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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”

Ieuan Ellis

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.

Professor Ieuan Ellis

Professor Ieuan Ellis

“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”

Karen Gillett

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.”

 

What do you think?

At 1pm Wednesday 28 May, we’re going to be hosting a twitter discussion on this story.

To join in, simply search for #NTtwitchat and include this hashtag in all your tweets on this subject.

Readers' comments (18)

  • This tend sto have a generic view of nursing based on adult nurses working in hospital settings. Clearly Child, learning disability and mental health care has change radically. LD & MH is now primarily community based on uses a social care model. Why then make them undertake education (NOT training) which is beeter suited to adukt. The 1982 RMN syllabus gave MH nurses the skills they needed to care, although lacked some knowledge base. Make nurse education to fit patient / service user need, not just what academics or senior professionals say is needed

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  • I trained in the 1970s as an RMN it gave me the ability to care. Those who came after me trained on the 1982 RMN syllabus, they had the skills and cared. Those who trained under Project 2000 were deskilled but cared. I'm not convinced what we have now truly gets nurses to care or skills them appropriately - but there academic knowledge/research skills are better. Maybe amalgamation of the different approaches would improve nurses care. So would proper funding though

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  • It's not helpful to set this up as a competition. I think my SRN training was excellent and prepared me well for nursing but that was another era. I believe nurses today need a degree- and there is clear empirical evidence for this. It's not a case of one being better than the other; it's different times and educational systems. What is needed is both theory and experience.
    The evidence suggests it is not the training but the system that nurses work in that determines hoe compassionate and safe their behaviour is.

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  • it looks like a very thorough new and serious analysis is needed to determine the role of nurses in the 21st century and restructure the profession accordingly and then set up education and training on line with this.

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  • I agree with Elaine. I would question whether my pre-registration programme of the 1980's would prepare me for the reality of practice today. Isn't this about combining the best elements - experienced practitioners to develop practice and theory to develop enquiry? Greater recognition and support of mentors in their very important role can help to promote this.

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  • Paula Shepherd | 27-May-2014 11:27 am

    I think some elements of my training in the 1970s and subsequent experienced gathered are lacking today and would still be a great asset, but there are other areas in today's practice where I would just drown unless sufficient time and instruction was allowed to catch up. I left just at the stage when I was still coping quite well on the outside but began to wonder for how much longer and with the unpleasant feeling that things were starting to get on top of me and I was losing my motivation and energy to keep on striving to stay on top.

    Sadly lack of support from my younger colleagues who do not seem to have the same understanding as older ones (of whom all of mine had left) through two close family deaths did not help stay on top of the game and forced me into early retirement but better that than stay on too long and go downhill professionally and carry around any failures or even errors for the rest of my life.

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  • michael stone

    She looked at 11 newspaper articles ... The majority of articles – 76% – took a negative view


    So how many of 11 articles, equates to 76% ?

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  • Hmm misreading table 1 ?
    Is that 76 articles = 61%?

    Was relatively easy to find from link.
    But I just briefly scanned her article.

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  • From experience in employing Hi tech individuals over a period of 30 years.

    The individuals who came from a purely academic ie University training route did not perform as well as the individual who had followed a City & Guilds training hands on route.

    I would presume it is very similar to today in nursing.

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  • It makes me wonder what has happened in the world when people (especially nurses) are judgemental of others for having a degree. Quite frankly I hate university & would much prefer to spend everyday on a ward but this is what is required of us. I have received nothing but negativity from senior members of staff be it HCA or RNs. Snide, catty remarks, and many of my peers experience the same. If this is how we are treated by our fellow nurses.. Let alone the media.. Maybe there is good cause for us to appear uncaring. So much of our training is about protecting ourselves!! Is it any wonder!

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  • Anonymous | 27-May-2014 5:26 pm

    doesn't sound as if your colleagues without degrees are any more caring! So it can't be degree training or not which affects the ability to care. I wonder what else it could be?

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  • It makes me wonder what has happened in the world when people (especially nurses) are judgemental of others for having a degree. Quite frankly I hate university & would much prefer to spend everyday on a ward but this is what is required of us. I have received nothing but negativity from senior members of staff be it HCA or RNs. Snide, catty remarks, and many of my peers experience the same. If this is how we are treated by our fellow nurses.. Let alone the media.. Maybe there is good cause for us to appear uncaring. So much of our training is about protecting ourselves!! Is it any wonder!

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  • An excellent discussion paper in the Journal of Advanced Nursing. It would be useful to have the actual findings from this research published so that readers can see who is constructing the image/identity of nurses and nursing ... the media.

    Nurse from NZ.

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  • Once again, NT publishes the headline and spins a story rather than offering an insightful critique and analysis of a piece of research concerning nurses. SHOW SOME LEADERSHIP!

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  • Think, even 20 years ago the treatment options we had were limited compated to today. Nursing and patient treatment has become a lot more high tech, nursing faces challenges such as MRSA & C diff alos financial pressures in trusts that weren't big issues in a lot of areas 10 or 20 years ago. Nurse education needs to keep up with the new demands on our profession.
    However we need to acknowledge that basic care and compassion are a large componennt in how a patient recovers. If you don't feel respected or valued whilst in a hospital or in the community by the nursing staff, your mental health is affected and this affects your phsical health. We need to balance how were educate and train our nurses of the future. Give more oportunities in allowing dual qualifications such as RN and RMN to help meet the needs of patients.

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  • michael stone

    andy | 27-May-2014 4:48 pm

    I must admit I couldn't be bothered to follow the link to the article - I just looked at the NT piece, and thought "wasn't I looking at a 'nurses can't do sums' piece here a couple of days ago'.

    11 did seem to be very small number for percentages - any sensible person would, for 11, be writing '6 of the 11 ...' anyway.

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  • michael stone | 28-May-2014 9:29 am

    andy | 27-May-2014 4:48 pm

    Agreed that many more articles should have been analysed.
    Sometimes my mind goes fuzzy when someone mentions statistics, especially during political debates where stats are presented from a very tight perspective only that politician can understand. (almost like saying 100% will die, sooner or later, and on average we're living longer - so now must work longer before retiring). Think some may have read a small book on 'How to lie with Statistics'.

    Hopefully when I get care, I'd like to receive best care with up-to-date skills, training, medication and equipment, delivered to meet my holistic needs and with dignity. However, it's lack of resources and political will to do what's right, which is affecting fair care being delivered to all our patients and doesn't feel nice to be on the wrong end of a priority list.

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  • Anonymous | 31-May-2014 8:03 am

    Lol, I'm not anonymous - the wonders of technology

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