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Practice Comment

Moving to an all graduate profession is a necessity

Controversy continues to rage over nursing as a graduate entry profession, but this move is a necessity to deliver healthcare in the 21st century, says Sue Bernhauser

The demands on the nursing profession in the 21st century are far more complex than those of the past. Historically, nursing has sometimes been viewed as a low status profession, but this must change if we are to embrace the challenges ahead (see this week’s In depth article).

Over the next 15 years and even beyond, nurses will meet challenges relating to changes in demography, disease patterns, lifestyle, public expectations and information technology. We will see the greatest demands in healthcare met by nursing or other therapy care. There will also be a growing need for healthcare professionals with advanced practice skills and they will need to develop these from a graduate knowledge base.

The announcement that nursing would become an all degree profession by 2013 was greeted with concern by those whose image of nursing rests in the past rather than in the future. Nursing is not – and should never be – simply the carrying out of uncomplicated tasks under the direction of others. Nor is it a vocation for which short term technical training will suffice. It is a profession that requires highly knowledgeable and competent individuals.

Changes to pre-registration nurse education will equip nurses to lead and deliver compassionate care and ensure that the practitioners of the future are equipped to work in a modern healthcare system. Such developments will bring nursing in line with other healthcare professions in the UK and with the requirements for entry to the profession in several other countries in Europe and elsewhere. Midwifery moved to an all graduate profession years ago and Wales has already moved to having an all degree nursing profession.

Research findings that support graduate level nursing can be found over decades and in different countries. Studies in England, Scotland and Northern Ireland have shown that graduate nurses spend longer working in clinical areas than their non-graduate counterparts. American studies have found that graduate nurses stay in the profession on average four years longer than non-graduates and, in addition, they tend to stay at the bedside more often, working with older people and those who are terminally ill. Research in the US has also noted that graduate nurses acted more independently and took more responsibility for their professional judgement and, additionally, took on advocacy roles. They were better than non-graduate nurses at making nursing diagnoses and evaluating the effects of nursing interventions.

Moving to an all graduate profession has important implications for social and economic change in the UK, since upskilling our profession to graduate levels will probably increase the proportion of women and black and minority ethnic groups in higher education and the health service. It is important that access to degree level provision should continue to be broad, to ensure a healthcare workforce that reflects and is responsive to the diversity of its patients. Universities work hard to enable people of all ages, backgrounds and attitudes to receive formal recognition for the skills and knowledge they already possess and value the experience of colleagues within the existing workforce.

Looking forward, rather than simply focusing on whether nursing should be an all graduate profession, our attention must now move to how this can be successfully implemented in England, while maintaining wide participation. Universities should look forward to meeting that challenge in the months ahead.

Sue Bernhauser is dean of the School of Human and Health Sciences, University of Huddersfield

Citing this article

If you cite this article as a reference, please use the following, as published in Nursing Times magazine:

Bernhauser, S (2010) Degrees will equip nurses to meet future challenges in healthcare. Nursing Times; 106: 21, 8.

Readers' comments (88)

  • Let me say that there is nothing 'upskilling' about de facto degree education - it depends entirely on the content.

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  • here here! to the above it is not only what you know it is if you can put it all in to practise ? hands on always shows the flawes? i suggest that universitie class mentors go back to hands on because what your teaching your students is nothing of the real world in face we get replys: they didnt tell us that, oh they havent prepared us for this, you have more understanding then at uni irest my case it is the content or the lack of?

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  • rovergirl6@hotmail.com

    OMG this will take the nurse even further away from the bedside. how can they possibly make diagnosis when they are so very distant from the real reason they went into training . may i remind you
    TO BE A NURSE.

    The worst decision ever made was to remove the SEN from our wards. in an effort to reduce wage bills and produce one level of nurse,this was soon rescinded and we were treated to the first level and the second level ,now the powers that be have decide to 1) upgrade Health Care assistants requiring them to do level 5 NVQ.
    which will by the way replace our SEN. They do indeed perform all the tasks of the SEN.

    2) Insist on degree level nurses. why oh why.
    all we really need is a team of staff on our wards who are able to perform all the duties as a team to care for our very important patients.

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  • How can one hope to carry out technical skills when one cannot even spell? We need well EDUCATED and TRAINED staff to apply effective nursing care.

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  • Well said! The bad grammar and spelling shows a lack of education!

    Do such nurse know what drugs they are giving and what doses?

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  • Sorry I have missed something along the road here.
    Yes all nurses need to well educated and knowledgeable to perform their role in society BUT when did we (NURSES) lose sight of what we are meant to be doing? Call me draconian but surely bedside, hands on care, delivering holistic, personal care to every patient as an individual is what the "profession" is about. I think in our haste to become "recognised as a profession" we have lost sight of our true ains. As a manager I have worked with some totally fantastic "old style" nurses with only a basic nurwse training but who enusred the had the theoretical knowledge to underpin their paractice. I have also worked with some very highly qualified academic nurses and that's all they were.....academics. They can right a fantastic care plan, conduct research and quote policy verbatem BUT hadn't got a clue what to actually "do" with a patient. Time to get back to grass roots and re-evaluate what Nursing is all about....not I say Nursing and NOT pesudo medical practitioners !!!!!

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  • .......and before anonymous (above this previous post) decided to pass comment about my grammar and spelling mistakes...it was typed in haste ok!!!!

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  • The status of nursing and nurses within healthcare has absolutely nothing whatsoever to do with Degrees. If any nurses, from the Chief Nurse to the most newly qualified think that the vast majority of other healthcare professions are going to treat them any differently because they have a degree they really are living in some kind of other universe. Nurses have always been seen as subservient and less skilled than others, and they always will be until there is a CULTURE change. Its a bit like comparing the alcohol abuse in the UK with other EU countries-its NOT about price its about ATTITUDE. Nursing is the same and all the degree-only move will do is make it more difficult to recruit the numbers and quality we need to fill the future workforce requirements (members of the public and government ministers -YOU HAVE BEEN WARNED!) and will
    exclude many potentially good students as they won't have the entry criteria. I am male, a university lecturer with a first degree and two Masters-do you think that makes me more respected? Don't make me laugh, its what is expected in my role, but I am under no illusion that others still don't look down their noses at me because I am a nurse.

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  • How can Sue Berhauser say that nursing in the past was viewed as a low status profession!
    I can assure you, I and many many others joined nursing as it was a profession to be proud of and was respected by the public.
    What has got out of hand is top heavy theoretical work and not 'enough hands' practical teaching.
    Surely with all the comments above you need to listen to what staff on the ground floor are telling you. What about putting it to a vote?

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  • As I have said previously, a nurse will find out more from a patient,medically, psycholoigically and emotionally, when she is bathing or toileting a patient than any degree will enable them to.
    Yes get nursing recognised as a profession but don't make them so over qualified that they lose sight of the actual patient. This is what has happened with doctors. They see a patient for about 3-4 minutes, maybe, on a ward round and actually know nothing about them.
    Don't make nurses clipboard carriers and note writers. There is so much more to nursing than that.
    There are thousands of people who will be put off, and would make excellent nurses, because it is too academic.
    Let nurses go on to get a degree, like I did, once they have mastered the basics of nursing. This is only attanied once a nurse has qualified.

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  • Peter Goble

    I entered nursing with 3 A Levels in 1956, at a 'non-Teaching Hospital' (not associated with a medical school). Most nurse-training took place in these 'ordinary' hospitals, and most student nurses had modest academic results from school; few had A levels, I was unusual, but I was a young man too.

    I had to start from scratch in nursing, my education counted for little. I remember polishing brass door handles and washing out the blackened polish-cloths by hand during preliminary training, and learning how to make a padded splint from scratch.

    Training was systematic and thorough, lectures and practical skill-training were delivered by experienced clinicians, and doctors and surgeons took pride in coaching and instructing nurses, even very junior ones.

    The hospital community was stable, and a student nurse was seen as the responsibility of the whole community from start to finish. Training included a moral dimension appropriate to the work, and professional behaviour was shaped up gradually, strictly but not unkindly, by mature mentors and guardians of the vocations of medicine and nursing.

    Records of training were simple, straightforward, unambiguous and to-the-point. Much of what was taught is still appropriate to today's care, although the pace and scope of treatment has changed vastly.

    Nurses are characterised by their being drawn to care for other human beings in need, by a fascination for human diversity, by an aware need for and satisfaction in personal intimacy (physical, emotional and psychological), within properly applied boundaries, a 'common touch', and a robust sense of humour.

    I obtained a teaching qualification after fifteen years, and a degree after twenty five. After thirty five years I completed the circle and returned to hand-on nursing, retiring after fifty-three years of continuous service.

    I am unimpressed by the quality of nurse education and training today, by the quality of the nursing degrees conferred, and - in general - by the quality of attention I have received from nurses as a patient. They seem much less knowledgeable about health, illness and medical treatment, and less dexterous or concerned about - and respectful of - the welfare of sick people than in the past.

    This is regrettable, and I wish it were different, but I don't think change is likely, and I don't think that universities are going to come up with a solution.



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  • I disagree on a personal level as I was not allowed to do the degree due to having no A levels and was told I would struggle with the academic side of things. I basically did not meet the entry criteria. I did the diploma and won both a scholarship and the nursing study prize, which were for getting the highest marks both in my branch and cohort. Therefore I would have totally been able to undertake the degree and probably would not have struggled at all. There is no system to judge people on their inidividual merits, I was just classed as not capable from the start. I have now completed my first CPD degree module to start the top up process, and was told by my assessor that my work was 'outstanding' and she wanted to use it as an example to others. It was unfair that I was not even given the chance to do the degree in the first place. I am a community paediatric nurse and do quite well in my job, thank you very much, however, if I had decided to leave it a few more years before training when the degree becomes compulsory, I would not be allowed to become a nurse. Making degrees compulsory will prevent people in my position entering a career that they love and can do well in, simply because of a set of entry criteria. If degrees really are to be compulsory, the entry requirements need to be looked at to overcome this discrimination.

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  • Well judging by the comments so far, the author of the article is in the minority and In my opinion should remain so. Hands on and not in the classroom is where the real learning is done where, as someone has already said, the teaching is usually done by lecturers who haven't been on a ward to do a shift for years

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  • Not surprising that the author of this article is in favour of an all graduate profession as it justifies her job role. I agree with the comment above there will be huge problems in trying to retain and recruit nurses in the future which will mean repeating the old cycle of having to recruit from other countries causing a nursing crisis in their country, my own experience has shown me that the nursing leaders, academic etc., never learn from past mistakes, i.e. changing the "Profession" from a 2 tier to one level nursing, then back again to upskilling HCA's, continuously changing the nursing curriculum, the author's comments were breathtakingly arrogant which does not surprise me one bit I assume she has been out of clinical practice for years.

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  • Sorry, but I'm on Sue Bernhauser's side. Like our colleagues in O.T. and Physio, we should be degree educated. Let's go forwards with nursing, not backwards.

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  • I do not understand why people feel threatened about raising the level of education of nurses? I feel it can only be a good thing to give nurses the skills to question the care they are giving and provide the highest level of care possible, which is much needed on the wards. I am currently a degree student and I do not feel that this will take me away from the bedside. I resent the debate that 'old style nurses are better nurses than those that are degree educated. I have excelled at my programme so far both academically and during the practice placements, attaining the highest levels of feedback possible from my mentor in areas such as care and compassion. I have met plently of diploma students and nurses on the wards that are truly and worryingly terrible at nursing and also lack the care and compassion that is often missing from the wards. I believe this is a general problem across the board and not to do with the fact that one is better at essays than the other. Lets all wise up to the fact that you do need to have a brain to be a good nurse and this move will be better for our patients in the future.

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  • Steve Williams

    Nurses can get as many qualifications as they wish - they will still get rubbish pay, rubbish treatment and zero improvement in their conditions. Sue Bernhauser is misguided if that is what she is eventually hoping for.

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  • I'm sorry, but I fail to see how learning to polish door knobs or keep the sluice spic and span as a student makes you a better nurse? Surely greater academic knowledge will help you care for your patients at a higher level?

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  • Malcolm Chalk BA, RN

    I've got to agree with Berhauser and as I've said before on here, we need to move forward in our profession. One of the things that's been holding us back is that stick in the mud, Blackadder old school of nursing drivel.

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  • Malcolm Chalk BA, RN

    This is along the lines of what I said in November:-
    Our profession 'is' evolving and we certainly learn far more as a university based profession than from the old nursing schools. Of course you build up your practical skills over the years the same as most jobs, but the difference now is the academic skills we can use as part of our nursing toolkit. Unfortunately over the last three decades thatcheristic ideology took the wind out of the sails of an understanding of workers rights, equality, and what really is fair pay. This nievity often reflects on potential and newly qualified nurses, as well as those old school nurses whom have still got their noses well and truly stuck in an uncomprimising nosebag of the past.

    We all need to push a lot harder for respect and recognition of our practical as much as our cognitive skills. I think we are all starting to realise that nurses are the new junior doctors and our pay should be on a par with theirs. We must not do ourselves down; academia whether university degree or university diploma (there's not much difference other than means testing between them) is the keystone to professional nursing and eventual parity with the medics.

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