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Let's make sure we are ready for an all-graduate nursing profession


Alastair Henderson on the need to anticipate change

As the Next Stage Review report A High Quality Workforce points out, nurses will always be at the heart of shaping patient experience and delivering care.

But what exactly does this mean for both nurses and for employers in the service envisaged by Lord Darzi? How much will nursing change in the future?

The NMC consultation response on pre-registration training in nursing - Standards for pre‑registration midwifery education 2009 - resulted in a welcome decision for employers with a move to an all-graduate profession.

With this in mind - and with the release of a range of research and reports to assist the profession in improving the quality of outcomes for patients - it is essential that the profession and employers start to debate and plan.

The discussion should be around what the move to an all-graduate profession will mean for the workforce, service delivery and quality of care from the patients’ perspective.

There are some who may see the move to an all-graduate profession as a shift that simply brings nursing in line with other healthcare professions and should not affect how nurses work.

Others see this as an opportunity to look at the overall shape and scope of the nursing workforce, and to develop it in line with future changes in requirements in the delivery of health care.

These two schools of thought need some reconciliation. Although there need not be a national prescription for the way the nursing workforce should appear, this is a prime opportunity for employers.

They should consider what opportunities can be gleaned from this change to the profession, while ensuring that there is flexibility for local delivery.

This debate must not just take place within the nursing community. It must engage patients and the public and it must also engage employers, both in and outside the NHS

There are a number of questions that employers and the nursing profession need to consider. But, in essence, we need to understand what will be different about having an all-graduate nursing profession and what implications this move will have both for service delivery and for the workforce.

Surely there must be some difference because, if there isn’t, why have we made the change?

Beneath the issue of moving to an all-graduate nursing workforce, specific questions will need to be addressed.

These will inevitably include:

  • What roles should the various parts of the nursing workforce - such as healthcare assistants, registered nurses, advanced practitioners - be playing?
  • What does an all-graduate profession mean for the composition and size of the workforce in the future?
  • What will be the impact on the nursing support roles? Is there an increasing role here for assistant practitioners to provide
  • one-to-one care for patients, while the registered nurse adopts a different role within the team managing the patient?
  • What does all of this mean for workforce planning and for education commissioning?
  • Will there be specific issues in relation
  • to the community and primary care
  • nursing workforce?
  • What nursing services will PCTs want to commission in the future?

None of this, of course, even includes all the complex issues and questions around the actual mechanics of introducing an all-graduate profession. These matters will involve establishing curriculums, commissioning courses, attracting students, student funding and so on - as well as the transition itself.

The wider debate on the implications of this change needs to be happening up and down the country.

Hopefully, the recently announced Prime Minister’s Commission on the Future of Nursing and Midwifery, will prove key to this process.

Chaired by health minister Ann Keen, and the first full-scale review of nursing care for nearly 40 years, the commission
will be able to promote this discussion and address these issues.

However, this debate must not take place just within the nursing community. It must engage patients and the public and, crucially, it must also engage employers, both within and outside the NHS, who are responsible for the provision of services and for the nursing workforce.

In trusts, this issue is about how services are provided and how the largest part of the workforce is organised. It is, therefore,
an area of concern for boards, chief executives, human resource directors and the other clinical professions.

To support the process and encourage trusts to ask the right questions to formulate a broader plan and define what good nursing is or will look like in the future, NHS Employers is producing a discussion document.

This document will create the opportunity for employers to debate these issues, inform their vision of good nursing and support the delivery of the quality agenda.

The debate is crucial – let’s make sure we all take part.

Alastair Henderson is joint director of NHS Employers


Readers' comments (4)

  • Nursing care standards have slipped badly over the years as many nurses are 'too posh to wash' their patients. I think all prospective nurses should be carers on wards for at least 6 months (paid) before they start training. This would filter out those who are unsuitable or who have unrealistic expectations. Nurses also need to be freed from the repetative paperwork they have to do which must be streamlined. Care plans take too long to do and take nurses away from the bed side. They could be standardized.
    I think the degree should be done after the basic training to build on knowledge. Lets get the basic nursing care right first!

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  • Im a RGN/RMN who would like to upgrade my Diplomas to degree level but the problem is there are not many unversities prepared to offer such courses.I qualified as a nurse 18 years ago overseas. I have all this time been practising as a nurse.

    Most are offering such courses to nurses who did advanced diploma at the universities within the last 3/5 years. Surely I cannot be expected to do a further 3 years training to have a degree.

    Will the degree bring more expertise and enhance my skills as a nurse. I bet a lot of nurses share my views. Please advise.

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  • What about those of us who are already qualified without a degree? The availability and funding for conversion or top-up is scarce. The attitude of the Univerity where I obtained my second Nursing Qualification in Children's Nursing was, you are a qualified nurse already so you can afford to fund yourself. I was also given placements that required a lot of travelling to as it was decided again that I had money to pay for my travel unlike the pre-reg students.
    How will we get time to obtain a degree whilst maintaining a full-time demanding and often streesful job of actually caring for patients.
    Will the patients even care if their nurse has University credits as long as they actually receive the care they require when they need it!!

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  • Having a degree does not make a good nurse but unfortunately we are in a time of accountability to the public and by having a university degree in Nursing is looked upon as a having more status and credibility with colleagues and the public.
    Entry to practice Nursing in Ontario, Canada had changed to university degree for new nurses several years ago. I was a diploma trained nurse (graduated in 1982) who went back to university and got my Post RN BScN degree 3 years ago.
    Now that I have my degree I don't feel that I am a better nurse. I believe that I was always a good nurse but a degree has given me more opportunities and has taught me to think critically. Writing papers taught me to examine my way of thinking and question things.
    Acceptance of a university degree for entry to practice for nurses is a fact of life now where I practice and some of the experienced nurses have gone back to school part time to obtain their degrees as it opens up more doors for them in their nursing careers. They didn't have to do this but chose to. Presently practicing RN's should not be forced to upgrade.
    I believe now that having a Nursing degree for entry level nurses is a very good thing for accountability for our profession.

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