With plans for an all-graduate profession likely to be endorsed, Louise Tweddell considers the implications of such a shift.
In a matter of weeks, the NMC will move to ratify key principles supporting a new framework for pre-registration education across the UK.
The most controversial principle, based on the NMC’s consultation on a review of pre-registration education, could make it impossible to register as a nurse without an appropriate degree.
If agreed, the move is set to become a key milestone in the history of nursing. But the debate has split the profession and its representative bodies (NT News, 19 August, p2).
More than 70% of nurses who responded to the NMC consultation were opposed to scrapping the diploma as a minimum requirement of registration. In comparison, 84% of key stakeholder organisations – excluding Unison but including the RCN – were in favour.
The college has previously stated that the move is essential to ensure the profession keeps pace with future demands (NT News, 19 February, p2).
But, with the shift looking a certainty, nursing will now have to consider its implications.
A key issue will be how it will affect students already in the system, according to RCN policy adviser Jane Naish.
‘If you have someone who is halfway through a [diploma] course that does not have the minimum standard of qualification when they are finished the course, then that will be a big issue, said Ms Naish.
‘It is really not fair for people to finish with a diploma then the next year it goes to degree.
We need to work with the Department of Health on that to make sure that people do not feel they are being short-changed,’ she added.
Some form of top-up for those who qualify with a diploma would be a simple solution, suggested Ms Naish. ‘It is about giving these people funding and time to top up to do a degree,’ she said.
One of the main criticisms of an all-graduate profession is that it would prove a disincentive for those from less academic backgrounds and therefore fail to recruit from as diverse a pool as it does currently.
‘We need to keep the background for recruitment wide so that people who do not have a formal education can still access nursing careers too,’ said Ms Naish.
She argued that most potential nurses would be capable of undertaking a degree and those who were less academically prepared could undertake a prior period of training. ‘I would not say a foundation course as such but there needs to be something to help people get up to speed and a lot of the universities do that already,’ she added.
Sue Bernhauser, chairperson of the Council of Deans of Health, agreed, adding that this was as important for those returning to study as it was for less academic school leavers.
‘The main challenges will be to ensure that we maintain numbers of good quality applicants and ensure they are not put off by doing a degree – they can be students who can lack confidence but not ability,’ she said.
She added that universities should maintain numbers of nursing students entering via the Widening Participation route – a Higher Education Funding Council for England initiative to ensure equal opportunities to higher education for all social groups.
For all students – current or prospective – overall funding arrangements, bursary changes and general support frameworks will also prove key issues.
‘There are already many students studying for a nursing diploma who have the entry requirements to do a degree but cannot “afford” to, as the lack of bursary for degree students disadvantages them,’ said Ms Bernhauser.
‘Funding from the strategic health authorities for universities to pay for any costs associated with that transition and bursaries for students on nursing degree courses are essential for the shift to work,’ she added.
Ms Bernhauser said it would be imperative for the NMC to allow appropriate time for the change to take place. She added that it was essential for universities to work with NHS colleagues to ensure appropriate placements, with good quality supervision.
An all-graduate route could see nursing facing the further challenge of having to compete with more professions for a finite pool of recruits.
Ms Naish suggests nursing must be promoted correctly to compete successfully.
‘The degree is becoming a passport to employment and a lot of school leavers will expect to do degrees, so there is an issue about making nursing more attractive to young people,’ she said.
In other parts of the UK the transition to an all-graduate profession is well under way. In Wales the change was initiated
So are there lessons to be learnt? Wales’ chief nursing officer Rosemary Kennedy told NT she was pleased with the results so far.
‘The introduction of the all-degree programme has gone well. We have not had any problems in recruiting to these degree programmes. Indeed, figures show that our retention rate is among the best in the UK with lower attrition rates.
‘The annual attrition of 4.3% in Wales equates to 13% over the life of the three-year course,’ she said.
Ms Kennedy attributed this success to a number of initiatives. ‘Support is offered to nursing support workers in NHS Wales to assist them in gaining access to pre-registration nursing programmes and the All Wales mentorship training programme was revised to prepare mentors to the change in student training,’ she said.
‘Higher education institutions invested time to ensure clinical staff understood the nature of the pre-registration programme and support is also given to undergraduates with student counsellors based within schools,’ she added.
The Welsh Assembly has also introduced practice facilitators – clinically-based staff who continue to provide support to mentors and students in practice and support links to the higher education institutions.
RCN Wales interim director Richard Jones agreed the move had proved a success in Wales, despite early concerns.
‘At the time I remember we were worried about whether we would have enough people to go on the courses but in reality it has worked extremely well. We believe it was the right way for us to have gone.’
However, the NMC’s consultation report itself says it is ‘too early to draw definitive conclusions from the Welsh system’.
One of the arguments for a shift to an all-graduate profession in England has been the necessity to keep nursing in line with other healthcare professions – midwifery will take similar steps next month.
The move, which is UK-wide, has been broadly accepted by midwives, according to Sue Macdonald, RCM education research manager. But she warned that the effect on current diploma holders needed to be addressed.
‘If you are going to have an all-graduate profession you must have more investment and commitment in existing nurses and their continuing professional development, because if you do not invest in them, then they will not feel valued.
‘We did a lot of work on this with existing midwives and they said it made them feel inadequate but when you started to invest in them they felt better and the service got better too,’ she added.
Stakeholders say that decisive action is now a priority.
‘We have had the arguments for and against, so we need to get on with it now,’ said Ms Naish. ‘Content is not as important – branches for example can be worked out later – but we need to make a decision and get going with it.’
Once the decision has been taken, it will require support from all branches of the profession.
‘They must make sure that the practitioners are quite committed to the move themselves,’ said Ms Macdonald.
‘With any change it takes time for people to get used to it. It needs to be a team effort from practitioners, managers and educationalists, so they are all working together,’ she said. ‘It takes time but it is worth it.’