All-graduate nursing debate hots up as minister accuses detractors of sexism

Readers' comments (20)

• Belinda Bushnell | 13-Nov-2009 3:13 pm

  I agree completely with Ms Keen. What other profession in the world would be criticised for increasing it's skills and tightening its entry requirements?

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• Stephen Johnson | 13-Nov-2009 4:54 pm

  Considering the amount of autonomy and the diversity of nursing, it is somewhat embarrassing that it isn't already a degree level subject.

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• Anonymous | 13-Nov-2009 5:19 pm

  I don't believe there is anything inherently wrong in improving and raising the standards of training to reflect a more diverse academic population and technically orientated healthcare environment. What does raise concern in me is excluding people who have huge potential for becoming great nurses who also have difficulty with academia. It is easy to polarise this debate but divisive and futile to do so. What seems to be a more respectful, inclusive and pragmatic solution is to integrate all abilities into the profession and value what people do and do well.

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• xhikarux | 13-Nov-2009 7:27 pm

  i think we should have a choice to chooose whether we want to do the last year or not. its really not fair to those who are completing their 3 years and become unemployed because they dont have a degree. these ppl will just move to another country. you train these nurses up with so much of uk tax payer's money and end up benifitting another country, not a wise choice.
  
  nursing moving to a degree will also limit people from taking the course. its credit crunch now so there are too many unemployed nurses out there but when the economy gets better, there will be less students wiling to even take the course!
  
  For those that are academic (the bright and intelligent students) - why not study science or enginneering or even medicine? why do nursing when its entry grades required are similar to those biomedical science degrees?
  
  and for those who have completed their diploma and are now working in the hospital, there are no problems with their kowledge and working skills. many nurses ive seen are still effcient and can do jobs as good as those who have the degree.
  
  
  i believe having a choice is an option.

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• hamish | 13-Nov-2009 8:14 pm

  Whilst the move to degree level in some quarters may seem appealing I would ask the question; what positive change would it make?
  
  Whilst Nursing is an honourable profession does it really need graduates? My answer would be no. Nursing is about caring, which is not processing an episode of input; but actually caring what happens to people. Over my time as a nurse I have seen fundamental changes to how people are cared for, some for the better and some for the worse. I have been called a dinosaur by those who have far more academic qualifications than me but I feel that I have more humanity by treating a patient as a human being rather than looking at an episode of “care” and have we ticked all the boxes. Graduate qualifications in my eyes mean “nought” I have met many a nurse who is academically in better shape than me but I can leave them in my wake as a caring human being.
  
  I will be glad to leave this “profession” soon not because of the patients in my care and the difficulties that sometime arise from them but because the changes that have occurred over the decades have not fully enhanced the patient “experience”. Having been a patient myself receiving care at the “bad” end of the care spectrum; also family members have been given at the best dubious attention by nurses so I will be glad to go.
  
  Nursing is; caring, compassion, and looking out for someone, it is not report writing, or using the correct terminology, or having to sit through endless “mandatory” training about subjects just to prevent litigation for a Health Care Trust.
  
  It is about time that Nurses woke up to the fact that there is little or no status in being a Nurse, the gradual erosion of status is pushing it further and further down the ladder of “caring” and having an influential voice.
  

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• Anonymous | 13-Nov-2009 10:23 pm

  Making nursing a degree is only to make it sound better. So that nurses won't get despised. btw the public still thinks that nurses are doc's assistants and they only do little things. A degree will make nurses only make nurses sound better and at a more higher rank, but not actually anything different from those who are doing diploma. Other countries are doing 3 year diploma and their nurses are doing fine.
  
  the nursing course is just gonna get less appealing for those who have the heart to study it but cant into it due to 'below average grades'. and what about the dyslexic students? i really dont know how they are gonna manage with the final 4th year of research mehtods.
  
  I dont suffer from dyslexia but when it comes to essay writing, Im very poor at that. i enjoy my nursing placements and i do hope to become a nurse, but i think my dreams are gonna be over. And when that day comes, im just going to say so long nursing, ive had my fun days.

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• Anonymous | 14-Nov-2009 12:44 pm

  I have been nursing for many years but now practising as a midwife. I startd my midwifery training in the 70@s but unfortunately had to give up for many years. The training then was hospital based with no degree at the end of the year. However, when i returned to complete my training one had to go to university and do a B.Sc(hons) midwifery. The triaing in the 70's taught me a lot more about been a midwife than i ever learnt when i did the degree. The degree course contained many topics which were not relevant to been a midwife in the UK.
  My daughter-in-law is a children's nurse and although been clever enough to do the degree could never have afforded to do the this training so did the diploma. If the only training available had been the degree the country would have lost a very good nurse. She has now chosen to do the degree while workin as a staff nurse isn't this a better option so we do not loose girls who just can afford to see themselves through a degree course

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• jjjez@hotmail.com | 15-Nov-2009 12:45 pm

  The eral issue ought to not even be whether people are doing a diploma or a degree. Most do the diploma so 'goodbye potnetial entrants. It would have made more sense to make it a four year degree with a diploma given in the third with the option to work and finish the last year with three years of qualifying.
  Would have been taken better no doubt.
  
  The real issue is between 'caring' and delivering therapies, medication and treatments and which is more important.
  I think the mistake has been to assume a 50:50 level of parity is 'balance' itself whereas most likely it is 70:30 at best towards the latter.
  
  I think if you were to ask a classroom of children what types of behaviours nurses should display they would give similar answers to adults, thus why this ordinary act of humanity - 'compassion' - is thought of as a skill learned not in childhood/adolescence but in classrooms.
  
  The real issue is that there is not enough detail in the teaching of students to prepare them for acute care, of which the majority of us work. Instead we rely on the random experiences of students to count as 'experience itself' regardless of whether any formal teaching occured at all.
  
  Let's all not forget that remaining un-vocal and docile about the way the government and the nursing elite are steering our profession is also one of the prime casuses our low moral and dissatisfaction. Ours is a job to be experienced if changes are to be made.
  We shouldn't let distanced people have the entire gamut of decision making power if we feel that they aren't effectively promoting our interests.
  
  
  

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• Catherine Rotte-Murray | 15-Nov-2009 2:02 pm

  Ireland moved to a full degree programme in the past 5-6 years after a transition Diploma programme. I am appalled that there are those who would knock the idea of nursing becoming a degree level profession and as for suggesting that those more academic should go for medicine that is merely insulting those nurses who strive to be both academic and caring. These are not mutually exclusive attributes. I state this from my position as a nurse who trained in the 70s under the apprenticeship system in 3 years. I went to university in my 40s to get a higher diploma in public health nursing and thoroughly enjoyed the academic challenge - but haven't seen a divide in Ireland between the old-style trained nurses and the degree nurses. Many older trained nurses go on to do the degree from choice and that's fine but our union ensured that there wouldn't be a two-tier level of nurse - all nurses get equal pay and conditions and older trained nurses aren't penalised for not having degrees as the option wasn't there.
  Degrees give more respect from other professions in healthcare. We have a stronger negotiating position when we seek parity with allied health professionals like physiotherapists and occupational therapists who might claim nurses don't have degrees so don't deserve pay parity.(We haven't achieved parity yet but we are still trying to get nurses' pay improved.) We do not see nurses as failed doctors and we do not want to be doctors but we want respect and if we don't get it from within the profession as seems the case from some of the comments here what chance have we - is nursing so demoralised in the UK? I hope not - we have a long tradition of collaboration between our two countries with many Irish nurses training in the UK in the past. Irish nursing has progressed hugely in the past decade with many pursuing postgraduate studies (I could access my H.Dip in PHN without having a primary degree such is the assessment system here) and I have the option of doing a Masters' anytime should I wish, and many colleagues have done so, and many also have PhDs in Nursing. That has increased nursing's status among other academics and medical/healthcare professional colleagues.
  That there are few jobs for graduating nurses is an economic factor due to a bloatedly bureauratic health service executive that has had a recruitment freeze in place for the past two years with few derogations - so nursing is suffering from that but not from the fact that nursing is a degree-level profession. Nurses are not "too posh to wash" who have degrees; they may take longer to develop skills with the patients and there is a skill mix we didn't have with HCAs. So don't stereotype unfairly - nursing has come a long way from the drudgery that it was and if we want respect we must have pride and self-respect in our well-educated caring nurses. Ireland had a steep learning curve to climb with the transition and I am sure it will be equally successful in the UK, just don't train nurses for export like we are currently doing - that's our loss and other countries' gain.

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• Anonymous | 15-Nov-2009 2:23 pm

  I have to agree with Stephen Johnson... it really is embarrassing that here we are in 2009 arguing about whether or not its a good idea to make Nursing an all graduate profession. Countries such as the USA and even some so called 3rd world countries have had a degree nursing course for ages, in fact since the 70's.
  
  I do agree with Ann Keen that there is a measure of sexism being displayed by the media who want to keep their patronising and somewhat sexy image of the 'angel of mercy'. I think it has been used to keep nurses' pay as low as possible over the years. Everyone knows that it was only after men started entering the profession that pay began to approach anything near decency levels though still low for us women.. You only need also look at how quickly they are able to rise in the ranks of nursing. Its all about power and control.
  
  I know for a fact that after I topped up my 'SRN' to 'Diploma' and then to degree, (yes, I had to do it in 3 stages, with the old University of London Parts A and B!) I got much more respect from the medics and everyone else. Suddenly I was not just a pretty face but a knowledgeable practitioner who had to be taken seriously. You can challenge their decisions from the evidence base, and it works. I certainly observed the difference. I remained the caring compassionate nurse that I was before I topped up my course. Having a degree did not remove me from caring, and any nurse who says it did that for them must realise its a decision that they would have chosen, perhaps without realising it. When I was a graduate Staff Nurse, I had to delegate some aspects of care, which is why you work in a team , just as I would have done before I did my degree, and just as before, I made sure that everyone knew I was still in charge of care delivery. I expected to get at least a verbal report about any care I had to delegate, and if there was a problem I would personally investigate and plan for the follow up care. thats what I thought, and still think a good RN does.
  
  For those who are now on Diploma courses, there's no need to panic or feel left out in any way. I know that there has been some resentment about those with a degree, but I think if it continues it will only damage the profession.. I think it will still be possible for everyone to upgrade when they are ready to do so, just like it is now. I am sure I also read somewhere this week that the Government is changing the rules so that nursing degree students will be funded, so that wont be a barrier as it was previously.
  
  It is absolutely true that most, if not all nurses with only a diploma are very bright and are excellent at their jobs. I think it is great that they will be able to upgrade, hopefully quite easily. This is not about being bright or dim, it is about our profession and the way it is perceived, and what is required to move it with confidence into the future.
  
  So I say three cheers to the powers that be for taking this brave step and moving us into the 21st century. All nurses stand to gain a lot from this fantastic move. I only wished it was around when I first started training many moons ago! But thankfully I was able to benefit from topping up and I heartily recommend it to all. It gave my career a massive boost and I have never regretted the decision. I am still a very caring and compassionate nurse and have many thank you letters to prove it.
  
  ...And by the way...Nurses are not all caring and compassionate... remember the Allot case among others? All who wish to become nurses must be educated and trained in the art and science of nursing, and we will always have some bad apples in the sack, but that does not mean that we should assume that all people need to nurse is compassion and a caring nature. It is not true. I want any nurse who is caring for me to also be knowledgeable and know how to use evidence base practice to plan and improve the care s/he is hoping to give me.
  
  In the 21st century, graduate education is the only way of ensuring that nurses know how to use evidence to inform and plan safe care. It does not take a lot to upgrade from the present diploma, and entry gates into Higher Education are widening all the time, so its not an impossible task. Everyone can start from where they are and move into a full degree when they are ready. It should stop the medics and some sections of the public, eg the media, from making stereotypical assumptions about us. In a few years time when the dust has settled we will all start to wonder what all the fuss was about! I agree we will still have the problem of shortages, but I'm sure we all know what will happen next!! I suspect its what the USA has had for ages. Do we watch this space??

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• joanne barnett | 15-Nov-2009 2:42 pm

  although i can see the reasons behind nursing becoming an all degree profesion, I qualified nearly 20yrs ago. i have neither a diploma nor degree, yet i have continuously updated my skills. I am a practical nurse not an accademic. I feel that i contribute my experince of doing what i consider a preactical role to students.
  recently on a day shift 2 patients asked me to explain what their diagnosis meant. after reading the medical notes and doing some research, i took the time to listen to each patients fears and give factual information and sign post them where they could find out more. each conversation took about 15 minutes. each patient told me that some of the younger less experienced staff had not wanted to explain things to them, saying that it was up to the dr's. these patients were then able to fully participate in their care and therfore were more likly to have a reduced stay in hospital. many newer nurse's lack basic communiation skills that are a vital part of nursing. will my skills be out dated, i fear so. will nurses like me be sidlined by those with degrees i fear so,,,

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• Anonymous | 15-Nov-2009 5:14 pm

  Why are so many people determined not to move on. Every other health professional such as physios, SALTs, occupational health, dieticians ALL have degrees. Why is nursing trying so hard not to improve itself. Stop moaning and move on. It is a life long learning career choice. This is by the by but each of these professions make more money that nursing.

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• Anonymous | 15-Nov-2009 8:39 pm

  It seems the arguments against all-graduate entry to nursing are coming from nurses without degree-level qualifications. Perhaps this is because they feel threatened by the progress being made and are worried about being left behind?
  
  The fact of the matter is that all the evidence demonstrates that despite their weightless arguments about "academic nurses" (I mean, really?) not providing good care, mortality rates are REDUCED as the proportion of graduate nurses increases.
  
  I am a nurse who undertook a DipN in the late 1990s. Admittedly I took that option as it provided better financial incentives as a student. Financial arrangements are not an acceptable argument against improving the education base of a profession!
  
  Since qualifying I have completed an honours degree and a masters degree, whilst working full time and completing a multitude of other professional development and training programmes. I can say whole-heartedly that as my education has expanded, so has my practice. As part of my role (which spans clinical practice, leadership and academia) I now teach both undergraduate and postrgraduate students in a country outside of the UK which has been all-graduate since the 1990s. Public surveys here tell us that nurses are the most trusted professional group.
  
  Arguing that "potentially good nurses" will be kept out of training because they cannot meet the academic demands of the course is a contradiction in terms. "Good" nurses need highly developed critical reasoning skills. They need to be able to understand, make sense of, utilise and communicate highly complex and often conflicting information in all formats - including writing. Being caring and compassionate are important but it is not enough.
  
  "Profession: a vocation or calling that involves a branch of ADVANCED LEARNING or science." Unquestioning, task-orientated technicians, however highly-skilled, are not professionals. They do not posses the ability to practice independently, with autonomy and providing direction for others. For those who want to care but cannot or do not wish to work at the level of a graduate professional nurse there are a raft of technical and support roles, in which they can work under the direction and supervision of registered professionals.

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• jjjez@hotmail.com | 15-Nov-2009 9:59 pm

  Saying that diploma posts ending will barr students form entering the programme is not contradictory.
  Seeing as we don't have one the most self-confident professional self-views i think that we have many Na's who are graet but think the reality of the academic work is beyond them. Obviously it's not beyond anyone who can read and write and tolerate hearing useless info for 3 years, but the diploma was probably less scary sounding to them.

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• Anonymous | 16-Nov-2009 10:19 pm

  With regard to the comments about excellent nurses being kept out of the profession as they are not academic enough to do a degree. Do you argue this point for doctors, physiotherapists etc.

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• jjjez@hotmail.com | 16-Nov-2009 11:10 pm

  I can't stand those people who say 'i'm not academic, i'm practical'. Where well do you think your training came from? Academia? Erm , yes!!
  
  If you don't consdier yourself academic then why are you doing a job currently reserved for educated professionals?
  If you aren't academic how can you describe your job as anything other than a series of tasks with predictable outcomes?

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• Bernadette McPolin, SRN, B.Sc, M.Sc. Anae | 17-Nov-2009 12:08 pm

  Nurses can be caring and academic, and I wonder if some of the comments here might indicate a fear of change. Going the academic route very much enhances and challenges nursing as a profession, it encourages questioning and reflection on what they do and why they do it and how this can benefit their patients. It does not compromise their ability to be caring professionals. How often have we heard complaints from nurses that they have no autonomy or do not get the respect they deserve. As with other professions nursing too has to progress and
  develop and what other way is there for it to do so.

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• Simon Browes | 17-Nov-2009 8:34 pm

  Joining the nursing profession is a hard-earned privilege, not an entitlement and not a free-for-all. Just because somebody wants to be a nurse, does not meant they should be!
  
  Nursing is a hugely demanding role, if it is done well. That includes a large practical component, but practical skills are nothing more than learnt technical tasks if there is no independent body of knowledge behind them. That is what distinguishes a profession from a technical, semi-skilled occupation. Nursing has moved on from the days when it colluded with medicine as an obedient, subserviant workforce of single young women and the dedicated ageing spinsters!
  
  Widening the entry gate and reducing standards because you want to bump up the numbers and give everyone a shot is not going to help anyone! You cannot say that on the one hand you want to open the doors to everyone with a burning, romantic desire to be a nurse, and then complain that the end product is nurses who scrape through training and go on to struggle to practice independently, with the requisite knowledge, skill and confidence!
  
  At least the decision has now been made. We will move on and the nursing graduate will become the norm. Soon enough we will have something else to in-fight about. Post-graduate education and training will become the expected pathway for specialisation and progression, just like every other profession on earth. Maybe we will start to argue that our medical student colleagues should go back to the old style of training, working 80 hours a week and not spending so much time learning how to communicate effectively; or those overeducated surgeons, spending too much time pioneering minimally-invasive techniques when they could be doing it the good old-fashioned way? Perhaps not.

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• June Bowden | 19-Nov-2009 11:46 am

  What a load of rubbish. What is the problem with being labelled a 'caring' profession. I am proud to be part of a caring profession and do not see it as a sexist comment or even anything that leads into a sexism debate at all. Men care, men are nurses. Rather a lot of nurse management is male.
  on the degree level stuff anything that suggests that we should all have degrees to put us on par with doctors makes me mad! I could have done a medical degree, but chose to be nurse because I wanted not to be in a profession that is science based, but one where care of the patient and making a difference to that patient was more important than diagnosing or curing. I also know that some of the best nurses I have worked with could not have and would not even have entered nursing had they thought they had to do a degree.
  There is also the issue that I came into nursing after having done a degree in the Humanities. I did a shortened training programme to encourage graduates (with different degrees from History to Chemistry) - like myself-into nurse training. The course was excellent and had a waiting list.Sadly the UKCC ended the course in the 80s. I stayed a frontline nurse for 25years, and only recently have entered the academic world of research.
  You want ot encourage people into nursing widen and do not restrict the field.

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• Anonymous | 20-Nov-2009 10:38 am

  Having read through the numerous comments and threads of this issue I can see there are lots of good arguments for and against. Having qualified as an RGN without a recognised academic qualification I decided that to enhance my knowledge skills and practice to first work towards my diploma and then onto my degree. I am now currently studying towards my masters. This has all took some years however I did complete my diploma within 5 years of qualifying. I do feel that the academic study has enhanced my practice and they key to this was being able to relate theory to practice. I have worked with a few nurses who despite gaining thier degree then struggled to relate thier learning into thier practice and this was clearly evident by the level of care that was delivered by these nurses, and the end result was that the patient suffered. I do feel that the way forward is an all graduate profession however as suggested earlier this could be that a degree has to be obtained within 5 years of qualifying rather than having to do this initially, this would then not exclude people who would be put off by the initial 4 years training. Academic institutes will give you support and guidance to enable students to be able to pitch thier study and academic writing to degree level and students should make use of this support to enable them to gain there degree.

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