Friday, 13 November 2009

Do Nurses need University Degrees?

The Westminster government has rubber-stamped plans for nursing in England to become a degree-only profession. The chief nursing officer for England, Christine Beasley told BBC Radio 4 that the change was a "small but important step" that would help give nurses the "real ability to think and make decisions" as care becomes more complex. "It's not about moving nurses away from direct care."

I'm sure readers will correct me but I think Scotland is going down this path too and I have a few concerns.

Firstly, I have no objection whatsoever to anyone from any walk of life gaining a university degree, in fact on the contrary, I think many deserve it.

But nursing is one of those vocations which does not necessarily rely upon academic ability as much as character. The work requires particular characteristics which aren't found in all of us - such as empathy, listening skills, the ability to react speedily to their own gut instincts. If a trainee nurse doesn't have these skills, will studying a degree provide them? Not very likely although it will provide an understanding of modern technologies and treatments which of course will be of benefit to patients.

Will the fact that a university course is required be a deterrent to some young men and women who would dearly love to enter into the nursing profession? Yes I think it will. Less confident young people will turn away from nursing because it requires this academic qualification. Some of them will possibly have the unique qualities required in a nurse so they will be lost to the profession.

Will knowing all nurses have a university degree instill more confidence in patients? I don't think it will. When you're ill you know when someone cares for you by their attitude, not by the academic qualifications they hold.

Of course nursing, like all professions, should encourage staff to develop as much as possible, but I would prefer this to be on a voluntary basis not a compulsory one.

Speaking of nursing reminded me of this article on the BBC site. I wonder if we'll hear more about it as details are revealed.


Demetrius said...

It is amazing to look at the course of human history and its many achievements and realise that very few of those involved had degrees. As for hospitals for over a hundred years so many nurses did so much without a degree. So what miracles can we expect from those who cannot nurse without one?

subrosa said...

Demetrius, I have no problem whatsoever to nursing staff having educational degrees, in fact I would encourage that.

My problem arises when anyone who would have the requirements I say are essential to nursing are left behind.

Who is going to give the basic care which doesn't exist in hospitals these days? I mean the holding hand of a frightened person, the cleaning of their backside if they've shit themselves because nobody came quickly enough when they pressed the 'help' button, the bedridden patients who need a bowl of hot water and soap once they've used a bedpan - just to ensure they don't pass on c'difficile to others?

I can tell you, next time I visit any hospital I will have a pack of sterilised disposable gloves with me and I will use them from the minute I arrive until the minute I leave.

Hospitals can push all the gels they want, but the biggest infection is c.difficile and that can only be killed by soap and hot water or bleach. Of course an antibacterial soap would be better, but these gels are only making money for the NHS Trusts and the producers.

Isn't it time we returned to basic hygiene before we have chemical gels which have to be so powerful they will strip layer of skin off our hands?

Dougie Kinnear said...

If they're doing a degree they might get more financial help than they do at present so that might be an advantage, and, where do they go at present to learn their trade? As far as I know around here it's all run by Dundee Uni so if a University delivers the training......

JPT said...

They shouldn't have to have a degree no. But with degrees in such things as media studies etc nursing becomes a very complicated job in comparison.
We will have academicably able nurses but will that be any good?

polaris said...

Unequivocally no - neither appropriate or relevant, and will make no difference to care, in fact may even lead to a "Doctor Lite' mentality - nurses reluctant to undertake the less savoury aspects of care of the ill, justified by "I didn't study for a degree to do this".

This is just a symptom of two sadder aspects of society now:

1. Nobody is a loser, everybody wins - we all deserve everything, not on merit just because we do.
2. The muddying of the quite clear ground between 'vocational', 'training' and 'academic'.

scunnert said...

My sister went through this in Canada. Trained as an RN she was told by her hospital, after years in the game, she now needed to get a BScN. In her early forties she took night school and after some years got the degree. Once finished her employer suggested she get her masters!

Now hospitals are hiring less BScN's and hiring more practical nurses (college level) as they're cheaper. All the BScN's do is sit in the nurses station staring at computer monitors. God knows what for - they never actually see a patient.

Now doctors are being replaced by "Nurse Practitioners". Maybe this was the idea from the beginning.

JRB said...

I’m sorry but I must fundamentally disagree with all who have posted.

Graduate nurses can only be in the long term interests of all patients.

Naturally that is but my opinion, and is based on my experiences, but these experiences have brought me into regular and close contact with many ‘graduate’ nurses.

In an earlier post it was asked - “So what miracles can we expect from those who cannot nurse without one” [a degree ]

That question, for me, is simple to answer – Save my life.

Perhaps to some that may seem an emotive answer, but it is nonetheless a true answer.

I for one owe a debt of eternal gratitude to those graduate nurses who, in turn, sat by my bedside for three days, performing those traditional and basic nursing skills, but more important to me, they were able to monitor my condition with a knowledge and understanding resulting from their enhanced graduate clinical training. And, when things did go wrong they were able to initiate life saving resuscitation and defibrillation, and on more than one occasion.

During the above events I was ‘out of it’, and it was not my hand those caring and compassion nurses held, it was my wife’s. It wasn’t with me they had the calm reassuring chat, but with my daughter.

Now, I have the services of a graduate specialist heart failure nurse, she has been my support, my guidance and a shoulder to cry on. I would not have coped so well without her.

I hope you never have occasion to need the clinical skills of a graduate nurse, but if you do, I guarantee you will be grateful that future nurses will have these skills as basic core skills.

If you have a minute please visit –

subrosa said...

Dougie, lots of universities and colleges offer nursing degrees here. In fact when I googled it one site said there were too many places available.

subrosa said...

John, I still think not every nurse needs a university degree.

Of course for some career structures within nursing a 4 year course may be essential but it doesn't make a nurse in my opinion. Not all nurses need to be specialists in an area but they do need to be carers.

I'm all for anyone improving their knowledge but to insist every nurse has a degree is unreasonable.

In your case of course you need a specialist nurse but does every nurse need to be trained to be a heart care nurse? Not really I don't think.

The nurses you meet sound rather like the Macmillan nurses. People with a great specialist knowledge and also possessors of the basic characteristics for nursing. Both don't always go together.

subrosa said...

Scunnert, my brother said exactly that not so long ago. In Vancouver that's what's happening. he sees a 'nurse practitioner' who he says knows what she's doing. But she costs less than half the price of a doctor to the health service.

subrosa said...

Polaris, as scunnert suggests, do you think this is a way of reducing doctors and thus costs?

banned said...

My Mum was an SRN, trained in London during WW2 as a proper nurse; her Matron always insisted that the first rule of good nursing was to " clean the drains". It was when they sacked the in-house maintenence crews in the late 1980's that hospitals turned into charnel houses.

Degree level nursing is all well and good but what the NHS needs is an influx of not particularly academic but caring and compassionate people ( usually but not always, young women ) of the kind who are nowadys found in care homes for the elderly. Perhaps they might be afforded the same status as teaching assistants in schools.

subrosa said...

Aye banned. I think we're going to lose a lot of women who would make good nurses with this blanket requirement of a degree.

Not everyone wants to study for years, many prefer the old fashioned 'on job' training style.

Dramfineday said...

Now here I am out in Uterbangistan under fire from the the militant front for no shaving and I have several wounded. Does the cry go up......"Medic, but only if you got a uni degree"!

Having given it a bit of thought I've reached a conclusion that a university education can be a liability in that it can lead to a communism of thought. This is reflected by people following standard group thinking and failing to develop much original from it. Take business thinking. From the comments in the blog above it's clearly circular " Let's educate our staff and get degree's, oh we have to pay them more, lets employ people wtih no degree's they're cheaper". The same thinking process in place across the western world and little original in it. Time for a new orthodoxcy and fresh thinking instead of the same formula being repeated endlessly

polaris said...

Suborsa, "Doctor lite" is considerably cheaper to employ than a Doctor, and it may be a way of reducing numbers. I doubt if overall expenditure will be reduced much, savings will be eaten up in the ensuing lawsuits if the NHS pursues that tack.

JRB, you personalise your argument despite as you saying "you were out of it". What evidence do you have that say an HND qualified nurse with appropriate experience would have been unable to deliver the same care? A degree does not automagically endow its holder with extraordinary additional skills beyond that of what is possible for those without a degree.

In fact the formative part of a rounded professional, in any arena, is post qualification experience. To counter personalise - I am an Engineer and the most dangerously incompetent individuals I have met all possess degrees and a false confidence in their abilities, not backed by experience.

This reaction is another example of a membership body and lower-academia successfully lobbying for self interest without real justification.

Gas Safe, Child Minding, The Law even MacDonalds are all proponents of exclusive professional qualifications that defy logic, as this proposal does.

polaris said...

Degree in Hamburger Flipping anyone? Now is that the faculty of Arts, Humanities, Science or Medicine?

subrosa said...

Polaris, when I googled nursing degrees I was overwhelmed with the amount of colleges which offer them. It seems there are so many nursing degrees on offer that there are plenty places around the country.

I can understand a midwifery degree or a community service degree but most of them didn't mean a thing to me.

How does the employer grade them? Is a nurse who say specialises in John's ailment hearts above a nurse who specialises in bones?

I thought nurses were given a very rounded and thorough training back when I was young and the ones who chose to be doctors were the specialists.

subrosa said...

There are plenty very small businesses who think like that today Dram and it doesn't mean the employee doesn't get a good training.

Around here there are a few agricultural engineering businesses and they just couldn't afford to employ a graduate, although one or two of their apprentices, who wanted to go into oil related businesses, have studied degrees but in their own time.

Clarinda said...

I've waited until this point after reading so many comments to give my opinion.

My credentials - trained and educated as a nurse in 1968 RIEd., where most of us had university entry qualifications, we were all roughly 18 and unmarried. Our training was direct 'hands on' from day one supervised by a hierarchy of Lady Superintendant (the Royal didn't have 'Matron'), Deputies, Assistants, Ward Sisters, Senior Staff Nurses and Clinical Nurse Tutors. I worked in the NHS for almost 35 years and the fate and potential of nursing still remains a passion for me!

My nursing education was academic with emphasis on what are now referred to as Life Sciences (anatomy, physiology and pathophysiology) spread across the various medical and surgical general and specialist patient care services in hospitals and the community. We had very little input in terms of the 'softer' sciences (eg sociology) which we were expected to learn and did under the watch of the Staff Nurses in particular, who in turn were under the piercing surviellance of Sister! Today, there is perhaps too much academic emphasis on these 'softer' subjects in the nursing curriculum and physical science is too frequently religated and regarded as medicine's territory.

We had exams and patient care studies to pass at a very high level on almost a monthly basis and end of year hospital and professional examinations. On-going reports from the clinical areas added to a huge portfolio of academic and clinical performance that today would knock the so-called degree studies into a corner! When I think back we only received a Certificate but which today would make a current nursing degree somewhat pale.

As we progressed after qualification to various nursing specialities there were similar educational systems in place to attain additional professional qualifications.

For some to think that somehow all you need is a tame, nice and obedient underling/hand-maiden to make everything OK in todays NHS nursing milieu is way off line. Patient's need intelligent, disciplined thinkers who can make rational decisions and take effective action - with compassion!What HAS changed is women's ambition to choose a university education and experience that doesn't tie them to work based commitment, as in nursing education, and one which offers greater professional and employment independence and opportunity. Because nursing has lost it's traditional cohort of 18 year olds with appropriate Highers etc. we have widened, downswards I reckon, the nursing enrty gate, which perhaps explains the devastating drop-out rate. This is also driven by the lack of time and personnel in hospitals today to supervise students who need to actively and directly develop their professional skills. My hat comes off to those who manage to survive todays rigours and become highly competent and professional nurses.

I eventually became a Clinical Nurse Teacher and finally a university Nurse Teacher in charge of Post Registration nursing degrees. I have to admit that the standard of academic and clinical expectation in the formative pre-registration years is not unreasonable but the ability of the students to achieve these standards is compromised by the systems within the NHS - NOT the university! I would also admit that in some cases not enough selectivity is put into admission criteria on both the potential academic AND personal level of the candidate.

University based education is not the problem - but the overly politically managed environment in which the student needs to learn and develop - does. Just ask any Registered Nurse about the relentless onslaught of politico-mangerial 'modernisation', 'change' and 'reform' etc they have to put up with which stiffles their innovation and ingenuity to perform as they have been originally educated!

Scotland has had degree education for entry level student nurses for years but we need to refine their clinical work environment much more than their educational system which will always need sensitive modification to meet today's health needs.

subrosa said...

Thanks for your comprehensive comment Clarinda.

As I've said I have no problem with anyone in any profession developing their education.

Does this mandatory requirement mean in future patients will be demanding no less than a nurse with a 2/1 to give them an enema?

Academic education does not ensure a nurse has caring and compassionate qualities and with the present desperation of universities to have bums on seats, I doubt if that will concern them.

Clarinda said...

Subrosa that's the problem - the entry was been widened with many universities struggling to fill places with the paradox that full time permanent positions in the NHS are as rare as hen's teeth for qualified nurses.
NO education can teach human qualities of compassion and kindness but with the proper professional example and encouragement of such skills they can be transformed from personal attributes to professional expertise. However, I would rather, every time, prefer to have a well educated nurse giving me an enema as anatomical knowledge could make a significant difference. You don't want to hear some true stories as to where some enema tubes have been inserted due to lack of awareness!
Again I emphasise - it's not just the initial student selection criteria or the form of education that's at fault but more the 'learning environment' offered by today's target driven, protocol ridden and vague clinical nursing leadership.
Excellence in nursing has now to rely on those who achieve advanced education and experience in specialisms post Registration.
Sadly expertise in direct clinical patient care has been superceeded by the false promise of managerial promotion.

subrosa said...

'Sadly expertise in direct clinical patient care has been superceeded by the false promise of managerial promotion.'

Clarinda, would I be right in thinking because of your statement above many highly qualified nurses leave the NHS and move to the private sector or abroad?

Clarinda said...

Not even that! Many are moved into NHS managerial positions which remove them from direct 'hands on' patient care where not only patients lose out on their expertise but students and junior Staff Nurses. Specialist areas of nursing still appear to have a grip on retaining competent nurses (and midwives) it is the more general areas that are really losing out. Scotland has much less demand in private nursing as our section of the NHS is still better off (so far!) than down south re- waiting lists etc.. You may be correct re -nurses moving abroad (Australia, New Zealand and Canada still attract many)where they are highly valued!
The desire in most nurses remains but they are up against it in trying to fulfil their vocational intentions required within their Codes of Professional practice and Registration criteria.
I would hope that as a UK broad university degree cohort, nursing ought to be more powerful in demanding and achieving professional clout on behalf of improving their working systems which can only enhance patient care?

subrosa said...

I would like you to get your wish Clarinda, but you know the heirarchy of the NHS and how they work. I can only surmise.

Thanks for your comments though, I do hope others have enjoyed them. I certainly have.

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