'The arguments around nurse training are getting louder as we get poorer'

11 June, 2010 | By Mark Radcliffe

So we’re lying in bed reading and listening to Radio 4. We are at that place in life where this constitutes a date.

An item comes on the radio telling us about an American performance artist - Laurie Anderson - who has written a piece of music specifically for dogs.

“Is there anything more pointless than music for dogs?” I ask.

“Golf clubs for cats,” replies my wife without looking up, adding: “How do you know you are a performance artist?”

“Same way you know you are a con artist,” I suggest. “After you’ve fooled a certain number of people someone sends you a badge.”

‘Bankers have always struck me as pointless; they may well make money but they don’t produce value do they?’

I am not against pointless or even self indulgent things. We grow flowers and get tattoos; we don’t consider these to be activities of artistic or social importance. They are just things we do. Other people carve stuff, someone I know likes to iron. It takes all sorts. But in these austere times I wonder if we think about pointless activity - and even jobs that don’t really produce anything useful - in a slightly different way?

Bankers have always struck me as pointless; they may well make money but they don’t produce value do they? Estate agents too. Nearer home I remain unconvinced by many psychologists, especially those who go on television to give a psychological perspective on things like divorce (“well, often people stop wanting to be married to each other; put the cheque in the post won’t you?”).

I believe it is wholly unhealthy to point the finger at others without having the good grace to first point it at oneself, but if I make a living teaching nurses - and assuming I am not terrible at it - I think I can say I am doing something useful. Nurses are necessary and I help them learn, ergo if not entirely necessary then I am perhaps at least a bit more useful than an estate agent. However, as I work in a university and can easily stand accused of being one of those people who “teach them how to write essays rather than how to put up a drip”, it is possible that I am a force for evil - what with my social science nonsense and silly preoccupation with emotional labour.

Obviously I believe thinking and the move to graduate entry nursing is vital, otherwise I wouldn’t encourage it. But I wonder what the humming presence of a recession and the “need to tighten our belts” does to our judgement about what is necessary and what is a waste. It seems to me that the arguments around nurse training are getting louder as we get poorer and, as a consequence, we may find we are - and, let’s face it, some of us have been here before - persuading ourselves that the cheap option is, by sheer coincidence, also the best option.

Shorter training, less educational support, maybe a different skill mix and perhaps lower knowledge expectations? Just what nursing needs. We can call it realistic, we can call it inevitable. Is it merely coincidence that now, of all times, some people will call it “right”?

Readers' comments (91)

mike | 12-Jun-2010 7:15 am
This article hits the nail right on the head.

Nursing degrees ARE essential, but the content of the course does need revising.

The problems with funding are ridiculous though.

Student Nurses are leaving in droves because they cannot afford to stay on the course.

Student Nurses are qualifying and are then unable to find jobs anywhere because the idiots at the top are not releasing the funds for posts that are needed. (Example, I know one ward who NEEDS 12 trained staff, but they can't get the funds released for that, how is that safe?)

Qualified staff are deskilling and not keeping up with qualifications because cash and staff strapped wards are not releasing them for mandatory training (and even when they do you often have to fight for it).

Qualified staff are being replaced with cheaper band 3 or 4 HCA's, who are not accountable, who are not as highly trained, but are a cheaper option to fill the wards with.

And as a result of all of these, care suffers, and more money is spent in the long run on massive compo payouts and crap retention due to staff burnout etc.
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Anonymous | 12-Jun-2010 9:53 am
I agree the training needs a change, I have now got to 7 months away from being qualified and only just learnt how to run though a bag of fluids! not rocket science but still vital on a daily basis.

Yes I have studied hard and all my essay's/exams have achieved high marks.

Am I ready to be accountable? I really do not know but as students we really do need correct placements to ensure we are taught the skills required instead of filling up the numbers and being HCA's for 3 years.
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Anonymous | 12-Jun-2010 11:03 am
Nurse training needs to go back to basics. If you cant get them right the rest of it is irrelevant.
A third year student who can't run a drip through is not ready to be accountable! Given that you have to be accountable for a lot of other peoples actions as well!
In 'the old days' a third year student was doing her management placements and was helping to run the ward,drips would be mastered within the first week of training!
In my opinion nurses do not need to be taught to degree level at the outset. I appreciate that to get on you do need one!
Nursing is ultimately a practical job requiring common sense,empathy,thick skin and the ability to get stuck in. A degree does not give any of these skills and therefore gives people a false expectation of the competencies required to be an effective nurse.
Ask any patient what they would want from their nurse and I'm fairly sure the ability to write essays to degree level will be low down their list of priorities!
You are not seen as an equal within the MDT,you are there to administer the prescribed care of everybody else! Making nursing a degree level qualification isn't going to change that. You have to be jack of all trades,when everybody else goes home you are the physio,O.T. speech and language therapist and house officer's mentor!!! Come 9 o'clock monday morning you are not worthy of any of these roles!
Nurses have been brain washed over the years. When there is something that the other 'professionals' within the health care settings don't want to do or they no longer have time to do it nurses have been trained to do it under the guise of professional development,but the expectation is they can do all the other jobs a nurse has to do as well!
If you want to study to degree level why not study something that gives you better pay,regular hours and an equal place within the MDT!!

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Anonymous | 12-Jun-2010 11:17 am
This argument just goes on and on and on!
Everyone fighting their own corner.
Come on, lets have a national vote from patients and see what they want from the NHS and how they would like to be treated.
No marks for guessing if they want someone educated to degree level nursing or someone with good GSCA/A levels and a core of common sense with good excellent nursing skills.
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Anonymous | 12-Jun-2010 11:24 am
Nurse training does not need to be to degree level. That is a notion that has,unfortunately, been put forward and those that have degrees jump on the bandwagon to agree. I do have a degree by the way.
Patients want the nurses to have a presence. This is not going to happen if they are educated to degree level and are taken away from the bedside.
There are many people who would make excellent nurses who will be put off because of the academic requirements now. That is very sad.
Nurses are not, and never will be, doctors unless they train to be one.
The doctors I come into contact with have a great deal of respect for the nurses and the role they fulfil and very much welcome their input. They also respect the knowledge that the nurse has built up over years.
The graduate degree nurse does not have that and should not be allowed to believe that she is superior just because she has trained to degree level.
Their role as a nurse will actually diminish because they will be expected to concentrate their time on social services, bed allocation, discharge etc.
I am very much for the nursing profession being recognised as paramount to the patients welfare. Having a degree does not necessarily provide this.
Let nurses educate to degree level once they have been able to consolidate their basic training and wish to educate themselves further within a specialised field.
Just because someone can write an essay and reference properly does not make them a better nurse!

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mike | 12-Jun-2010 11:37 am
Anonymous | 12-Jun-2010 11:03 am, I am sorry but it is exactly that outdated, ignorant thinking that is the reason Nurses are treated so piss poorly.

Nurses in the past, or as all you older Nurses are so fond of saying 'in the old days' may have been unworthy of an equal place in the MDT, not worthy of the roles that everyone else does despite being able to do them etc as you say.

But today's Nurses are not. We want more and deserve more, and quite rightly are starting to demand better status, better pay, etc. We can do these roles, we are beginning to be educated (despite all the hurdles and older Nurses trying to drag us back down) to the same standard as everyone else, so why the hell shouldn't we have these things?

And I am afraid you have very little conception of what degree level training can do for Nursing, and probably what 'back to basics' means too. Practical training can be and is taught at university level in many disciplines, including medicine! It is not just about 'us' going off and writing essays, and 'you' doing all the practical work! I really don't know where half of you get your ideas from.

Yes there are a lot of problems with the training, but don't you think that if a Nurse cannot put a drip up by third year, it is down to you 'old school Nurses' who are not giving them 'hands on training' whilst out on placement? Not the fact that they are university educated? Like the poster above you stated, we do not need to be HCA's for 3 years!

The simple fact is yes, the training does need revising, as does placements.

I myself did not run through many bags of fluids untill the last half of my third year, because the training on placements was so haphazard. But I could treat a gunshot wound and knew a lot of theory behind that. I wasn't very good at PEG feeds, but I was excellent at venepuncture. Etc, etc etc. Other Nurses were the exact opposite.

We are so reliant on pot luck wether we get a good placement and good Nurses who will take the time to teach us, and this needs to change.

As for the course itself, yes it does need change, but this does not mean Degree level courses should be scrapped so that all Nurses can go back to being glorified HCA's, which seems to be what you lot advocate half the time.

In an ideal world for example, I would have the course at 4 years. The first year being a foundation course (with subsequent qualification) teaching the basics, for those Nurses who need a step up academically, with the opportunity for those who have previous education or experience to bypass this. Then the 3 year degree would start, with modules that focus specifically on A&P, pathophysiology, illnesses and injuries, medications and pharmacology, and constant and repeated skills labs! Doing away with many of the more pointless modules on research for example.

The third year would focus more on skills labs, giving us the skills and quals that the preceptorship gives us now.

I would still keep the level of placement/theory ratio, but I think something needs to be done to adress the pot luck aspect of the training we do get whilst out on placement.
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mike | 12-Jun-2010 11:45 am
Anonymous | 12-Jun-2010 11:24 am, I see what you are saying, but the patient care aspect of the Nurse is already diminishing because of lack of staff and lack of focus on what the job should be.

That is not degree Nurses doing that, that is the vast majority of higher banded Nurses who are in charge! Basically the ones who were trained 'in the old days'! These Nurses are already doing the job of the OT, physio, social worker, middle management, etc.

A degree (if it is taught correctly with the right content) can change that, it can focus Nurses again, focus them to be highly educated and highly skilled practitioners who give excellent patient care and give them a stronger presence to act as their advocate.
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Phil Dup | 12-Jun-2010 12:11 pm
Having had MANY types of jobs pre nursing including engineering I believe we should undertake Nurse Training in an apprenticeship style rather than University education style - one day a week at college - 4 days a week on the wards.

My training was done in the project 2000 era - what a load of toss that was - we spent hours undertaking lectures and assignments on stuff like " Is nursing a profession " - who the hell cares !
That sort of pseudo intellectual does not help patient care one iota.

We are all born and we all die - in between most of us work at a job.
Nursing is just one of those many jobs and all jobs are picked up better by lots of hands on training.

Imagine the British Army sending soldiers out to Afghanistan after training using mainly books and computers in the classroom !
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Anonymous | 12-Jun-2010 12:23 pm
It is not a degree that is vital it is knowledge. I have 2 daughters (one a student nurse on the way to a degree and the other studying for a Master's in Law). So, I certainly am a proponent of further education. I think that nurses with degrees can be excellent, as can nurses of my era. I also think we each have our share of the 'less able'. I do not think that I am any less of a nurse, or any less knowledgeable than my daughter. Could I also say that the practice aspect of training would need to maintain a high standard. There is some pressure, by some tutors, on mentors to be lenient on students, particulaly if a student is doing well academically. I have no problem with degrees, but make sure the balance is right.
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Latterlife Midwife | 12-Jun-2010 12:47 pm
Mike is absolutely right. Nursing needs to be BSc qualified, and the course should be 4 years long for direct entry, or less for those who are already nurses.

The old-timers are indeed trying to hold back progress towards nursing being a profession, not a vocation. Very romantic notion maybe, but not appropriate in this current world. I am an old-timer, graduated with a diploma in 1972, but I can see how it is necessary and beneficial. Though without question, the curriculum and the placement system needs revamping as discussed! That seems to be the source of all the objections, so let's work on that rather than throwing the baby out with the bathwater!

It feels shameful to me to read how complicit many nurses are in wanting to keep nursing in the past. Our young men and women need to be educated to the highest order to allow the best and the brightest to want to become nurses. Nurses are not born anymore, as we felt in the olden days. It takes more now to keep nurses from dying out.

Anonymous | 12-Jun-2010 11:24 am writes: "Patients want the nurses to have a presence. This is not going to happen if they are educated to degree level and are taken away from the bedside.
There are many people who would make excellent nurses who will be put off because of the academic requirements now. That is very sad."

A natural change will take place when nursing entry is degree-level, so all nurses at the bedside will eventually have degrees and management will be post-graduates. Nurses *should* all be highly intelligent, well educated, caring people who *also* know how to do excellent direct patient care! They are not mutually exclusive. Where does this idea come from??

Anonymous | 12-Jun-2010 11:17 am wrote: "Come on, lets have a national vote from patients and see what they want from the NHS and how they would like to be treated. No marks for guessing if they want someone educated to degree level nursing or someone with good GSCA/A levels and a core of common sense with good excellent nursing skills."

This is absurd - patients deserve excellence in nursing care in all facets that comprises, and that is what they want and should have. They don't care, and indeed it is not their business how their nurse is educated, but how she/he produces that care. If we the nurses want to be taught as a profession at degree level, that's what ought to happen. Otherwise, as has been mentioned, we might as well just train HCA's up to a slightly higher level and let them get on with it - is that what you really want?

Anonymous | 12-Jun-2010 11:03 am wrote: "Nursing is ultimately a practical job requiring common sense, empathy, thick skin and the ability to get stuck in. A degree does not give any of these skills and therefore gives people a false expectation of the competencies required to be an effective nurse."

I think you sell yourself short here...yes, the practicalities require all those, but nursing practice is greatly enhanced when the practitioner also has the ability to think critically, anticipate (not just based on previous experience but on what the research has shown), and to be able to participate with professional colleagues on an equal footing, whilst representing the different disciplines in patient care. It can be difficult to explain but it's something I know in my heart and in my head, and it is vital to the growth of nursing as a profession. If some folks don't like that, perhaps they ought to just get out of the way rather than deliberately sabotage the future.
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Anonymous | 12-Jun-2010 12:48 pm
I agree with several of previous posts especially re 'apprenticeships'- why not go back to having Schools of Nursing ' based in each hospital-the student nurses had cheap accom.and a wage-and did so many weeks placements on each ward,and so many weeks 'study blocks' between wards-this way a highly skilled team was developed and multi skilled and also a job at the end usually-you became loyal to your hospital too-why do you think UK Nurses were classed as the best in the world and now definately not?
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Anonymous | 12-Jun-2010 1:13 pm
Yes please go back to the basic training then allow those who wish to take degrees do so.

Third year student (three month to qualifying) does not know the reason a patient is Nil By Mouth pre-op.
Well in fact she thought it was so the patient didn't urinate whilst under anesthetic.

Nurse with Asthmatic degree, does not know
Why you don't use direct fan therapy on an asthmatic.

The nurses from the old days as previously mention try to guide but this is taken as being old fashion. You can't allow young nurses to learn by their mistake not in this game!!

The lack of care in the profession now is deplorable. To many patients suffer a bad experience whilst an in-patient, some are ex-nurses who can't believe the deterioration in care.
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Anonymous | 12-Jun-2010 3:30 pm
Yes please go back to the basic training then allow those who wish to take degrees do so.

Third year student (three month to qualifying) does not know the reason a patient is Nil By Mouth pre-op.
Well in fact she thought it was so the patient didn't urinate whilst under anesthetic.

Nurse with Asthmatic degree, does not know
Why you don't use direct fan therapy on an asthmatic.

The nurses from the old days as previously mention try to guide but this is taken as being old fashion. You can't allow young nurses to learn by their mistake not in this game!!

The lack of care in the profession now is deplorable. To many patients suffer a bad experience whilst an in-patient, some are ex-nurses who can't believe the deterioration in care.
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Malcolm Chalk BA, RN | 12-Jun-2010 3:55 pm
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. 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, fairer and better pay.
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mike | 12-Jun-2010 4:23 pm
Well said latterlife midwife.

Anonymous | 12-Jun-2010 3:30 pm, as others have said there are both good and bad on both sides. I have met many older nurses, not university trained or trained 'hands on' as you lot are so fond of saying, who have insisted on using bad practice. Using your own logic does that mean we should switch wholesale to University training because older Nurses are all useless then? Come on, lets just use a bit of common sense here!

Nursing IS becoming an all degree profession. Stop dragging newly qualified Nurses down for having a university education, help them gain the skills whilst they are students on placement, then watch as the profession gets stronger and patients are given much better care as a result.
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Anonymous | 12-Jun-2010 4:39 pm
oh dear-malcolm-you may have a BA but you can't spell!-you have entirely missed the point and only re-inforced mine!It is only logical that people working with people over time get to know the differences between normal and abnormal;build self confidence;know when to act appropriately to solve a problem out of the norm.indeed to recognise a problem in the first place-it could save lives-this can only come with experience gained from day 1 on the wards-not in a classroom spending weeks on an essay that bears no relation to any of the above-I know as my friend has just finished her 'degree' and I am saddened at her lack of knowledge,her lack of confidence and her downright fear of going out on the wards ,in charge simply due to lack of experience.Also it makes monetary sense to have student nurses back working/training/learning on the wards-no more grants-loans to pay back,and no more need for Agency Nurses,-there would always be enough staff-and lastly(I could go on )-it can actually be FUN-yes FUN!-how dare you make a remark like 'old school nurses having their noses well and truly stuck in a nosebag of the past!!!-don't be such a degree snob and see the light-it is only LOGICAL-bring back dedicated 'SISTERS and CHARGE NURSES,bring back Student Nurses,bring back Doctors parties,bring back the BEST training of Nurses in the world.You know it makes sense-
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Malcolm Chalk BA, RN | 12-Jun-2010 5:17 pm
Anonymous | 12-Jun-2010 4:39 pm
Show your name!
I haven't got a nursing degree, nursing degrees are BSc's. I fully go with what Mike is saying, he makes a lot of sense and I bet the vast majority of nurses agree and understand what he is saying (I must admit he puts it across a lot better than me). Students do work/train/and learn on the wards, (remember where to put you commas), and they do it for at least 18 months full on. Your friend has got as much knowledge as you, when you first started out; try reading Patricia Benner that might explain things a little more clearly.
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Latterlife Midwife | 12-Jun-2010 5:38 pm
To Anonymous | 12-Jun-2010 4:39 pm, I'd like to add on to what Malcolm wrote: "Your friend has got as much knowledge as you, when you first started out,"...I'm sure that's absolutely true, and she most likely has even more, but wards are now in such a terrible state with much sicker patients and with staffing so much worse thanks to budget cuts that the poor new nurse is likely terrified just starting out. This is NOT how it was when we old-timers first arrived as graduates. If you are still working, anonymous, you would know how much harder it is for new grads now. They need more of an education than we ever had; plus, don't forget that even we needed time to become confident. It was always said that it took a year of working full time to really start feeling comfortable as a new nurse. Let's get behind the call for degree preparation and help revise those programmes to really meet the needs of nurses and patients of the future!

I don't see this is my hospital as it's undergoing a huge transition, but I'd like to have a uni lecturer on-site daily in hospital for every group of placement students, supervising them as they (the students) work with staff nurses who have been prepared to, and are committed to, nurture and teach the students throughout their everyday care of their patients.

This didn't happen during my midwifery training - the daily preceptors changed constantly as they were always changing shifts or units at the last minute, leaving me hanging with someone else who wasn't expecting a student, and didn't always appreciate having one! My main mentor stayed the same but catching up with her to do paperwork was a big challenge, leaving much to be completed at the last minute. There needs to be a bigger commitment to the education of our nurses and midwives.
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Anonymous | 12-Jun-2010 6:54 pm
When will the debate for an all degree education ever end. At the end of the day all student nurses study at a university and even on the diploma course they must have 5 G.C.S.E's. If they do well they are offered a place on the degree course, so how exactly are people put off studying for a degree? I think that the quality of placements needs to be looked at carefully. Yes we all know that we can learn from an HCA heck I was one, I have no problem making beds and cleaning patients. What I do have an issue with is being paired up with an HCA and not a qualified nurse because they are too busy to educate us on clinical placement.

As for clinical skills in the university this must be looked at, a 2 hr session on a skill with 20 minutes practical? No wonder student nurses are given a bad name.
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monica hartman | 12-Jun-2010 8:17 pm
With patient physiological management and needs being much more complex and demanding in this day and age, having clinical nurse specialists as the entry level would be stellar. For ICU patients and more critically ill individuals, having a nurse at this level to critically think through the myriad of variations in patient presentations, etc. can improve outcomes and quality of life. For non-critical areas, perhpas having at least one advanced practice nurse on the floor could make this staffing dilemma more feasible. While I do not underestimate the value of the handmaiden tasks and the therapuetic value they impart, the reality is, we are pulled away from this by having to spend ample time in more advanced and complex delivery of care. Patients need nurses who not only understand nursing, but a certain degree of medicine as well. Schooling must be very rigorous in teaching critical thinking skills as this does not come naturally to everyone.
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