Email your comments

I have been following with interest the debate in the press on the NMC recommendation that all new nurses will be required to be educated to degree level by 2013.

I trained in the 1980s and did not progress to higher education until later in my career. The world was much simpler then. The training was good but focused on learning by rote and obedience and much of the care was routinised e.g. back rounds, fluid rounds. I don’t feel that this culture adequately prepared me for the ever developing complexities of health care where a questioning attitude and an understanding of complex principles are crucial to the role of a nurse seeking to apply best practice.

I work in a hospital as well as the community and for nurses, higher levels of skills in many areas are now required. Nursing is about the whole care of patients rather than just their personal care. In relation to older people today, this means that it is necessary to have a comprehensive understanding of multiple co-morbidities, pharmacology for non medical prescribing, psychology, technology, complex legal principles (e.g. Mental Capacity Act), funding issues (e.g. CHC) in addition to being a good communicator, negotiator, educator, empathiser and advocate.

Much of the debate has focused on the ‘too posh to wash’ side of this argument but I believe that this is another discussion. The role of caring and providing personal care in society is not valued as it should be. The care of our frailest older people with the most complex of conditions is often delegated to the people with the lowest levels of training and expertise who are often working without adequate clinical leadership or supervision. The growing awareness of vulnerable adult abuse in institutions such as hospitals and care homes and the investigations carried out in these areas have repeatedly shown that clinical leadership, training and supervision are key areas to providing high quality care. This is more to do with the value that, as a society, we vest in caring as a skill than it has to do with basic training.

In my hospital and community work, I do not experience nurses being averse to providing the care that is needed by individual patients, whether they are educated to degree level or not. In my student training with district nurses, there were many patients who were provided with weekly bathing by the team, but at some point this became a ‘social’ rather than a ‘health’ need and so was no longer seen as part of the nursing role. These ‘health’ and ‘social’ distinctions are divisive, unclear and not particularly helpful as people can rarely be easily classified into one or another category or system.

I work with many excellent nurses without degrees. However, many of them, have had to take on additional study to prepare themselves for their role and for the needs of the patients on their caseload, while juggling the demands of work and families. The response of academic institutions to this proposal is key to ensuring that nurses can access modules at degree level which will support them in improving their clinical nursing expertise, rather than amounting to academic ‘hoop-jumping. Equally valuable, is the importance of the clinical placement with access to practical training, role modelling, mentorship and time with patients in a structured, learning environment. The aim of this proposal is to improve quality – I hope that it does but it seems that this measure alone will not be sufficient to achieve what is hoped for. It must be complementary to a radical review of the workforce and changes in the ways that we think about, and value care.

Nursing as a profession, is something to be proud of and value. Florence Nightingale has been quoted many times in this debate but I’ll finish with Gordon Brown’s description of nursing - “something that we do with our head, our hands and our heart, all at once, and this, for me, sums it up perfectly”.

Aileen Fraser
Nurse Consultant

BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25