://www.nursingtimes.net/nursing-practice/clinical-specialisms/educators/there-will-be-fewer-trained-nurses-and-their-role-will-be-largely-supervisory/5028499.article

"There will be fewer trained nurses and their role will be largely supervisory". The reason degree educated nurses are not as good as traditionally trained nurses at looking after their patients is because they are not the ones looking after their patients, care assistants are.
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mike | 20-Apr-2011 11:28 pm
Edwin,

How exactly does a degree in nursing help anyone "compete" with a Doctor, physiotherapist or pharmacist when these are completely different disciplines to ours?

With respect, you misunderstand what I meant by compete, I used the term in the context of the saying 'compete on a level playing field' but that was most likely because I did not explain myself well. By 'compete', I did not mean 'pitting our skills against the skills of very different disciplines', I simply meant in a more rhetorical sense, our views will be (in time) seen as just as valid as a Doctors, pharmacists, etc on medical/health matters. As an example, look at the vast majority of programmes on the TV where a medical/health opinion is sought, the Staff Nurse is very rarely asked for their opinion.

'and you think having a degree certificate to wave at them will change that?'

Not in and of itself, but it IS a large part of it, yes.

'he reason degree educated nurses are not as good as traditionally trained nurses at looking after their patients is because they are not the ones looking after their patients, care assistants are.'

That is absolute crap. Older Nurses are no better than younger Nurses and vice versa. As for the HCA's looking after our patients, who do you think they run to when anything clinical needs doing? As I stated quite clearly, problems such as this are primarily the fault of external factors such as staffing levels. If for example we had a real Nurse/patient ratio (as in Australia), I would have the time I need to truly spend with my patients.
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Natasha | 21-Apr-2011 0:10 am
I think this invisivble wall that some nurses put up only creates further fraction when at such a time, now more then ever, we must support each other and back each other or else some who knows who might take advantage. . . but not the government of course (cough cough).

This comes down to adaption. Take Lorraine for example, Health care was different when training in the "old days". The nurse training met those needs. I years gone by the health care system has evolved (for many different reasons) and no doubt Lorraine adapted to that change and evolved herself. But good or bad, the health system has become much more complex and it about preparing the future nurses adequately to meet the current standard. Lorraine, you are already at that level and beyond!
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Adrian Bolt | 21-Apr-2011 6:15 am
“I used the term in the context of the saying 'compete on a level playing field”

Ok how does having a degree help us compete with a Doctor, Physiotherapist, or Pharmacists “on a level playing field’ then? You see it still does not make any sense and the rest of your rhetorical twists and turns can’t hide that fact.

“That is absolute crap”

Have you read 60 seconds with Sara Owen?

"There will be fewer trained nurses and their role will be largely supervisory".

That means that the role of a nurse in the future will be largely SUPERVISORY and there will be FEWER of them. So when that care assistant notices anything clinical that needs doing, assuming that they recognize that the problem lies outside their level of expertise, they probably won’t be able to find the one (degree) qualified member of staff on the ward to ask them what to do about it. And if they do, that qualified member of staff will probably be too busy “supervising” to help anyway.

You talk about staffing levels but completely fail to recognize that the trend towards constantly hyping up the qualifications of nurses will eventually lead to the situation where you have one qualified nurse managing a number of wards from an office while an army of untrained and largely unsupervised care assistants actually do the work. Much better I think to have an army of nurses trained to a perfectly acceptable standard (like Lorraine) doing the bulk of the work ably assisted by a small number of care assistants.

Your reply reveals another interesting facet of this debate. You obviously consider core nursing duties such as washing patients, feeding them and generally keeping them clean and tidy below the dignity of a degree educated nurse. Happily consigning these duties to the care assistants to do while you are only “consulted” on matters of a “clinical” nature. Washing a patient IS a clinical duty, that is when you should be looking for signs of pressure sores developing. Feeding a patient is when you look for signs of aphasia, cleaning an incontinent patient might be when you first notice the first signs of c diff on your ward.

You state boldly that I am wrong, without providing any evidence to back up your assertion or for that matter the rest of your argument. Come on Mike you talk about evidence based nursing how about some evidence based debating.
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leanne farrow | 21-Apr-2011 7:34 am
I do wish that all those Diploma/old school trained nurses would stop playing such victims in this "debate" no where has anyone ever said that you are lesser nurses or bad at your jobs....this is about the one person who matters to a 'good' nurse...the patient.
Stop whining and get back to work......
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Adrian Bolt | 21-Apr-2011 10:45 am
@leanne

The only people whining round here are entitlement monkeys like Mike who appear to think that the world, or more accurately the state, owes them a living.
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Adrian Bolt | 21-Apr-2011 11:18 am
Ok I withdraw the term "entitlement monkey" that was uncalled for and i apologise for that but no one this side of the debate is whining about anything.

It is interesting to note that a debate which is "officially" over a lot of people appear to have a lot to say on the subject of a degree only nursing profession.

Perhaps before those of us without degrees get back to the job we were trained to do the rest of you might like to consider this.

"O, be some other name! What's in a name? that which we call a rose. By any other name would smell as sweet"

Shakespeare's Romeo and Juliet

I wonder what difference having a degree only profession will actually make to the standing of the nursing profession in the end. The basic nature of the job has not significantly changed as far as I am aware and we are all nurses at the end of the day even if some of us can put BSc or BA after our names.
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Lorraine Scaife | 21-Apr-2011 1:04 pm
Comment on: 'Degrees will build in values to underpin and ensure good care'
Edwin Harnell's comment 20-Apr-2011 2:44 pm

Lorraine have you not been listening, the debate is over, closed, finished. Your nursing certificate and 33 years experience count for nothing when placed against these shiny new graduates with their shiny new degrees. You are a dinosaur and soon to go the way of all dinosaurs (? early retirement) shape up or ship out!

Edwin, thanks for telling me my experience is worthless and count for nothing! I'm pleased I do not have to work with you.

If every nurse like me retired and took our experience with us the Profession would be a poorer place.

I do not plan to retire early - still have at least another decade in me and plan to continue what I have done all my career, do my best every single day at work for my patients, my colleagues and my profession.

This is one dinosaur who is far from extinct!

Leanne,
I am not whining and as far as I can see I am entitled to post my opinions. I am not being a victim, I believe I am as good a nurse as any trained today. My point is, degrees don't make good nurses. People make good nurses.

As for getting back to work.....FWIW I was on my day off when posting yesterday- something else I believe I am entitled to!

Mike
I will come back and answer more of your points when I have a bit more time
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Adrian Bolt | 21-Apr-2011 3:45 pm
Lorraine that was irony
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Richmondmouse | 21-Apr-2011 4:10 pm
Edwin @ 3:45pm

"Lorraine that was irony"

Not lost on this dinosuar Edwin, and one of the most entetaining debates I've read here in a long time.

I suspect there will be more to come.

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Lorraine Scaife | 21-Apr-2011 4:20 pm
must have had my irony switch on default. :-( I wasn't quite sure which way to take it.

I like shiney and new but I also like dinosaurs! ;-)

Mike I am not saying degree nurses are no better at caring, I am saying that having a degree doesn't it any easier to be a good nurse. I agree that the main problem is of course one of nurse to patient ratio's. My sister is a HCA in another part of the country to me, one of her frequently lamented complaints is that the nurses never do any of the nursing, they are always sat at the nurses station on the computer. TBH I've given up trying to win that arguement and explain why and what it is they are doing there.

Whilst being good at all the "clever stuff is great" its not good for patients if we are still getting the basics wrong. HCA may deliver the care but nurses supervise this.

Anyway, I'm off to enjoy a well earned holiday. Enjoy the sunshine everyone.
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Adrian Bolt | 21-Apr-2011 8:15 pm
@Richmondmouse

Pull up a chair and have some pop corn
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Natasha | 22-Apr-2011 5:21 pm
"The basic nature of the job has not significantly changed as far as I am aware and we are all nurses at the end of the day even if some of us can put BSc or BA after our names."

It makes a difference having the BSc at the end of a name actually because fact is (backed with good research) mortality rates are lower with degree nurses. As I've said before, Health care is a lot more complex today. People are living longer, when only 5-10 years ago they would not survive. yes basics may stay the same but what about the other stuff we do like dealing with social issues, legal/ethical issues, the different treatments we deliver, etc. Health care isn't black and white anymore.

Nurses' with a degree do not make them "to posh to wash" and frankly that is soo insulting!! But what is fundamentally happening on most wards is it is impossible for the trained nurse to do all the trained nursed tasks and the basic stuff. The basic stuff I know is just as important, such as washing for skin assessment, mobility assessment, cognition etc etc, but we need the carers to do the basic tasks so we can do all the things that require a trained nurse. Which is why communication is so vital! I think they should bring back the name nursing assisstant.

"Whilst being good at all the "clever stuff is great" its not good for patients if we are still getting the basics wrong"

Its not because we're learning about the "clever stuff" that we're getting the basics wrong (whatever you mean by "clever stuff"). Research shows that wards are less well staffed then they used be. How are we supposed to care and support patients adequately if the staff themselves are not cared for and supported. When nursing goes to all degree (which I thouroughly back) what we must make sure of is that this is no excuse for government to use less of us cos we're more expensive or whatever. This is why (as Mike has so often said) we need to fight for a nurse patient ratio! Then perhaps the basics will be right.

Back to degree nursing. A quality nurse does need some1 that is caring and compassionate, and I agree one does not need a degree for that. But anyone who says that is forgetting there is more to nursing then mopping the patient's brow. What about critical analytical skills, drug knowledge, managing care holistically, etc etc. As I've said before, knowledge is power. The more we know the better off patients are. Which comes back to my original point that we must embrace this change!
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