One sign of a profession is that it has a code of ethics. Another is that it builds a wall around itself to make it hard to enter. That is the issue behind yesterday’s announcement that, from 2013, prospective nurses will require a degree. There are already many excellent nurses who are proving, every day, that they do not need a degree to be a nurse. But this is not about being a nurse. It is about being a profession.
In recent times the distinction between nurses and doctors has been narrowing, to the obvious consternation of the latter. Nurse practitioners are now permitted to carry out tasks previously reserved for junior doctors. These include investigations into the gullet or stomach, benign moles and cysts, the prescription of some medicines and the authority to admit or discharge patients.
The reform has been welcome. Since the first nurse-led NHS walk-in centre opened in January 2000, nurse-led services in both primary and acute care have developed all over the country and their success is well attested. A 2007 study in the Journal of Emergency Medicine found that emergency nurse practitioners were just as good as doctors at managing patients with closed musculoskeletal injuries. A study of more than 1,000 patients with coronary heart disease and chronic heart failure found a nurse-led disease management programme for the secondary prevention of cardiovascular events to be both clinically and cost effective. Last June Lord Darzi of Denham’s final report on the next steps for the NHS noted that specialist nurses can help to keep patients out of hospital, reduce their reliance on acute care or prescribed drugs and reduce the number of unnecessary hospital admissions.
And so ministers hope that increasing the credentials required to be a nurse will help to allay doctors’ suspicions and reduce resistance to their new and useful work. But it is probable that there is more suspicion in the relationship than can be allayed by a degree qualification. At the same time, the unintended consequence of increasing the burden of entry will surely be to reduce the number of nurses.
There could scarcely be a worse moment to make becoming a nurse more difficult. Over the next ten years 180,000 nurses are set to retire. There are 100,000 nurses aged 50 and over and another 80,000 aged 55 and over. It is proving difficult enough to retain the current workforce. A third of nurses told the Royal College of Nursing in 2007 that they were thinking of quitting because of poor pay. The Department of Health has predicted a shortfall of 14,000 nurses by 2010. The increased cost is also likely to exacerbate the shortage. The Department of Health is insisting that the nursing degree will cost no more than the current diploma. It is hard to see how this can be so when the minimum level for NHS trainee nursing positions — sometimes a two-year diploma — will be increased to a three-year degree course.
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The demands of an academic course will also deter many superb nurses who do not view themselves in that way. Not all knowledge is best imparted in the classroom and there have been very many people whose lack of theoretical prowess in no way means they would not make first-rate nurses. It is telling that the one voice from outside the affected professions, from Katherine Murphy, the director of the Patients Association, was lukewarm. She pointed out that increased graduate entry to nursing has already recruited a cadre of nurses who are less prepared to do some of the unpleasant basics.
A university degree is a precious and valuable thing. Very many nurses could benefit from a university education. Degree-level entry to nursing should certainly be available. There is just no need for it to be mandatory.