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Practice comment

“Celebrate the pioneering move to raise education status”

Can nurses provide better care if they have a degree?

The considered answer seems to be “yes” as universities phase out nursing diplomas over the coming year in favour of three-year undergraduate programmes.

But recent coverage following the death of Jean McFarlane, who did so much to transform nursing to a degree-status profession, shows that some still have doubts over its benefits.

Praising Baroness McFarlane’s intentions, Illora Finlay, professor of palliative medicine at Cardiff University, nevertheless suggested in turning nursing into a graduate-entry profession “basic caring got overlooked”. She argues in a recent article in The Times that students should instead be learning alongside experienced nurses in real clinical situations.

It seems Baroness Finlay - and perhaps others serving the health sector - may be unaware this is already a key component of graduate programmes. All nurse educators are experienced nurses in their own right and half of all student nurses’ education programmes continue to be in clinical environments. Simulation and skills laboratory sessions merely help students learn and perfect skills safely, before practising them for real, under supervision of clinical staff.

So nursing has not lost the art of bedside care, and raising education standards cannot be correlated with poorer standards of compassion. Where bad practice exists it must be addressed, but there is no evidence that this is perpetrated by graduates.

Before becoming involved in teaching, I worked as a ward sister in intensive care and coronary care units. In my experience it is often the undergraduates and newly qualified graduates who are able to articulate how practice falls short against best evidence and who raise concerns about poor standards, which have been tolerated by the permanent staff.

Our understanding of good practice has been acquired through nursing research conducted by degree-qualified nurses.

As qualified nurses and nurse educators, my colleagues and I are passionate about the need to provide high standards of care. At Worcester we use a range of selection activities to ensure students have the academic ability and also the attitudes and behaviours that will enable them to become knowledgeable, compassionate nurses.

Patients are actively involved in curriculum planning, delivery, assessment and programme monitoring to ensure they have their voices heard.

An excellent nurse is knowledgeable, technically competent, maintains high standards and is able to provide ethically sound care. For this, the nurse also needs courage - both to maintain those standards within challenging environments, and to raise concerns when others do not.

Far from getting in the way of caring, the qualities acquired when studying for a degree alongside personal attributes of good communication, care and compassion, helps give nurses the confidence and skills to be able to do all this. For this reason we should be celebrating Baroness McFarlane’s legacy, rather than bemoaning it.

Jan Quallington is associate head, Institute of Health and Society, University of Worcester

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Readers' comments (48)

  • There are thousands of people who would make fantastic nurses but don't have the academic qualifications to get on a course. They cannot always spend at least a further year on an access course.

    That is the worst thing about degree nursing.

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  • I read a piece by B. Finlay in the Times just after her friend died, and one of her points was this - unless nurses are actually at the bedside, talking to and observing their patients in a wider sense than 'briefly taking clinical observations', the nurse cannot 'pick things up'.

    I agree with B. F. about that point, but not with everything else she writes.

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  • A degree in nursing from a jumped up Poly. Wow! Big deal. You can have, degrees, Mscs, and more. It will do you no good if you are just some ward drone. Intelligence counts for nothing on most wards, because they are run by HCAs. This is usually in connivance with your boss. You are/will be disenfranchised by your very leaders. Stop deluding yourselves into thinking you will make a difference. Affect change? Ha ha! Listen, we don't even get to have a tea break. Also, even though you may work until exhaustion, the NHS, when it's finished with you, will throw your dried up husk of a body out the door. Ha ha!

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  • Most of the newly qualified nursing staff that I have met are intelligent, articulate and eager to learn. They are also confident and aware of the huge responsibility they carry to appear knowledgable after their degree course. However passing the course is just the start of a lifetime of learning as it has always been. Whilst I agree with 'anonymous' above that there are 'thousands of people without academic qualifications who would make fantastic nurses', I would question whether someone who had attended school since the 1990's but did not reach the criteria required for a nursing degree would be able to cope with the highly technical nature of the job today.

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  • Nursing and what is expected from nurses has changed almost beyond recognition since I began my career 32 years ago.
    I don't now believe that anyone with a good heart and the desire to nurse train (but less than the required academic level) would be able to cope with the either the training or amount of the post grad learning that comes (and does not cease) after qualifying.
    It's not just about keeping upskilled, for me, who only graduated in nursing after already being a nurse for 20 years, there's a constant desire and drive to learn, improve, challenge and question to be a better practitioner, which can only result in improved patient outcomes.

    I maintain we can make a difference, although maybe small in many instances that's how most change begins. Its sad to hear of poor culture still existing but we all know its around. I worked on a ward where, similarly the ward sister and HCSWs were the decision makers but that was in the 1980s!!

    I agree with the comments re- nurses who have been educated to degree level have the confidence to question & challenge. Knowledge is a powerful tool. However the graduate nurse also has to be able to put that knowledge into practice to win credibility of his/her peers. That's what people fear will be missing (there's been anecdotal stories giving a bad light) which is unfair to many good nurses coming out with degrees who want to be 'hands on'.

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  • I would suggest that the person who wrote that "thousands without academic qualifications would make good nurses" actually has NO idea of what nursing is! You can be as caring as you like, but being unable to understand the significance of subtle changes in biochemistry, complex drug interactions and calculations, and above all not having the academic confidence to challenge medical colleagues while advocating for the patient leads to the sad cases we see in the press. We need more, and more educated, nurses, as a vital part of the team. HCA's, nurses, doctors, AHP's, admin, WA's etc etc are all specialists in their own jobs, and are all valuable and certainly not interchangeable. The idea that nursing is ONLY about bedside hands on care is the dangerous one for patients. When I am in hospital I want a clever nurse, not one who can only hold my hand while having no idea why my condition is worsening and what to do about it.

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  • Anonymous | 5-Aug-2012 4:28 pm

    Hi, you make some interesting points about the importance of academic ability to function effectively in a modern health care environment. I suppose from my perspective (I achieved my degree well into my career) my academic studies taught me how to rigorously consider research and information and write good assignments using critical analysis etc.
    What it didn't do is help me to learn " how to" in the work environment. In a nursing role you have to have so many other skills, interpersonal, critical observation, clinical decision making in action, supervision and mentoring - the list of knowledge and skills nurses use every day is endless.
    If I am ever an inpatient hospital I also want a nurse who is academically able and functions well in a fast paced high tech environment, who is able to challenge poor clinical decision making on my behalf from a sound knowledge base; but I also want them to be able to deliver the softer side of the role, making sure my needs and the needs of my relatives are met. I hope I have expressed this well, what it means to me is that nurse education has to have enough of both elements, academic ability and ward/ community based learning "on the job" from a good role model who will act as a robust gatekeeper to the profession.

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  • raggedtrouseredphilanthropist | 5-Aug-2012

    You put it across very well and I think everybody should be able to look at nursing from their own personal perspective as you do and examine their role in the context of what they would expect if they found themselves in any of the situations of their patients receiving their care and their patients' relatives and how they also have their needs met. We should never lose sight of this.

    My post reg., post grad degree late in my career also helped me, in addition to the assets you list, to better understand the management process as well as organisational and team behaviour and being a part of it and how to understand how conflict can arise and possible ways of diffusing it and dealing with it even if it escalates out of control, and the advantages of being able to lead by example from the bottom up as well as the top down and that everybody at every level has a vital and valuable contribution to make to the smooth running of the organisation as a whole and every department and each individual person in it, no matter what their role and which obviously has an impact on patient care.

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  • I am in my 40th year in the NHS, working as a research nurse for the last 6 years. I have only had one student nurse who has approached me showing an interest in what we do. I consistently have training sessions on the studies we run with information folders, information boards and presentations. These nurses provide 'evidence-based practice' they say, but when they have the chance to participate in future treatments, there is amazing apathy. I get a more positive response from the trained staff, the vast majority are non-degree nurses. However, there are barriers. The school of nursing have no room for us to provide teaching sessions in their rigid curriculum. It really beggars belief and questions whether current research/evidence-based is actually valid.

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  • Anonymous

    raggedtrouseredphilanthropist | 5-Aug-2012 9:19 pm
    Anonymous | 5-Aug-2012 9:51 pm

    I agree with both of you, and clinicians are not considering the full picture if they don't grasp:

    'and examine their role in the context of what they would expect if they found themselves in any of the situations of their patients receiving their care and their patients' relatives and how they also have their needs met. We should never lose sight of this.'

    Anonymous | 6-Aug-2012 1:18 am

    'It really beggars belief and questions whether current research/evidence-based is actually valid.'

    There are lots of questions about the evidence base for things falling into the category of 'beliefs and behaviour' but outside of simple issues. Some things are pretty clear: can a particular antibiotic kill a particular bug.

    But somehow, many claims are backed up by no actual evidence. A few years ago there was study reported in the media, that keyboards were covered in bacteria, and the conclusion reported was that you shouldn't eat at your computer - the implication being that if you did, you would get food poisoning.

    But you test whether eating at your keyboard gives you food poisoning, by studying the number of food poisoning cases, and the study didn't do that. It just measured bacteria on surfaces.

    There is presumably an awful lot of 2 +2 + 3 = 9 out there.

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  • Anonymous | 6-Aug-2012 1:18 am

    This is a really worrying post in relation to student nurses attitudes to learning and seizing opportunities. I suppose we can argue there are a variety of pressures on people to meet the reading and writing required for academic assignments, as well as meet the demands of a busy placement, and maintain a work/life balance. Phew just writing the sentence makes me realise the juggling act for people every day!!.
    However, I would have expected that to spend time with research nurses, who I think would practice every day the fundamental skills required for academic success would be beneficial for students??
    For you not to have the opportunity to support pre and post grad learning just amazes me and I can only wonder what the reasons might be.
    In the area I work they are fostering the rebirth of second level nurses, Assistant Practitioners - and I wonder how they fit into the plans for a degree only profession. Correct me if I am wrong but I think they currently do a two year qualification that enables them to practice a band 4??
    For any one directly involved in planning for future nursing education I don't think they can look at just RGN, if they do then they could miss the bigger picture of how it all fits together to create an effective team with the right knowledge and skills across the disciplines.

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  • 1.18 am

    presemably all degree courses what ever the subject include a basic research module!

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  • Thank you every body , academic and skill and all of the above are needed for for nurses to function effectively.

    In all honesty since the degree in nursing came to light a lot of bed side skills and communication skill have been droped or not picked up at all with the degree holders in nursing.

    I have been in nursing 31 yrs , i did general nursing training , which included pharmacology, biology etc. surely this is equavilent to a degree but the bed side and hand on skill are equally important. This things are now missing in nurses.

    All the degrees have not made nursing better and publicity morals and pay are still low , a degree holder in IT , LAW, ACOUNTING , etc get more pay than nurses with degree . And hardly are morals , publicity and pay low in those professions / sectors.

    We are not ment to condem each other but to compliment one another .

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  • michael stone

    raggedtrouseredphilanthropist | 6-Aug-2012 11:04 am

    This is off topic, ragged, but I have spotted that you share an interest in end-of-life behaviour with me.

    I have posted something in the forum section under 'Have your say' titled 'What should happen in this situation ?', and I would be very interested in your opinion/analysis of the situation I describe.

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  • I qualified in 1985 with no degree. I still don't have a degree. I don't think a degree make for better nurses. I believe that nursing is 99 per cent common sense and 1 per cent theory. Call me old fashioned.

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  • Nurses often talk about having these great technical skills that you need a degree for. I haven't got a degree, or a diploma, just an RN course in the days of the DC entry test.

    Amazingly, for someone so thick as I obviously am, I can calculate complex drug dosages, understand blood chemistry and even speak to my medical colleagues as equals.

    Please don't patronise those of us who don't have a degree but are intelligent thoughtful human beings.

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  • Replying to raggedtrouseretc - I am anonymous 4.28pm

    Yes, I absolutely agree that the soft skills are indispensible, and somehow hope that anyone wanting to nurse does have some inkling of these feelings of empathy, interpersonal skills etc, all of which are honed on the job as are the academic skills. I remember learning some phrases and ways of interacting from senior staff in my junior days which inspired me and changed my own practice, for example.

    I am terribly worried by people like anonymous 4.56 who truly believes that nursing is "99% common sense" - why ever do we learn anatomy, physiology, psychology, as well as how to replace suprapubic catheters, intercostal drains, take complex neurological observations etc etc when we could do it all by "common sense"!

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  • if nursing is 99% commonsense I see little point in spending three years training, degree or not. As for the 1% theory this could be learned relatively fast and would also not require three long years or any CPD! this would cut out the three yearly re-registration with the NMC.


    would you need to pass an exam in commonsense as well as the theory to get NMC registration?

    can you rely on commonsense alone to understand the research process and evaluate the literature to inform evidence based practice?

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  • Is anyone beginning to feel this argument is getting boring, degree vs non-degree. There are good nurses with degrees and good nurses without degrees.

    What is all this 'technical' stuff nurses are supposed to do these days that we didn't do before?

    I do think having a 'common sense' module would be a great idea because many nurses haven't got any common sense at all but are very good at arguing and at making something simple seem extremely complicated.

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  • above

    answer to first question YES!

    my question, how can you teach somebody 'common sense'? does anybody really know what this is?

    you last statement, i totally agree.
    I used to have great fun when my colleagues spent ages in the office arguing about how to best approach a problem. maybe it was just an excuse to keep the weight off their feet for longer? I would get very bored and restless and slip out of the office and go and do the task myself, usually in a few seconds, and then let them find out for themselves, sometimes after having prepared all the material, only to discover it had already been done! some of their reactions were a study! I am a doer rather than a chatter as people tend to explain or discuss something quite simple one way and then continue rephrasing it in lots of different ways, usually louder and louder as though they think their interlocutors are thick, until they run out of vocabulary! when it is not boring, or time wasting, it can be amusing!

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