Sir, I am amazed at the coverage given to the news that in England (at long last) entry to nursing will require a university degree (reports, Nov 12). This is already the position in most countries of the developed world; it is the position in the UK for all other health professions and it has been the position since 2004 in Wales, where we have demonstrated that it does not impede recruitment and does produce caring and compassionate, as well as knowledgeable, nurses.
The reason for the move is simply that the complexity of 21st-century healthcare requires an extensive knowledge base, and the rapidity of change in healthcare requires, in addition to the technical and social skills that are as important as ever, the development of the cognitive skills required for decision making and the ability to develop practice to meet the changes that are inevitable across a career of perhaps 40 years. Nursing is not a subordinate subdivision of medicine; in addition to the knowledge base of medicine, it uses its own distinct knowledge base that modern academic nursing, just like academic medicine, has the responsibility to develop and validate. The modern (Royal College of Nursing) definition of nursing is “the use of clinical judgment in the provision of care”. Without good clinical judgment the most compassionate care is not enough and may even be harmful.
I know of no evidence that shows an inverse correlation between educational level or intellectual ability and compassion. On the other hand there is clear evidence that a better educated (graduate) nursing workforce is correlated with better patient outcomes such as lower mortality and lower incidence of infections and other complications.
It is time that the old stereotypes of nursing as limited to holding the patient’s hand and carrying out the doctor’s orders were abandoned. Modern nursing is a challenging intellectual as well as practical discipline, which requires education as well as training.
Professor Dame June Clark
Former President
Royal College of Nursing
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Sir, The decision to make nursing degree-only will deprive the profession of very dedicated, caring nurses. A great deal of nursing care takes place when a patient is being washed or taken to the toilet. It is when information is found out about the patient other than their condition. This information is invaluable as it allows nurses to give holistic care, which is the ethos of the Nursing and Midwifery Council.
I am a nurse with a degree, therefore I have no grievance in writing this letter. We already see student nurses on the degree pathway who find that it is beneath them to carry out basic nursing care. Basic care is 90 per cent of what a patient needs. Patients want to see a nurse looking after them. All too often they say they have not seen a nurse apart from when a drug round is taking place. How sad is that.
I am not against higher education in nursing, but it is not for everyone, and I feel sad that so many people who may only wish to train to diploma level, will be deprived from entering a profession that they could very well excel at.
Janet Bailey
Kettering, Northants
Sir, Doctors of my age (early sixties), particularly those of us married to nurses of a similar excellent vintage, have watched with dismay as the increase in academic content of nurse training translated into a corresponding decline in the quality of nursing care at the bedside. An insistence on degree training for nurses will simply accelerate this process.
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While it is true that some nurses are rightly going on to gain higher level skills and take on some of the tasks previously the province of doctors, there is scope to do this within the current post-qualification training system. Erecting artificial and unnecessary barriers for those entering the profession will exacerbate the lack of skilled nursing care and produce a generation of nurses more familiar with a clipboard than a bedpan.
Dr Bob Bury
Leeds