Tuesday, 10 August 2010

Nursing Degree

It might be thought that I personally am unsympathetic to the idea that nursing training should be a degree course. Actually I am not, though I do have one reservation, which I will come to.

Degrees are given for all sorts of things including puppetry, surfing and the Klingon language. You can also find degree courses for such anti science as chiropracty and homeopathy.  Nursing at least has the advantage of not being based on pseudo scientific bollocks, and is a profession highly valued by the general public, so why should they be denied university status education.

It has been argued that the change will attract fewer non academic types, and thus excludes many who would be good nurses. It is also suggested, by the RCN no less, that some of those now attracted into the degree course are not committed to the ethos of caring nursing.
The nursing unions and the general public seem unconvinced that this is a particularly good idea. I think these views are largely speculative.

My own view is that the whole thing is actually an irrelevance. In the past nurse training consisted of ward training, with regular release for formal teaching. The degree course consists of formal training, with regular release for ward work. Since there is, in neither system, an inflexible view on the relative proportions, the two systems in fact are identical. Certainly the content is different now than it was 20 years ago but that is inevitable given the advances in patient care that have occurred. Content and rigour of the course is something that can, and is addressed constantly, but this could just as easily have been achieved under the old system as a degree course. It is the contents that are important, not the packaging.

So why were the government so keen to make the change in nurse training? This where I have my reservation. I think it was a con.

In the past when nurses were trained vocationally they were considered employees, and paid accordingly. They also had the benefit of cheap, subsidised accommodation. In changing to a degree course there has been no improvement in training that could not have been achieved under the old system. But the government saves money because now nurses in training have to pay for their own training and for their keep, just like other students. They now have to face student loans, course fees and graduate tax, instead of drawing a wage. They consequently have a high drop out rate. That is the only material change. Nurses have been conned. They have been robbed. They have been taken as suckers. And some actually think they have been done a favour.


  1. The training for us lab bods has gone terriby awry in my opinion. Back in the day (which I am allowed to say, now that I'm middle aged!) we did a technical HNC course. This was a day-release kind of course, so the bulk of the learning happened in the lab with the college course supplementing the theory. The essay questions would be topics such as "discuss causes of erroneous blah-de-blah results", "explain follow-up tests for an abnormal wotsit test" etc etc. It was all aimed at learning to do our job. The practical sessions would be about doing pathology tests by manual techniques so that we understood what our fancy analysers were actually doing.

    Our profession then became degree-entry only, and not wishing to feel left out I sat the new-fangled BSc and indeed an MSc and it was all waffle. "Discuss the molecular biology of diabetes" was one such essay I had to complete. How is that useful for teaching newbies how to perform and interpret pathology tests? Currently, the practical sessions that are included in the Biomedical Science degree course rarely, if ever, have any pathology application at all.

    Add to it the portfolio that the HPC insist upon, that covers vital pathology topics such as equal opportunities and maintaining fitness to practice, and it's easy to see why we get graduates start on their first day quite literally unable to use a pipette, let alone have any understanding at all of pathology test results. It's not good.

  2. Sorry but research carried out in the United States and Australia shows that patients of bedside RNs who have higher education have improved survival rates. The problem in England is that qualified Nurses are being removed from the bedside.

    The course has a high drop rate in this country however. You are right about that.

    When those Nursing students realise just how tough it will be to find a job they panic. When they realise that if they actually find a job that it will be as the sole RN to 30 patients they RUN LIKE HELL. The students I know who have dropped out have all said the same thing: once they realised what they were going to get thrown into: "No fucking way".

    Compare the amount an RN needs to know and is forced to take on and the sheer amount of life and death responsibility he has for such little pay and no control. It's not worth it and it is a very difficult program to get through compared to a degree in education or english...or any basic BS degree.

    It is hard to do a program like that and then deal with a public who sees no difference between yourself and a minimum wage care assistant. They think we are all just "Nurses". There is a bigger difference in education between an RN and a care assistant than there is between an RN and a doctor. An RN has so much responsibility and liability and has to understand what is going on behind those doctors orders. She has to understand pharmacology, pathophys, anatomy etc. A care assistant makes beds and goes home on time.

    But that is just my perspective. I trained in the States where I had to take years of university science and maths and get top grades just to get into the 4.5 year Nursing degree program.

    I had to pay for my own education over there and it was expensive. But upon graduation in that part of the world I was guaranteed a higher salary than most 4 year uni grads and FANTASTIC health insurance coverage so it was worth it.

    Not worth it here though. This country treats RNs like shit.

  3. Half of what you have written has not actually said anything, but I will pick you up on the other half.

    Physiotherapist - degree course.
    OT - degree course.
    Radiographer - degree course.
    Dietitian - degree course.
    Social worker - degree course.
    Hell, even the lab technician above - degree course.

    Why on earth would anyone want to be looked after by someone too thick to pass a degree? I do not want someone with a 'good heart' looking after me, I want a professional who knows what they are doing and has enough knowledge and life skills to pick up when I go off and also to stop the junior doctor from killing me.

    If you are going to reference journalistic articles please reference relevant ones;
    The BBC one is 6 years out of date and this issue has been addressed. The next article, while more up to date, quotes Unison and Unite, THESE ARE NOT NURSING UNIONS! The nursing union is the RCN. Unison and Unite are for health service workers including HCA's, porters, cleaners and occasionaly the odd nurse.
    Strange that when talking about the content of nursing education you fail to mention the changes in medical training. A comment from our consultants to us, "The junior doctors we will be getting from now on will be less knowledgable and less experienced so the ENP's and the nursing staff will need to watch out for them". The cheap, subsidised accomodation you write about was a hang over from the nurses home days and in most cases were cheap, subsidised slums. You talk of the 'old' system, which one? Do you mean P2000, Comprehensive or Modular or whatever existed before them?
    The third article referenced about drop out rates gives a couple of the reasons in the first few paragraphs. One student thought she would be swanning about talking to doctors - the media to blame for that one, Casualty, ER, Holby City et al. The other student left after a semester and is now doing 'fashion', sorry but she was no real loss.

    "They have been robbed. They have been taken as suckers". Why? They have a (useful) degree from a British university which is slightly better to my mind than some eejit from Oxbridge who has studied "The Classics". A degree which can be used as a basis for further education.

  4. "In changing to a degree course there has been no improvement in training that could not have been achieved under the old system" - I'm afraid that's simply not true, Dr Zorro.

    I trained under both systems - first as an RMN (apprenticeship model) with a week's block in school, pre, and post clinical placements.
    Later I joined the adult (RGN) branch of P2K - but this time the split between the Uni campus, and the work place was more like 50-50.

    The central ideological plank to this change (leaving aside issues associated with professional status) was the notion that students of yesteryear copied qualified nurses without necessarily understanding WHY certain things were being done in a certain way.

    It stands to reason that a succession of well meaning but often misinformed nurses would blow oxygen on wounds (to cite just one example from ye olden days).
    Needless to say this kind of guff was perpetuated on the wards by successive generations of students simply because there was an absence in nursing culture of a willingness to challenge either the hierarchy or the status quo.

    Perhaps it's worth adding that this unsatisfactory state of affairs predated the widespread use of computers (one of the most important clinical tools available to nurses nowadays) and occurred during an era when 'evidence based practice' was still an emerging phenomena.

    The classroom (from P2K onwards) became a more important forum to begin to learn about theory/principles underpinning practice, and as Nurse Anne has told us time and time and again - educated nurses save lives.

    It amazes me that certain members of the medical fraternity have yet to grasp this simple concept?

    The A&E Charge Nurse

  5. Thank you Grumpy. I went off on a tangent while you made sense.

    The lack of understanding that medics have about the Nursing profession amazes me.

    Yesterday a doctor handed an IVI chart with a prescription for fast IV fluids and IV antibiotics to a health care assistant. The health care assistant just tossed it on the nurses station and forgot about it.

    I didn't find out about the order for an hour later and by that time the patient was going into septic shock.

    "But I gave the orders to a Nurse" said the medic.

    No you didn't asshole. You gave them to a health care assistant who doesn't even know what an IVI chart is or why that stuff is important.

    If the doctors see the health care assistants hanging around and think that they are Nurses then we have a hell of a battle on hour hands trying to get them to understand the true nature of short staffing.

  6. Anonymous
    I did not say there has been no improvement in training, I fully acknowledge that, like medicine, nursing training has evolved enormously.
    The point I make is that this would have occurred anyway without necessarily changing the title of the course. It would have had to.
    You have not said anything which convinces me that the improvements have been solely (or in any way) due to the purely cosmetic change of calling the training a degree.
    What can not be argued with is that current generations of student nurses are hugely financially disadvantaged as compared with their predecessors and that this IS solely due to the change.
    The conferring of degrees is not something to which I am opposed, but it has been used by government to change the financial basis of nurse training so as to shift the financial burden of training from state to student.
    This might be justified if degree nurses had enjoyed a lift in salary as a result of the change, but that has not happened has it? Nor is it likely to, is it?
    In their eagerness to attract the status of a degree the RCN totally ignored this aspect, but then why should they care. They are already qualified.

  7. A&E Charge Nurse,

    Thank you for that, I had forgotten egg white and oxygen, in a plastic bag if it was a hand or foot wound. Dettol in baths, rubbing pressure areas to get the 'circulation' going, yogurt for fungating breasts. Oh happy days - I think not.

    Dr Zorro,

    "This might be justified if degree nurses had enjoyed a lift in salary as a result of the change, but that has not happened has it? Nor is it likely to, is it?"

    Sadly you are correct, however, at present only 30% of nurses are degree trained in England so if there is more degree trained nurses we might be able to fight our corner a bit more effectively.

  8. My own discipline, physio, hasn't been a degree course for all that long. A significant number of my lecturers qualified before it changed. Nurses are more visible but the situation is probably much the same for us.

    You raise some excellent points that I had not considered. However, the con is not as bad as you think. Financially, the NHS pays all tuition fees and a further means-tested bursary. That bursary is usually in the region of £200-300 a month for students with no parental support and studying outside of London. The paperwork is onerous but the NHS will also pay some of the costs associated with clinical placements. First time students can also get the usual student loans as well. The cheap digs may have gone but we're still being paid to learn.

    I appreciate that you are sympathetic to nurses and I get the impression that you do not want to get sucked in to the usual too-posh-to-wash vs degreed professional bunfight but there is another benefit to the shift to university education that nobody seems to talk about. Evidence based practice.

    Proper scientific research by physios has really blossomed since we switched over. For a profession that clings to the medicoscientific model we lacked a sound evidence base for a lot of our work. Before the 1980s we mostly only had literature from the medics and surgeons to rely on but now everyone has a taste of research methods at uni and we're seeing more physio-led work published.

  9. I should have added that salries and wages in the NHS, apart from doctors, dentists and senior management are all based on nurses salaries. When we get a wage rise everyone gets a wage rise in line. If we are an all degree profession we can perhaps get away from being classed along with the porters and domestics.