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Would a four-year programme better prepare nurses for practice?


The ever-marching progress from the Nursing and Midwifery Council in expanding the role of the qualified nurse is the biggest thing to happen to nursing since it became a degree-level qualification.

ian dove

Ian Dove

The draft pre-registration education standards hint towards a more advanced curriculum and skill set required for qualification.

The problem I see as a nursing educator is how is this all going to fit within the current three-year programme? Time is already stretched between simulation, placement, classroom learning and assessment. The current degree package as it stands is fit to burst, yet there appears to be more curriculum content on the horizon.

The NMC may lift the cap on simulated learning hours, but is this the answer with the resource intensity and time needed for high-quality simulation?

The current higher educational model of large group intakes results in limited rich learning opportunities within simulation suites and problem-based scenario role play. Educators with cohorts of 100 students have to segment groups and run shorter sessions to ensure everyone gets an equal opportunity.

How do educators find the time to provide nursing students with the quantity, as well as quality of learning that learners deserve? My honest answer is to lengthen the course to four years.

As unpopular as that may be with regards to added fees and time taken to train nurses so desperately needed on the front line, do we just want feet on the ground or thoroughly trained, free-thinking nurse graduates?

I’m concerned that with the coming expansion of the curriculum, we can’t have our cake and eat it. To cultivate independent, courageous and skilled nursing takes time.

Both mentors and final placement students have admitted to me during placement visits that they had feelings of being under-prepared for registration. Resources going into preceptorship programmes are growing at an exponential rate to bring first post nurses ‘up to speed.’

The answer could be to take the time in the protected learning environment of an extended education to arm graduates with more experience and maturity. Now the apprenticeship model of nursing education has firmly arrived, higher education providers have become increasingly fluid with both exit and entry points into training.

”We can’t afford to further diminish the appeal of nursing education after the loss of bursary funding”

A three-year exit point could still exist for a nursing role, but could an additional year of study, to a four-year, degree-level course answer the question of when and where the advanced skills are going to be taught to students?

I’m sure this debate has been had before and will be heard again in future. The demands on student nurses are becoming larger and more foreboding. We cannot afford to further diminish the appeal of nursing education after the loss of bursary funding.

The nursing community need to consider the future of the nursing profession and one way to attract and retain great learners is to have a patient and graded learning experience that truly prepares graduates for registration.

Ian Dove is lecturer in adult nursing, University of Bedfordshire


Readers' comments (6)

  • It would be first be helpful if the university's got there act together. There are not enough proper mentors at least half of my training I was completely alone on placement with no direction and rude nursing staff. Compassion is lacking not years on the degree. Educators ability can also be mixed.

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  • If you need 4 years to undertake a basic nursing degree then there is no hope. Pushing through students at a 40% pass rate is deleterious to the cause of proper practice.

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  • In general, I support a four-year nursing degree, with caveats. 1) As others have mentioned, there must be enough trained, experiences and skilled instructors for this process to work. With out the proper cadre, the product will NOT meet the practice standards of modern nursing in any environment. 2) My strong belief: all nurse need the formal "book learning" and skills training to meet the needs and expectations of our patients. As I have said many times: "Nurse" is both a verb and a noun. Without hands-on training and practice, the nurse becomes a figurehead. What about the adage of :1) see one; 2) do one and then 3) teach one.? We have ALL got to support high-level superior nursing care where ever we have our practice. This is not a dance: One step forward and two steps back. That sort of education and training will never last and WILL ultimately fail.
    Joseph B. Warren RN BSN CWON LTC (retired) Army Nurse Corps

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  • From my experience, universities are very inefficient at teaching/training. A nursing course does not need to be four years. For a while now several universities, primarily in London, have been offering two-year accelerated programs for people who already have a degree (and not in a related subject). The nurses produced are well regarding by the hospitals. Universities just need to stop chasing the money and do a good job.

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  • I was trained in the old style before project 2000 came about. We were trained on the wards with clinical staff to come and work with us to aid our practice. We provided the work force and were practical nurses listening to our patients and doing basic care and gradually extending to other skills.
    We were in school as well as on the wards. I would never have gone into nursing if I had to do a degree. Surely people are being missed out on because they are like me. We had good bedside manners, shown by example, and competent in giving the care needed.I say get everyone back into apprentice form so the work force is upheld, basic nursing care is given, and more of the right people are brought in. The wards I have been to as a relative have been horrendous. I sympathise with the student who said the staff were rude.
    I am just starting my return to practise so hope to make a difference.
    Start by making certain wards the apprentice wards carefully governed as to the approach of the staff so that learning good behaviour is paramount for the students. Learn from the passed instead of reinventing the wheel.
    I probably could do a degree now due to maturity as I have done a lot of academic work since then so degree standard before starting isn't the be all and end all..

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  • It’s already been done. I did 4 years myself. All it does is put money in the pockets of the University staff and give students a bigger debt. I had to visit students union soup kitchens to stay alive and the situation socially is worse now. I worked as a teacher in a college. ‘Care’ was seen by my manager as not an option. When disciplining a student for persistent latenes she said to her ‘ you don’t want to be a career do you?’ I encouraged students to go into nursing and explained my qualifications, the response from 16 year olds: ‘that is so expensive’. Students from an early age now don’t want the debt.

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