As a sometime historian, I might be forgiven for the sense of deja vu listening to the hysteria surrounding the move to degree entry for nurses. What is it about nurses and degrees that polarises opinion?
No other profession has to defend itself against the absurd accusation of being “too clever to care” or “too posh to wash”. These arguments belong to the 19th century and should be consigned to the dustbin of history.
Darwin’s evolutionary biology was used by doctors and scientists to argue against the higher education of women on the grounds that energy required for reproduction would be diverted to the brain, damaging their fertility and the fitness of the race. Under this theory, growth and development had to be reconciled with energy expenditure and conservation. Thus, any energy required for intellectual exertion would deprive other areas of supply.
Fears of “brain-forcing”, malnutrition of the cortical cells and neurasthenia were afflictions caused by overtaxing the brain through education. Indeed, the ability of women to be educated was determined by the smaller size of their brains, often observed in postmortem studies of the insane. Fatigue, fear of exhaustion and the enforced idleness that governed women’s lives was what Florence Nightingale railed against in her feminist tract Cassandra.
‘You wonder, when hearing antediluvian opinions about nursing degrees, whether they were the work of the devil or whether you’d been teleported back to the 19th century’
Of course, the application of this theory was highly selective - it did not affect the majority of working class women employed in factories or domestic service.
The fear of overeducating women was that women would be “unsexed” and unfit for marriage. The picture of the “bluestocking” was one of ridicule, the shrivelled spinster, oblivious to her appearance and repulsive to men. Thus it was middle class women who led the charge to open the professions to women and who were vilified in turn for daring to storm the citadel of medicine. Their physical delicacy was derided as making them unfit for the dissection room. By contrast, it was women’s proximity to nature in nursing which was perceived by medical commentators as the ideal prelude to marriage and motherhood.
The point of the above is that both class and gender attitudes continue to shape public perception of nurses’ ability to be educated. Attitudes are slow to change but now medicine admits more women into the profession than men.
Yet, you wonder, when listening to the antediluvian opinions expressed about nursing degrees, whether they were the work of the devil or whether you’d been teleported back to the 19th century.
Nurses’ brains are not shaped like bedpans. That doesn’t stop the power of nostalgia, however, pulling us back into our comfort zone, the “good old days” of yore at times of threat or rapid change.
The public perception that poor care is caused by nurses being better educated needs to be challenged. But it is not better education which is the cause. On the contrary, evidence demonstrates that better educated nurses deliver higher quality care.
The problem is how care is organised, whether it enables nurses to spend time with patients, their families and loved ones. We need nurses with the skills and capabilities to champion care and respond creatively to the challenges of tomorrow. And, believe me, these challenges are some of the greatest of our times.
The sheer scale and speed with which we need to meet that challenge needs clever hands, hearts as well as heads. We are at a critical juncture where we face a double squeeze - a squeeze on care combined with an economic squeeze. This combination is potentially combustive unless we respond quickly and with all the ingenuity we can muster. We need a strategy for investment, innovation and the will to succeed.
If we can put a man on the moon, surely we can crack the quality of care. If we can tackle climate change, surely we can implement care standards. If we can break world records in sports, be world class leaders in the creative industries, surely we can provide truly world class care.
We cannot achieve any of this alone. We need to work creatively and in collaboration with patients, carers and families as well as other professionals, policymakers and managers. To achieve this, moving to degree entry is a must - not apocalypse now.
The world has not collapsed in countries that have already taken this path, such as in the rest of the UK and much of mainland Europe. There has been no choking off of applications. Far from it - applications and recruitment are up, in keeping with the trend in other professions, notably teaching and social work which have also raised the bar.
Furthermore, the students I meet are an inspiration and a source of hope for the future. They are a credit to the profession and the public. Letters from grateful patients testify to the high standards our students achieve. We have much to be proud of.
Perhaps our greatest enemy is not the prejudice and ignorance of others but our own internal fear - fear of what to do when the blindfold of prejudice is lifted, when we have no one to blame but ourselves. Let us lead the charge and light the path ahead. Let not Cassandra call us back and say: “I told you so.”
Anne Marie Rafferty is dean of the Florence Nightingale School of Nursing and Midwifery, King’s College London