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Student nurses face tougher tests for course places

Will higher academic entry requirements for nursing degree courses result in better care in the years to come?

Almost two thirds of institutions offering nursing degrees are increasing their entry requirements in the face of unprecedented demand for places, a Nursing Times investigation can reveal.

The survey of higher education institutions also found huge variation in the grades universities demand from prospective nurses and in the amount of time students spend on placement.

Entry requirements for nursing degrees ranged from 80 University College Admissions Service (UCAS) points, equivalent to one C grade at A-level, to 320, equivalent to an A and two Bs. Time on placement meanwhile ranges from 53 weeks to 85 weeks over a three year degree.

Of the 54 universities who responded to Nursing Times’ request for information about their three year undergraduate adult nursing programme, 62 per cent revealed they had increased entry requirements or were considering doing so, mainly due to high demand.

Gill Robertson, student advisor at the Royal College of Nursing, said it was likely the “social economic climate” was driving interest in nursing courses as people looked for a more secure career.

She said degree level education was essential due to the increasing demand for analytical and decision making skills among nurses.

“People who can’t meet that requirement can still care as associate practitioners or healthcare assistants… you have to have academic ability [to be a registered nurse].”

However, Dave Munday, lead professional officer at Unite, said he was concerned that some people who had the potential to become excellent nurses could be excluded by rising entry requirements.

The investigation found universities were asking for an average of 235 UCAS points for their next intake, equivalent to three Cs at A-level, with many also specifying one of the subjects was a science. In the past nursing diploma courses, which will be phased out by 2013 when the profession becomes degree only, have been open to applicants with five GCSEs at grade C or above, in line with the Nursing and Midwifery Council’s minimum requirements.

Director of policy at the Council of Deans of Health Matthew Hamilton said institutions would still take into account other relevant experience and entry on to degree level courses would be possible through foundation courses or other A-level equivalents.

He said: “We’ve got to welcome and celebrate the fact we’ve got more people wanting to be nurses than ever before.”

However, many universities are receiving up to 10 applicants for every place.

From next year applicants to the heavily oversubscribed Florence Nightingale School of Nursing at Kings College London must have 320 UCAS points, making it the toughest course to get on to academically in the UK. However, school head Professor Anne Marie Rafferty said grades alone would not guarantee a place if the student did not perform well at interview or pass numeracy or literacy tests.

Ms Rafferty said increasing entry requirements were a “positive trend” for the profession where increasing acuity, complexity and dependency of patients meant there was a need for a “highly educated workforce” but differing entry requirements created courses that catered for “different parts of the labour market”.

Just over a tenth of courses asked for more than 300 UCAS points, while just six asked for less than 200. The latter tended to be courses, such as those at Robert Gordon University in Aberdeen and Nottingham University, where students could go on to complete a degree or a diploma depending on their performance during the first year.

A spokeswoman for the NMC, which accredits all nursing courses, said there were no plans to stipulate minimum UCAS points for entry on to nursing courses once the profession became degree only.

She added: “As we move towards the degree-only education system it will remain important that higher education institutions have the flexibility to be innovative in the development of curricular and be able to respond and adapt to constantly changing health care environments.”

Readers' comments (22)

  • SO glad i trained years ago....i love me job but not academicly minded but i know what i am doing and get my job done. Does it matter if i can only write short paragraphs and not 2000 word essays, to say what has to be done and what the problme is????????

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  • If I was to do my Nurse Training now, with those expected grades I think I'd go into medicine at least you will be appreciated.

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  • About time, I have seen the quality slip. The uni I trained with used to graduate around 25 from an intake of 50. They are now graduating 250. We used to be proud to be degree nurses. We should be again and drive up intake standards.

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  • Anonymous | 31-May-2011 12:40 pm I actually agree, whilst I have reservations about our profession being worth it, pay, conditions etc which I voice regularly, I agree that the standards of entry for our degree course SHOULD be high. Not only that, the course content needs to be looked at to ensure we as a profession produce highly qualified and skilled, knowledgeable practitioners.

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  • Although I support nurse training becoming degree level, I am sceptical about the increase in demand for places. I do hope it is by people wanting to be a nurse, and not the attraction of getting a degree, only to go and leave the profession. Not all degree courses offer the work experience you get with health-related courses. Many nurse in high positions have worked their way through the ranks, from N/A to PhD, so I hope the openings for this progression continue. You cannot decry experience from the University of Life. So to coin a phrase, I hope the baby isn't thrown out with the bath water. I just hate the attitudes, not here at the moment I hasten to add, that after 3 years of training to degree level makes someone a better nurse than their forebearers. From what I have read, there are more comments in 'all' blogs about standards of care dropping since we 'became more academic'. Like everything else, time will tell.

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  • Degrees may improve patient care, but they won't beat the NHS system ( while it still exists that is)

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  • I am proud to be a one of the last traditionally trained nurses. I agree that that standards need to be raised but at what cost to the nursing profession. How many people will now not be able or feel they are able to enter our profession because they do not have the academic qualifications? Does having good grades make you a more caring person? I have worked with people who have excellent qualifications but do not seem to have an ounce of compassion who I wouldn't want to look after my dog let alone a relative.
    I just hope that some consideration is made to people who feel that nursing is their vocation but who lack the grades (yes, I still believe that nursing is a vocation)
    As someone else has said, if degree nursing was option when I trained I would have used my qualifications to be a doctor instead. I have been a CNS for two thirds of my career now, I still don't have a degree (have more than enough points though) but I teach at Degree and Masters levels.
    A piece of paper from a University does not make a good nurse nurse or improve patient care. It is the passion of the individual that does and a person either has it or not.

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  • presumably this new generation of nurses will be awarded more attractive employment conditions to retain and recruit them than is currently the place otherwise no one will consider it worthwhile entering this course of study.
    it seems that the aims are to have fewer qualified nurses so maybe there will be fewer of these posts and less graduates to fill them in the future and more associate practitioners and healthcare workers who hopefully will also receive appropriate and adequate training and certification so that patients are looked after by an all qualified workforce.

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  • I am proud to be a one of the last traditionally trained nurses. I agree that that standards need to be raised but at what cost to the nursing profession. How many people will now not be able or feel they are able to enter our profession because they do not have the academic qualifications? Does having good grades make you a more caring person? I have worked with people who have excellent qualifications but do not seem to have an ounce of compassion who I wouldn't want to look after my dog let alone a relative.
    I just hope that some consideration is made to people who feel that nursing is their vocation but who lack the grades (yes, I still believe that nursing is a vocation)
    As someone else has said, if degree nursing was option when I trained I would have used my qualifications to be a doctor instead. I have been a CNS for two thirds of my career now, I still don't have a degree (have more than enough points though) but I teach at Degree and Masters levels.
    A piece of paper from a University does not make a good nurse nurse or improve patient care. It is the passion of the individual that does and a person either has it or not.

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  • Anonymous | 1-Jun-2011 11:48 am lets not start this whole ridiculous my way was better than your way argument again. It is quite frankly divisive and pointless. Yes, a piece of paper does not make a good Nurse, but a good Nurse NEEDS that piece of paper to work in a highly demanding environment. Nursing IS a vocation, but it is ALSO a profession! The two can exist side by side and more people are starting to realise that. The notion that they cannot is archaic. I also disagree about the 'Doctor' comment. I have the grades to have studied medicine if I chose to, but I CHOSE Nursing because I wanted to be a part of this career. To insinuate that it is any less of a career than medicine is insulting, and is part of the reason why the bar must be set high for the course, if we are to be considered as qualified as our COLLEAGUES (not our superiors as many still have the preconception of). I do agree that we deserve the same level of pay, respect and status as our colleagues though and I know this is still the reason many choose to study Medicine rather than Nursing, this does need to change.

    Anonymous | 1-Jun-2011 10:03 am you make an excellent point about no one considering these courses unless the jobs, pay and conditions are there for them when they qualify, it is one that I wholeheartedly agree with, as I was just saying.

    To maintain a reputation as highly skilled and qualified professionals, then the bar must be set high. Would it really do the professions reputation any good if anyone without any qualifications or grades can simply waltz in? No, it doesn't. Would a medical degree accept people with no A levels or very few GCSE's? No. Would they allow people to continue if they could not keep up the academic standard required? No. So why should we? Nursing is an amazing profession and deserves the best people, and those who aren't up to the academic standard may be very caring, but if they aren't up to the standard, they should not be in the job, there are roles for carers who are not up to the standard. I have always argued Nurses now (and in the future) will need BOTH academic ability AND a caring attitude. Those who do fit the entry requirements and can keep the academic level required through the course will be no less caring.

    BUT, as I was saying, there MUST be the jobs, pay and status available to those people when they graduate. Highly skilled and qualified professionals deserve no less, and will not stick around if they are not.

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  • Mike
    from Anonymous | 1-Jun-2011 10:03 am

    unfortunately my remarks are only based on my presumption of what should happen in an ideal world. Can you really see this happening?

    I do believe that nursing in future will look very different, as it does now in comparison to say 50 or even 25 years ago, but what direction is it really going to take? Is it only the government which will determine this and to its own financial advantage. Will there be nurses who are more highly qualified but far fewer of them? Will they be paid salaries in line with their expertise, or are they going to let standards of care drop even further with the profession going down the drain?
    There are so many golden opportunities out there for the profession, but they must not be frittered away by a succession of unscrupulous governments who are merely driven by finance rather than the social and healthcare needs of the population.

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  • Anonymous | 1-Jun-2011 6:22 pm I agree that I share that assumption of an ideal world, and I can and I can't see it happening.

    If the profession carries on as it is doing now, then it will never happen and we will slip back into being nothing more than HCAs with a lot more accountability, second class workers to the almighty Doctor.

    If the profession stands up and fights, which I have been urging, arguing and pleading for it to do, then we stand a chance of becoming a truly powerful profession in our own right, offering high quality, highly educated and skilled Nursing care at the highest possible level, with the same status, pay and respect as Doctors and much, much better working conditions. I CAN see this happening, we are on the verge of it now, but only if we fight and take control of our profession and the future of the NHS.

    And back to the point of the article, ONE small aspect of that is ensuring that an all degree profession has the highest calibre of candidates coming out of it.

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  • I agree with nursing being a degree discipline instead of Diploma and nurses being seen in the same professional way as Doctors etc. But what about those excellent nurses out there who only did higher education Diploma in nursing are they going to be seen as second rate nurses bearing in mind some nurses out there have degrees in different subjects like my self, also what about the potential nurses who could have done the Diploma in nursing due to life experience etc but have to have A levels to get on to a degree course. And does a degree guarantee a more excellent/professional nurse, I am not criticising just asking questions

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  • I agree in principle with higher entry standards for nursing. The problem as far as I can tell are the presence of personality and emotional measures that are also very important in developing skills and abilities at practice level. Who will measure and monitor these?. (not all mentors are good at this!)
    Many people want to be nurses and do have the requisite academic standards. But, as someone has already said ,will they remain in the profession or seek more powerful and monetary rewards to fulfil there personal ambitions?.
    There is always room for middle ranking nurse professionals who love their work and simply want to assist patients to optimum health and well being. Many R.N.s' fulfil that role well and have a mature and steadying influence on the profession. A powerful academic professional may have a negative effect too and become remote and 'coldly' indifferent to patient/public opinion. We mustn't lose our support base, the patient! the reason for our very
    existence .

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  • Anonymous | 1-Jun-2011 10:13 pm No not at all, I hate many of the attitudes and arguments that pop up when discussing the academic advancement of our profession. Those without degrees trained in a time when it was not a degree profession. Many have gone on to gain degrees and qualifications post qualifying, and have also gained a wealth of experience. (By the way, I count myself in that number having gained a Degree in a separate discipline before I trained as a Nurse). This in NO WAY means they are 'lesser' Nurses, simply trained in a different way. Future Nurses will not only gain more quals and experience over time, but will have the benefit of starting out with a degree. This makes them no better or worse than Nurses trained in different ways, but WILL help to enhance and shape the profession in ways that was not possible in the past. That HAS to be a good thing, right?



    Anonymous | 2-Jun-2011 10:56 am, I see what you are saying about graduate Nurses remaining in the profession or seeking more powerful and monetary rewards to fulfil there personal ambitions, I even agree to an extent. I have argued many, many times that there need to be the jobs, and the pay and conditions to keep these graduates. However, I will also counter that in time, these graduates will force the profession further, there will/should be advanced roles for these graduates to move into that STILL allow them to simply 'love their work and assist patients to optimum health and well being'. There is room not only for newly qualified band 5 Nurses and 'middle ranking' professionals, but also very advanced Nurse practitioners, perhaps even new roles of Nurse Physicians etc, that allow Nurses with Masters and Doctorates to Nurse at a very advanced level. That doesn't always have to mean a move into management or away from the profession. BUT, to see this happen, the roles HAVE to be put in place, there HAS to be the pay and the conditions to keep highly qualified professionals, and THAT is what we have to fight for now.

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  • I find it sad that by becoming a nurse via degree that I am perceived as being uncaring.

    It seems obvious that once the diploma has gone and almost forgotten that they will gradually bring in compulsory NVQ's for healthcare assistants or introduce a role that follows some kind of 'diploma' path. This will then allow for a larger pay gap between nurses and assistants and the ability to reduce nurse positions. Not rocket science?

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  • “We’ve got to welcome and celebrate the fact we’ve got more people wanting to be nurses than ever before.”

    Entry to a nursing career is advancing to degree level, on one hand, and there are more applicants, on the other...it doesn't add up.

    '...grades alone would not guarantee a place if the student did not perform well at interview or pass numeracy or literacy tests...' I just can't believe that degree level students may not have numerate and literacy skills.

    I have fought and won in my department to recruit band 6 nurses with either a degree /andor relevant clinical experience. A newly qualified nurse with a degree certainly is not seen as superior to an experienced nurse.

    As for the comments on pay, think ourselves lucky that our pay, without a degree or diploma we have been on par with those who have..APHs



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  • Anonymous | 5-Jun-2011 0:08 am

    "Entry to a nursing career is advancing to degree level, on one hand, and there are more applicants, on the other...it doesn't add up."

    Why not?

    " I just can't believe that degree level students may not have numerate and literacy skills."

    It is simply a fact many didn't and the tests I believe were a remnant from the diploma (I may be wrong). Isn't this the point of raising standards though as the article suggests?


    On the pay issue, no you are dead wrong. We should not in any way shape or form consider ourselves lucky.


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  • One of the most effective ways to ensure Nursing attracts quality appplicants is to improve the pay and working conditions. Nursing in the UK has lower salaries than any of the other English speaking countries even when compared to the cost of living and school leavers notice these things. Nurses in the UK, while some of the worlds best are working to the point of burnout and having worked around the globe a bit I have seen the difference. It is significant. All these will have to change in order to change public perceptions of nursing.

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  • I'm only a first year student, but I couldn't agree more. I worked my bum of at college to gain maximum UCAS points to ensure I got a place on my course, the demand for places is dramatically increasing, I was too worried about not getting a place. I also couldn't agree more that there is more to Nursing than the acedmic side, but Universities must get tougher about who they accept on these courses. The interview stage, academic references and academic grades must all be looked at and they should all be compared. These potential students will be going out into practice and eventually as a registered nurse with the responsibility of the publics health and well being.

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