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'All degree nursing education must not lead to a two tier workforce'


All courses leading to the registered nurse qualification will be at degree level by 2013. While this move could increase the status and inluence of the nursing profession, it has implications for diversity and equality.

Black and minority ethnic students are less likely to study at degree level and more likely to take vocational qualifications than white students (Unison, 2007; Tribal 2006). The move to all degree entrance to the profession could mean that fewer BME students take nursing courses. A two tier workforce, with BME workers over represented in the lower tiers as healthcare assistants, could emerge. We could struggle to produce a diverse workforce, which could make culturally appropriate care less likely.

There is evidence that BME nurses are at a disadvantage compared with their white colleagues in terms of promotion, and a two tier workforce will make this worse (Unions, 2008; Tribal, 2006).

This is not only an ethnicity issue. Mature students and those from poorer families are, likewise, less likely to do degree courses and, traditionally, we have depended on the valued perspectives of these nurses in care practice.

The financial pressures that plague university students disproportionately affect BME students, mature students and students from poorer families. The government has yet to confirm the funding arrangements for nursing degree courses. However, any reduction in financial support might make it more difficult for these groups to stay on degree courses than younger students, white students and those from more advantaged social backgrounds.

Nursing’s wide entry gate has allowed a range of talented people access to a worthwhile career. Protecting that tradition cannot be left to chance. Without delay, higher education institutions should review their recruitment, selection and admission practices, which have sometimes disadvantaged groups like BME students.

Retention strategies should address the financial burden minority students face on degree courses. For this, we may need to learn lessons from US scholarship programmes that specifically and aggressively target under-represented groups.

Other factors that will challenge recruitment and diversity. The Prime Minister’s Commission on the Future of Nursing and Midwifery in England exposed the public perception of nursing as low status and low paid, and of nurses being mere helpers to doctors. Stories of poor career advancement and discrimination also make the profession unattractive to some BME students and their parents.

The nursing profession must act now to ensure that the increased educational qualifications needed to access degree courses, admission and selection procedures and that the financial burden of degree study do not exclude under-represented groups from gaining the degree level RN qualification.

Stacy Johnson is lecturer and course director, School of Nursing, Midwifery and Physiotherapy, Queen’s Medical Centre, Nottingham


Readers' comments (11)

  • Why say that black and ethnic minority students are less likely to study at degree level as a nurse I find that statement rather insulting. If someone would bother to do a proper survey you will find that black and ethnic minority students will have degrees in another discipline and are more than capable to study at degree level. I think the lecturer who wrote this piece should look at the bigger problem financial constraints at present are affecting the whole of society not one particular group, race, or someone of a different ethnic background because things have changed from say 10/15 years ago, and yes we need to know how degree courses will be funded. We should however be mindful that because someone can study at degree level does not necessarily make them a good nurse.

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  • Anonymous | 16-Jan-2011 0:26 am I have to agree. The part of the article relating to 'minority disadvantage' is absolute nonsense. The issue of 'diversity and equality' in my mind is extremely tiresome. It should be a given that recruitment is based on talent and nothing else, and talent is found in all races, colours and creeds.

    The biggest obstacle to recruitment and retention on courses is financial constraints, it is as simple as that. And guess what Stacy Johnson, there are a large number of white people that struggle with this issue as well! I was one of them! Having money worries is not solely the preserve of 'minorities'! I find that assumption rather insulting, actually. 'Positive discrimination' (a hateful term) or 'specifically and aggressively target under-represented groups' as you put it is not the way forward in 'reviewing recruitment practices' as you suggest, and in my eyes is a form of racism in itself (favouring one group over another on the basis of their colour or ethnicity?) Recruitment should be based on talent and capability alone, and financial help should be available to EVERYBODY on that course. A basic salary whilst training would be ideal.

    The article is right in the sense that the perception of Nursing is also a major problem, as is the perception (and reality) of poor career prospects. This is a major problem yes, but it is not just 'some BME students and their parents' that find that unnatractive. Are you suggesting that those prospects are attractive to white families? To even mention that is insulting.

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  • Whatever our feelings on positive discrimination the basic tennet of this piece is that BME university candidates (relative to their numbers in society at large) are not applying to nursing courses. This article may have some suggestions for addressing this issue that are unpalatable to some, but at least it is bringing the matter out into the open and asking why? As a very mature (another of the minorities) white British female, I would not have applied for my Children's Nursing course, if I had not been able to do a Diploma. Working class, with little self confidence, I NEVER thought I would be able to complete a degree. I also live, and studied, in a city with a proportion of BME citizens that was certainly not proportionately represented in any of our nursing course cohorts. If our nursing practitioners are not representative of our local populations, then at the very least it's worth asking why .

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  • I'm sorry Anonymous | 16-Jan-2011 2:07 pm, but as long as the courses are open to everyone (assuming capability of course), then there is no place in society for positive discrimination. If people want to apply and they have the talent, then welcome. If not, then ok. It should be as simple as that. As a footnote, my own course I think was pretty representative of the major city I trained in, with a large mix of colour, races and creeds.

    Now as for the class issue, I do see your point, but that is not always the case. I had a degree before I studied for my second degree in Nursing so I can't talk specifically about the Nursing entry, but before my first one, I too came from a very poor, working class background. I never once thought that would not be able to do it. I didn't get in on a poor persons 'positive discrimination', I got in on the strength of my academic results. Now money was an issue, but I worked for that. You say you had little self confidence; I think it is that which has more to do with you thinking you could not do a degree rather than your class or background.

    As for WHY numerous groups seem not to apply, then perhaps it is worth asking and tackling, but not to the extent that the powers that be 'specifically and aggressively' target those groups for special treatment at the expense of the majority.

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  • BME maybe not representative % of total number of nursing students be because their parents were nurses and would never allow them to enter such a weak and marginalized profession, better accountancy, banking, pharmacy or medicine where the money and influence are.

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  • Tongue in cheek, semi serious point above. Certainly BME students are actually over representative of the student body in some areas of the cou
    ntry. And so many were poached ready trained from sub saharan africa by the doh in the early noughties.

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  • I think your all wrong and ill informed.

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  • the first 2 commentators don't seem to have understood the article. It clearly states that we need to recruit more BME students into nursing degrees and questions as to why this is not already the case since there are a greater number of BMEs working as HCAs. As a male student nurse I am also a minority, like many nursing students this will also be a change of career - I would never in a million years have considered nursing earlier for the very fact that the majority of the public don't see nursing as a profitable and challenging endeavor for those with brains. The problems I see are that the healthcare culture keeps nurses from advancing - nurses are their own worse enemy and ambition is a dirty word. The public see doctors as the high achievers and intelligent young people who fail to get into medical school are not choosing nursing as an alternative.

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  • Anonymous | 17-Jan-2011 12:53 pm

    'I think your all wrong and ill informed.'

    perhaps you would care to qualify your statement so that readers know what points it is referring to.

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  • I have to say i am really disgusted with the article as a recent black african graduate with a degree in CHEMISTRY i applied for a diploma in nursing not because i was STUPID as this article seems to apply but due to financial difficulty and it seemed more applicable for my current situation. We should welcome all talents because that is what brings about progress and innovation within the profession and talent is in all race, colour, sex, age etc

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