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Senior nurses line up to reject surgeon’s views linking compassion with graduate nursing

  • 11 Comments

Nurse leaders, educators and researchers have come to the defence of nursing as a degree-only entry profession, following controversial views on compassion aired in a newspaper by a surgeon.

Ruth May, executive nursing director of NHS Improvement, is the latest senior member of the profession to respond to the comments published in the Daily Telegraph earlier this month and then widely shared on the social media site Twitter.

“Compassion and knowledgeable expertise are not mutually exclusive”

Ruth May

Robert Jackson, described by the paper as a fellow of the Royal College of Surgeons, claimed making nursing degree-only entry had led to the “demise of the traditional hands-on compassionate nurse”.

In the letter published on 20 January, he also suggested that nurses were merely employed to “support” doctors and the loss of “vocational nursing” was contributing to destroying the NHS.

Mr Jackson said: “Thirty years ago my doctor colleagues and I were strongly opposed to the introduction of nursing degrees, but no one took any notice.

“While nursing degrees may have introduced a new tier of healthcare worker to support the over-stretched medical profession, they also led to the demise of the traditional hands-on compassionate nurse,” he wrote.

He added: “The loss of vocational nursing will do more to destroy our much-admired heath service than any level of mismanagement.”

“Nursing, like medicine, is improved by higher levels of specialist study”

June Girvin

Mr Jackson was himself responding to an editorial published online and then in a shorter print version by the same paper on 18 January by Kathy Gyngell, co-editor of right-wing website The Conservative Woman.

In her piece, Ms Gyngell argued that nursing had “lost its humanity” when it became a graduate profession and that “young British women” were now shunning it as a “go-to career destination”.

But in a subsequent letter to the paper, seen by Nursing Times, Dr May highlighted that there was “clear evidence that greater knowledge, skills and education improved outcomes”.

She noted that nursing had a long tradition of working in support of medicine and had often been perceived as a “handmaiden” to the doctor. “But such stereotypes are long gone,” she said.

“Compassion and knowledgeable expertise are not mutually exclusive. Nurses do both, and do it well,” said Dr May, who is also deputy chief nursing officer for England.

Alison Leary

Alison Leary

Alison Leary

In another letter sent to the Telegraph, Professor Alison Leary, chair of healthcare and workforce modelling at London South Bank University, said she was “dismayed” by the surgeon’s views.

“It is incorrect to attribute the current state of the NHS to improvements in the education and skill of the workforce,” said the nurse researcher. “Care has become far more complex, the workforce needed to meet this need requires more, not less, skill underpinned by rigorous education.

“Mr Jackson also seems to be under the impression that nurses are there to service doctors. They are not,” she said. “The purpose of nursing to look after patients.”

Similarly, June Girvin, emeritus professor of nursing, said Mr Jackson had failed to understand that “today’s registered graduate nurses bring both education and compassion to their work”.

“Nursing, like medicine, is improved by higher levels of specialist study, and nursing care is measurably safer when provided by graduates,” she said in a letter already published in the paper.

Professor Girvin said that Mr Jackson presumably believed that nursing required “no underpinning knowledge or critical thinking skills – just cool hands and a warm heart”.

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Ruth May

She added: “In our overstretched health service, doctors and nurses support each other in multi-disciplinary teams, and value one another’s knowledge and skills.”

Meanwhile, Professor Roger Watson, a nurse academic at Hull University, wrote: “Nursing education remains 50% hands-on, and many of the students I meet still refer to their vocation.

“The demographics and intensity of care required by patients have changed radically in the 30 years since I entered the NHS. Mr Jackson’s attitude is unhelpful,” he said.

Attacks have continued to dog nursing since it became a graduate profession during the 1960s and ultimately degree-only entry in England in 2013 – though it was preceded by the rest of the UK.

The argument has often centred around the former use of state enrolled nurses, but the debate has also been reawakened by government policy to introduce nursing associates and apprenticeships.

Assistant nurses, later known as the state enrolled nurses, appeared in 1943 but were phased out during the early 1990s after the restructuring of nurse education under Project 2000.

Enrolled, or vocationally trained, nurses were recorded by the General Nursing Councils – a forerunner if the Nursing and Midwifery Council – but did not have to undergo full registration.

The letters in full

“We must applaud Kathy Gyngell (Comment, January 18) for drawing attention to the demise of the vocational nurse. Thirty years ago my doctor colleagues and I were strongly opposed to the introduction of nursing degrees, but no took any notice.

While nursing degrees may have introduced a new tier of healthcare worker to support the over-stretched medical profession, they also led to the demise of the traditional hands-on compassionate nurse. The loss of vocational nursing will do more to destroy our much admired heath service than any level of mismanagement.”

Robert Jackson FRCS

“I read the recent letter by Mr Jackson, FRCS, regarding his views of the vocational nature of nursing and his perceived detriment to the profession. It appears that myself and Mr Jackson were contemporaries in clinical care in the NHS and can say with some certainty that his view was a minority even then.

Nursing is a profession, which I’m proud to be part of. The nature of professions are that they are required to have extensive knowledge and expertise to function. Nursing, has been so for many decades and has like his own (medicine), developed over time to include new knowledge and thinking to further enhance the skills that are required to care and manage the complexities of illness.

newspapers.jpg

Nursing has long had a tradition of working alongside and in support of medicine, and I freely accept that it was often perceived as a ‘handmaiden’ to the doctor. But such stereotypes are long gone, and were very much on the wane when he first raised the issue. There is good reason for this, firstly that increasing knowledge and specialisation of nursing was in response to the accelerating change in clinical practice that required higher skills and capability.

Nursing recognised this and in line with other countries internationally moved to a graduate program so nurses had the required knowledge, critical thinking and clinical skills to deliver expert nursing practice. It is important to note that such a move was made by many professions in healthcare as there was clear evidence that greater knowledge, skills and education improved outcomes.

Finally, all health professionals ‘care’ and nursing does not have the monopoly on this, but what is important to note is that compassion and knowledgeable expertise are not mutually exclusive. Nurses do both, and do it well.”

Ruth May, executive director of nursing, NHS Improvement

“Robert Jackson, who laments “the loss of the vocational nursing”, fails to understand that today’s registered graduate nurses bring both education and compassion to their work.

Nursing, like medicine, is improved by higher levels of specialist study, and nursing care is measurably safer when provided by graduates.

I don’t suppose Mr Jackson would suggest that his degree-educated medical colleagues lack any sense of vocation. But presumably he believes that nursing requires no underpinning knowledge or critical thinking skills – just cool hands and a warm heart.

In our overstretched health service, doctors and nurses support each other in multi-disciplinary teams, and value one another’s knowledge and skills.”

Emeritus Professor June Girvin

“I was dismayed to read the letter from Robert Jackson FRCS and his poor regard for nursing colleagues. Thankfully, many medical colleagues do not share his views.

It is incorrect to attribute the current state of the NHS to improvements in the education and skill of the workforce.

Care has become far more complex, the workforce needed to meet this need requires more, not less, skill underpinned by rigorous education. There is plenty of evidence to support this including Linda Aiken’s excellent study in the Lancet on improvements in survival when cared for by a graduate nurse. The current English policy of returning to simple vocational training is an unknown risk and contravenes the available evidence but is no doubt borne from the same root. That nursing is women’s work and only requires a good heart and obedience to their betters.

Mr Jackson also seems to be under the impression that nurses are there to service doctors. They are not. The purpose of nursing to look after patients.”

Professor Alison Leary

“Nursing education remains 50% hands-on, and many of the students I meet still refer to their vocation.

The demographics and intensity of care required by patients have changed radically in the 30 years since I entered the NHS. Mr Jackson’s attitude is unhelpful.”

Professor Roger Watson

  • 11 Comments

Readers' comments (11)

  • A lot of what is said is true but only to an extent ,I started nursing many years ago and I have no degree,in those days you did a lot of hands on care you don’t now because you are doing things dr s used to,hands on is left to the hca even they are doing extra work as doing venflons etc,who is left to look after the patients,you can’t go back. the idea of having degree nurses was a good thought but not thought through .bring back the old sen not the ap,s

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  • Bring back this! bring back that! Jeez! Some people need to start to come to term with the fact that we don’t live in the “good old days” anymore! We live in a constantly changing and modern world. We’ve got no choice but to accept it and adapt!

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  • I agree wholeheartedly with the Consultant. It started with project 2000. Nursing now means having a certificate for every thing or you won't be considered for a role you are MORE than qualified for !

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  • I did twitter that this is an example of surgeons "arrogance personified !" I have worked alongside surgeons since 1982 in the operating theatre, and did so today as an Orthopaedic Surgical Care Practitioner, as part of a great perioperative surgical team! But tonight, came across this phrase on Medline article. Volume of care to value of care. In a target driven NHS we forget, the value of the care we provide to patients, who put their complete trust in us. As we worked together today, to relieve pain and disability by providing a safe joint replacement!
    I do however believe that nurse leaders need to shout this from the rooftops! Volume of care to value of care.

    Adrian Jones RN-SCP
    President - Association for Perioperative Practice

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  • Nursing has always evolved. You do not need a degree to ensure high quality evidence based care. Otherwise those who trained when we did before P2K would never have survived if the Degree had its way.
    The article suggests Enrolled nurses were not qualified. They had to pass practical exams and a final exam many current degree nurse students would struggle to pass.
    Nurses doing the work of junior doctors, with the doctors poorer for it. HCAs taking on vital staff nurse work because their hands are full doing junior doctors work. HCAs struggling doing staff nurse work with no formalised training recognition or reward.
    My family are lucky, they have me. I have despaired as a patient and visitor at the dynamic present on so many wards today.

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  • Oooh, great, I can get my lamp and cape out again! What a pile of tosh. I don't agree that all nurses need a degree but I SERIOUSLY don't agree with this Dr's old fashioned, rose tinted view of nursing and nurses. Nursing back in the day was a hard, thankless, slog within a culture of bullying second only to Hollywood!! Doubtless he would love to go back to the days when student nurses had to stand up when a Dr entered the room, where sister provided tea in china cups after the Dr's round and where his opinion was rarely, if ever, challenged. The nursing profession woke up and decided we are not handmaidens or servants to the medical profession and we are the better for it. That said, I do not have a degree. Undertaking one and adding more letters to the end of my name (yes, even those of us without degrees have those) would be meaningless and not provide my patients with better care than I already provide.

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  • I qualified in 2000 with a degree. I chose to do the degree over the diploma pathway as I wanted to stretch myself academically & also as I was advised I would end up doing it anyway, in order to progress up the ladder.
    I am certainly not "too posh to wash". I love nothing more than to give essential nursing care to my patients, getting to know them & their loved ones.
    My degree has given me the ability to look more deeply at the evidence base behind my knowledge & enhances the skills I have & the care I give. My compassion, essential for a palliative care nurse or indeed any nurse, is part of me. My parents instilled that in me, my career has only brought it out & used it to give the best care I can give.
    I agree wholeheartedly with those who say look forward, not back. I am not a doctor's handmaiden, but I can work alongside them & have gained so much from their knowledge. We can also educate them, our knowledge & skills in our own fields is huge!
    Every system has it's flaws & I hate the way that nurses are taken further from the bedside. However, I believe this is not the fault of the degree nurse but advancing medicine & a system that is failing to keep up.
    Sufficient staffing levels & nurses having their fair share of both the hands on work & the necessary paperwork to document their patient's care would go a long way.

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  • Nurses need to get back to real front line nursing and stop doing non nursing jobs.

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  • I challenged a surgeon whilst caring for my sick patient in a busy neurology ward. He was adamant that the patient was post ictal from a seizure and that would explain his deterioration in GCS. I had enough knowledge and expertise, and confidence, to say no, you should send him for another MRI. That patient had taken a bleed on his brain and would have died.
    If it were the "good old days" I would not have been taken seriously and it would have been to that patient's detriment. I believe that having a degree adds to the increasing respect that doctors have for nurses and means they come to see us as equals. Healthcare is a lot more complex than it was 30 years ago. This surgeon needs to retire.

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  • Have to say I agree that making degree course only is a error.
    Sure for the bright girls and boys no problem.
    You need a hospital based diploma course as well where the emphasis us slightly more practical.
    Any dr/specialist would often seek the advice or at least consult the nurse as to how their patients were doing when I trained - all diplomas and sure some were also degree grads.
    Possibly the reason for pushing for degree only is possibly from those who felt inferior?

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