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


Health minister Ann Keen has accused media commentators of sexism following yesterday’s coverage about nursing becoming a all-graduate profession.

Ms Keen launched a strongly worded attack on commentators who said nurses did not need degrees and should instead focus on “caring”, saying she believed the comments were motivated by sexism.

Speaking to the Chief Nursing Office summit in Newcastle yesterday she said: “I have really had enough of this. When do you stop? Do we need to go to school? Do not let them get away with patronising us.”

She told Nursing Times the perception would not be the same if nurses were not mainly female. She said: “This is a personal view. We are predominantly a female profession and I wonder about the status of nursing had it been all men. It is about ‘women’s work’.”

Nursing academics also added their weight to support for the move to all-graduate entry.

Council of Deans of Health chair Sue Bernhauser said: “We have strongly supported proposals for all nurses to be educated to degree level.

“Preparation at graduate level will be essential for new professionals to meet the future requirements and expectations in relation to the complexity and intensity of their roles, together with the need to extend and expand roles to reflect changes in patterns of healthcare delivery. Ultimately this move will help to continue and secure a dynamic and progressive workforce and a high quality of care for service users,” she added.

Professor Anne Marie Rafferty, head of the Florence Nightingale school of nursing and midwifery at King’s College London, said: “Research demonstrates that better educated nurses deliver higher quality care than less well prepared nurses. 

“We need to raise our game if we are to raise standards of care. Education is the only way to do this.”


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Readers' comments (21)

  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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