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‘Let’s axe the culture wars on nurse education’

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Rachel Sylvester, The Times journalist, recently argued axing bursaries was an act of self-harm.

The Times is not known for its Soviet-style socialism, so even to an outside observer it seems ludicrous that this policy should not be rethought.

“This is merely sticking a plaster to staunch the flow of nurses out of the system”

As teachers, one of our roles is to give feedback. So if we were judging the robustness of this policy as a student assignment, we would likely be marking it down and consigning it to the revise and resubmit category. Although Jeremy Hunt promises more training places, this is merely sticking a plaster to staunch the flow of nurses out of the system.

The real problem is not recruitment, but the leakage of talented, well-trained nurses already in the system. We have reached the tipping point in which, for the first time, more nurses applied to work abroad than were applying to join the register from abroad according to the Nursing and Midwifery Council. Brexit will only add to the burden; worst case scenarios estimate nurse staffing supply could fall by as much as 42,000 nurses.

Does any of this sound familiar? In 1983, Roy Griffiths, who was asked by Margaret Thatcher to review management arrangements in the NHS posed the question “if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge”.

“The frightening answer might be no-one or at least no-one who seems prepared to own the issue”

The answer to the question is likely today to provoke several answers from several different people, all pointing an accusing finger at each other. Who is in charge of the policy as a whole? The frightening answer might be no-one or at least no-one who seems prepared to own the issue.

Never before have we had such a well-educated workforce, but we are not serving them well or giving them the chance to show their value and perform at their best. Rather, we are pushing them to the limit and pushing them out of the system to seek opportunities where they can use their skills and see a career ladder leading to a brighter future.

What we should be paying attention to is the brain drain from within the NHS as much as the exodus of nurses from the UK. There is also the danger that we will provoke a backlash against well-educated nurses, which will hit the wrong target.

Judging by the comments that followed Rachel Sylvester’s article, there are signs that this is already happening. A friend of mine from Spain (not a nurse but a writer), who came to stay recently remarked upon the comments. She found it absurd that people would be so down on nurses being well-educated.

“Research shows there is little point pouring well-prepared nurses into poor work environments”

“No-one in my country thinks like that – it’s mad”. She is right. No-one would dare argue the less knowledgeable you are as a doctor the better. This debate is daft and distracts us from focusing on the main game, which is the conditions under which nurses are having to work.

Research shows there is little point pouring well-prepared nurses into poor work environments. So let’s put our energies into targeting the right challenges: staffing, workloads, skill mix and improving the quality of the work environment for nurses.

Let’s axe the culture wars on nurse education. To not do so would be self-harm. Given we know that self-harm is often a proxy for other ills, we should focus on overcoming the barriers to change and insist the relatively low-cost, evidence-based solutions we already have are implemented without delay.

Anne Marie Rafferty is professor of nursing policy, King’s College London

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