Analysed: Is nurse education hamstrung by a vision of a past 'golden age'?
A new study warns a rose-tinted view of a “golden era” of nurse training, which is often depicted by the press, is damaging efforts to tackle problems facing the profession today. Jo Stephenson looks at the evidence.
Nostalgic descriptions of nurse education published in national newspapers offer a “sanitised” version of the past and risk creating unhelpful divisions between new and more experienced nursing staff, said study author Karen Gillett, a lecturer in adult nursing at King’s College London.
She looked at British national newspapers that featured articles on nurse education from January 1999 to July 2012 for her review, which was published this month in the Journal of Advanced Nursing. The review involved 123 articles in total with further in-depth analysis focused on 11 of them.
“This paper points to the dangers of promoting nostalgic views of individual nurses”
The majority of articles – 76% – took a negative view of the increased academic level of nurse education, often complaining nurses were no longer “taught to care” and would benefit from more practical, vocational training on the wards.
Writing in the journal, Ms Gillett warned that an idealised picture of spotless wards and strict matrons in crisp uniforms was shaping public opinion and increased the risk of “retrograde” policy-making.
“By sanitising the past and forgetting the problems with traditional approaches to nurse education there is a risk of repeating the same mistakes,” she said.
Ms Gillett told Nursing Times there were real dangers in idealising past training regimes. “It’s an issue because it means we look to solve our problems by looking to the past. But the care that nurses give is different than it was 10, 20, 30 years ago so we need to focus on now,” she said.
The idea that “everything was rosy in the past” has influenced policy including schemes like the re-introduction of matrons onto hospital wards and, more recently, an emphasis on new routes into nursing that may not require a traditional degree.
Concerns expressed in the paper were shared by the higher education sector.
“This nostalgic narrative carries real risk for nursing education and for the profession – particularly when it is being used to conceal an NHS efficiency agenda,” said John de Pury, head of health at Universities UK.
“So it’s not only a return to old standards of compassion and compliance but cheaper too. Small wonder this appeals to Health Education England and ministers.”
He said higher education for nurses conferred professional status and encouraged analytic capability – “the confidence to appraise what you see on your ward and in your community and compare it to higher standards of best practice and evidence”.
“Don’t we need exactly these independent-minded, skilled and compassionate professionals right now preventing another Mid Staffs?” said Mr de Pury, in reference to the high profile care failings at Mid Staffordshire Foundation Trust that prompted a public inquiry.
He feared if nostalgia was translated into funding it could affect the health service’s ability to cope with fast-paced changes in care and technology, and new challenges including increased demand, greater complexity of care, and multiple settings and partnerships.
“Will these requirements really be satisfied by returning nursing education to ‘apprenticeships’ in hospitals?” he said.
Professor Ieuan Ellis, chair of the Council of Deans of Health, said: “This paper points to the dangers of promoting nostalgic views of individual nurses of their experiences of training in the last century, as a basis for ignoring current evidence of education and training for the 21st century.
“Design of current education must be based on evidence, for example that increasing the proportion of degree-level educated nurses by 10% is associated with reducing hospital mortality rates by 7%,” he said.
“We also need to look ahead to what patients will need in the future and ask how this affects education and training – for example, the level and type of education to help professionals working more autonomously across the full scope of their roles.
“It’s also vital take account of the reflections of new and recently qualified graduate nurses on their experiences of education, not only those reflecting on their initial qualification in a previous century.”
In her analysis, Ms Gillett found there was no one “golden age” that was consistently harked back to, but a common theme was that past practices were better.
“This ‘golden age’ of nursing varies. If I had a golden age it would probably relate to nursing when I started in the 80s, but people who started in the 70s were talking about the 70s and people who started in the 50s were talking about the 50s,” she said.
“The newspapers are shouting loudly and we haven’t got what sounds like a credible response”
The concept could create rifts between those entering nursing and those who had been in the profession for a while, with a tendency for experienced nurses to look down on new recruits.
“If you believe people who trained when you trained are caring and compassionate and that people who are trained now are not, then there is automatically a divide between the new, keen, enthusiastic people we’re getting on board now and everybody who trained under a different system a few years ago – and that’s an awful shame,” she said.
Often those who wrote nostalgia-ridden articles were retired nurses who had not been involved in frontline nursing for a long time, she explained.
One issue was the fact the profession – and especially student and newly-qualified nurses – lacked “a voice” to counter claims that everything was better in “the good old days”.
“We don’t have any strong nurses in the public limelight who are able to present a different argument and be more forward-focused,” she said. “And that’s a big problem – the newspapers are shouting loudly and we haven’t got what sounds like a credible response.”
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