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Nurses hit back at minister over university-based education 'regret'


Nurses have accused a government minister of “talking down” the value of university-based education for nursing students.

They hit out after skills and apprenticeships minister and former district nurse Anne Milton said the move to degree-level nursing had made the career unattainable to many would-be nurses.

“We have to be aware and understand our history but not try and replicate it”

Professor Paul Galdas

She said nurses like her who trained through the old hospital-based model had “regretted” the changes brought about by Project 2000 because she believed gaining skills on the job was beneficial.

The minister added that the new apprenticeship route into nursing was “in effect” a reintroduction of this old model and would help to widen participation in nurse education and fill workforce gaps.

“If the only way to become a registered general nurse is through a full-time degree, you are going to lose a huge pool of talent, and we have been losing a huge pool of potential talent that we can now take advantage of,” said Ms Milton, who trained as a nurse in the 1970s.

The comments attracted fierce backlash from the profession with many pointing to evidence showing the association between the level of nurse education and patient outcomes.

Dr Nichola Ashby, head of professional learning and development at the Royal College of Nursing, said: “It is not the existence of a degree that puts people off studying nursing.

“The NMC-mandated UK-wide degree level nursing in 2008 as they reasoned that nursing must become a graduate profession to meet the needs of complex care delivery in an increasingly fast-paced healthcare system that demands flexible, responsive and highly skilled practitioners.

“This required the transformation of nursing practice through better evidence, stronger professionalism, developments in technology, scientific advances and responsiveness to individual and population healthcare needs.”

The “real issue” was the loss of the student bursary for nursing degrees in England, said Dr Ashby, calling on the government to reinvest in higher nurse education.

Professor Paul Galdas, head of nursing and midwifery at the University of York, said the assertion by Ms Milton that the move to university-based education had made nursing unattainable to people who would have made good nurses was not based on evidence.

“I would suggest that on the contrary by talking down what the benefits are of a university-based nursing education, we are losing a pool of talent of people who would choose nursing were they fully informed about the fantastic opportunities that are available for a career and the uniqueness of what a degree in nursing actually involves,” he said.

Professor Galdas said he was concerned that a “false dichotomy” was being created between nurses who were educated through the university route and those who completed an apprenticeship, noting how actually the academic and practical requirements were the same for both.

“In the end, nothing can make up for proper investment in the workforce”

Professor Peter Griffiths

He stressed that universities were already working hard to widen participation into nursing through initiatives such as access courses and highlighted how universities worked in collaboration with employers to deliver apprenticeships.

While he believed the apprenticeship route into nursing was a “positive” one as it allowed employers to grow their own workforce, Professor Galdas said it must be used to complement, not replace, the university route.

“I don’t see any benefit to looking back to a time when the role of the nurse and the complexity of patient care was completely different to what it is now,” he added. “We have to be aware and understand our history but not try and replicate it.”

Professor Peter Griffiths, chair of health services research at the University of Southampton and executive editor of the International Journal of Nursing Studies, said he agreed with Ms Milton that a variety of entry routes into nursing were needed.

While he did not oppose the idea of apprenticeships, he said he feared the emphasis on them could allow leaders to get away with not investing in nursing education and lead to the belief that a high level of education for nurses was not “strictly necessary”.

“In the end, nothing can make up for proper investment in the workforce,” said Professor Griffiths.

“We can’t do it on the cheap and demanding a high level of qualification of nurses is not about preventing ‘able’ candidates from entering the profession it is about ensuring that nurses have the knowledge and abilities that are needed to properly care for people in the health system of today and tomorrow not that of yesterday or the 1970s.

“It seems almost pointless to keep saying it, but time and time again evidence tells us that the best outcomes come when we have more and more highly qualified registered nurses.”

Leanne Patrick, final-year student mental health nurse and chair of the Scottish Health Students Council, said university degrees equipped students with the skills needed for modern nursing such as critical thinking and appraisal of evidence.

“Throwing more people onto the pile won’t fix some of the more systemic issues”

Leanne Patrick

“We should be demanding high standards from the future workforce,” added Ms Patrick.

“If we want to attract people into the profession and keep them there then we need to better communicate what an impressive and rewarding profession modern nursing actually is and address workplace conditions.

“Throwing more people onto the pile won’t fix some of the more systemic issues like workplace incivility which is a leading cause of staff absence,” she added. “I don’t think we can reasonably expect to achieve that by consistently undermining each other on the degree vs no degree battleground.”

She highlighted the importance of acknowledging the history of nursing while respecting the importance of the need for future growth and change to adapt to modern challenges.

“We’re all agreed that we need more staff, better working conditions and skilled staff – let’s keep moving forward as a profession as we work toward solutions,” said Ms Patrick.

Meanwhile, primary care nurse lecturer and Queen’s Nurse, Ellen Nicholson, said the “resounding” evidence base showed that graduate nurses provided safer and better patient outcomes.

“It is therefore concerning that a minister with these responsibilities is unable to relate the evidence base to current practice,” added Ms Nicholson, who is also chair of RCN General Practice Forum.


Readers' comments (6)

  • Ms Milton is just like the Tory Govnt are out of touch, The Govnt took away the bursary which should be brought back or even better pay the student nurses, so making them feel a real valued member of team along with increased places for student nurses . This would help increase the numbers of nurses, unlike the large shortage of nurses, we currently have !

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  • Myself and many of my colleagues are managing to nurse just fine without a degree! Anecdotal evidence from my peers shows we would not consider nursing if it had been degree only when we trained. I think the lack of support eg the bursary has been a huge mistake

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  • The bursary needs to be reintroduced and made adequate for living expenses. Qualified nurses need to be paid properly so nursing can compete with jobs like retail, which may in the near future be a more attractive option.

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  • Again, this is an example of a former nurse who trained a while ago sticking the knife into present nursing. Nursing like so many other aspects of modern living has moved on and so should all those experiencing nostalgia . The profession is presently struggling to acheive professional recognition and these attitudes are not helpful. I really hope that Ann Milton is not appointed Minister of Health in the next government.If she is , hopefully nurses are prepared to fight for he profession.

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  • I’m on a year out from my degree at the moment and starting back in September. As a mature student, with financial responsibilities, I get just over £8000 a year to live off from student finance. I am terrified about starting back at uni because I know how little money I will have. It doesn’t even cover my basic bills, so I’ll have to bank as well. I think to make nursing more attractive, especially to older students they need to rethink the finance options available to us, pay us for the work we do on placement, anything! Maybe recreate part time degrees to support mature students?
    It is so difficult and demeaning to live off £8000 a year whilst paying to get to placement and paying to work.
    I think we’d have better NQNs if we negate the need for us to bank so much, because that way, we’ve got more time to study for exams, we’re less stressed, and the drop out rate would reduce massively.
    It’s not just about degree vs. no degree, it’s about supporting student nurses who are trying to be a good future for the NHS.

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  • Nurses who have degrees are expecting to be paid at the same rate as other graduates understandable. You do not need a degree to be a competent and a capable nurse. You need compassion and common sense. Registered Nursing has become elitist and almost inaccessible for 50% of the population. I do not care how many access courses there are out there for getting into university to do nursing. For the average Joe it means another year of study and another year of debt on top of the 3/4 year degree programme. I trained the hard way, started as an enrolled nurse and eventually got my degree. I was pressurised into doing the degree course and have never used any of the 6 modules I had to do part time over 2 years with 2 toddlers at home. I can say hand on heart the modules I took, have never been used in my every day nursing career.

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