Nursing by Degree
21 Nov, 09 | by Iain Brassington
A couple of weeks ago, the government announced that, from 2013, all nursing staff would have to be graduates. ”Degree-level education,” said Health Minister for England Ann Keen,
will provide new nurses with the decision-making skills they need to make high-level judgements in the transformed NHS.
I’m not so sure of this.
There’s a whole raft of considerations that one might bring to the table here. One is a question of why it is that graduatisation has to be seen as improving matters. Perhaps the idea is that there’s a guarantee of competence that is underwritten by a degree. But that doesn’t mean that a degree is the only way of getting esteem, and the idea that you can’t have professional esteem without a degree is silly. A degree is an underwriter, perhaps - but it’s not obvious that there couldn’t be others.
Moreover, while a degree of theoretical and academic insight into nursing might be desirable, it doesn’t seem to be inherent into what nursing is about - which is, primarily, the care of patients. You don’t need a degree for that. Indeed, I can imagine a line of argument that went something like this: graduatisation represents an attempt to put nursing into the same sort of league as doctor-ing; but this implicitly grants a priority to doctors, and treats doctoring as the kind of thing that all medical professions ape. To try to make nurses more like doctors is to misunderstand the nature of both nursing and doctoring. Bluntly: graduatisation doesn’t help nursing - it demolishes it by denying what makes it its own art in the first place. What we should be doing is raising the status of nursing in its own terms, and embracing the particular virtues of the art, and that doesn’t need degrees. Just as you don’t advance the cause of women by forcing them to wear a necktie in the workplace, you don’t do anything for nurses by forcing them into an academicised discipline.
I’m not sure how far I’d follow this sort of argument, but it seems coherent and capable of being taken quite a long way.
And let’s not forget that, although doctoring does have a higher status than nursing, it doesn’t follow that doctors always come up trumps, and can always do things that a nurse can’t. I can think of plenty of situations in which I’d rather be diagnosed and treated by a nurse with a couple of decades’ experience on this ward than by a doctor who’s fresh out of med school. Nothing against the doctor, of course - it’s just that, sometimes, the nurses know more, and are better at making people better. And yet they still have a lower status, and are frequently legally prevented from acting without the oversight of a doctor who knows less well what to do.
Over at Liberal Conspiracy, this is a point made wonderfully well by Paul Cotterill: it’s well worth following the link and reading the whole thing. But, as an appetiser, here’s a sample:
I grew to realize that just for a second, in the heat of the emergency moment, class relationships had been overthrown, and that [the doctor] now felt he needed to re-establish the proper hierarchy.
There was no reason he should have known about 50% glucose, but that it was perfectly normal that I, as an experienced staff nurse, would do. What mattered, it seemed, was the convenient fiction that (male) doctors had the scientific knowledge of drugs, while (generally female) nurses took the orders, however adept they might be at making clear what orders they expected to be given on their ward.
The problem here has nothing to do with competence or degrees. Rather, it’s to do with a kind of inter-disciplinary respect. Insisting on degrees does nothing to garner that, though. And, if overturning a hide-bound attitude and generating respect is good, and if graduatisation helps do that, then that’s great. But we could overturn and generate without graduatisation, couldn’t we?
Obviously I agree with you. Nothing wrong in having some ‘degrees’ for nurses that wish to specialise in areas after they have been working for a few years (It shoud be easier for nurses to switch to being doctors and visa versa - good for both branches) But entry degrees are a very bad idea and goes against the nursing ethos.
Keith Tayler
November 22nd, 2009 at 12:24 pm
Hello, I’m a nurse student and this post is very helpul to me. Thank you!
A Nurse
November 23rd, 2009 at 9:01 am
I think there are a few misconceptions about nursing education based on some antiquated ideas about what nursing is, what nurses do and an ‘ethos’ of nursing. Let me attempt to highlight a couple of them. Degrees in Nursing are no new thing - they have been running for many years, and what is taught on ‘Nursing Degree’ programs is that which is taught at the Diploma level - the difference being the level of critical analysis required. The ‘degree’ nurses are still taught ‘nursing’ and they spend the same amount of time in practice learning to ‘nurse’. They do the same as every other nursing student, but they do ask questions because they have critical insight to ask questions about, for example, the routines of health care practice and challenge the often unequal and irrational norms that are inherent in health care systems that do not always serve the patients best. This is how nurses ‘care’ for patients – it might be a different sort of care, but its certainly preferable to the nurse who follows orders despite knowing those orders do not best serve the patient. What you call the ‘art’ of nursing, has always been, and is, taught and given a high priority, so in reality, degree nurses should give the best of both worlds – ‘to care for’ and ‘to care about’ the patient and patients. Another point is that people seem to think it is up to education can make nurses care, or be virtuous (whatever that means). I see no shortage of students (both pre and post reg) who want to care –but feel they cannot always care because care is not seen/valued in some clinical areas. That is where the problem is – and that is where some students learn the ‘behaviour’ of the cultures of care in care environments – which may or may not best serve the patients. Nursing degrees are not about professional esteem, or about becoming doctors – they are about enabling nurses to work with and in health care systems in order to help people maintain their independence. You are right - graduisation does not necessarily always produce the best nurses - but we’ve got a better chance of having bright, inquisitive, caring nurses than not.
H
November 23rd, 2009 at 8:35 pm
One of the problems is that if you require a degree to enter the profession you are excluding those that might not have academic qualification. (This is a difficulty social work and the probation service has) It is also important that people training to be a nurse can earn money as soon as possible. This is especially important for emigrants who come to UK to train and need to support themselves and sometimes there family. How are they going to afford foreign student fees and keep themselves? Most of them will not be able to do degrees and will end up at the bottom of the NHS as unqualified workers. Institutionalised racism has always been a problem in the NHS and this policy does nothing the address the problem.
Bit worried about “antiquated ideas about nursing”. My experience might date back to the 60s, but I am not convinced that a degree will reduce the problems of institutionalisation and epistemic enslavement I have observed. I think nurses should receive high quality training throughout their career, and that professional and managerial boundaries within the health service should be more flexible. I am worried that a compulsory degree course is an “antiquated idea.” It does lack imagination and also helps the present government to reach its target of 50% of school-leavers going to university. Its too political and is not based on evidence.
Keith Tayler
November 23rd, 2009 at 11:06 pm
I think you raise a some interesting points here, and most I agree with, however, such issues relate more to organisation of the nursing workforce - not that of the nursing degrees themselves. You are right - it has a political agenda - but nursing has always been a political pawn. Think back to when nursing was first assimilated into HE - nursing was slow to react because it lacked a politcal voice to disagree. this is not to say that nurses did not think about disagreeing, but they didn’t necessarily at that time have a discourse to counterargue the case. You are right also that it will occlude many who would be exceptional nurses and/or carers, which brings to my main issue. If degrees are to be the ‘only’ nursing qualification - we might find that nurse ‘training’ (not education) goes back to being ‘in house’ within the Trusts/service providers. This is worrying as some institutions may not want questioning practitioners, rather they prefer automated rule followers who pose no risk. On the flip side of this, is the argument that degrees will, in the least, equip future nurses to be able to challenge, for example, institutionalsation. Whether or not they have the capacity to use these skills is determined by the instituion of employment and the ‘braveness’ of the nurse and nursing workforce. So to sum up - you are right - degrees in nursing are not the whole answer to issues practitioners experience in their daily working lives, but the knowledge bsae they gain, and the confidence to be recognised as a graduate, might just help patients to get a better deal.
H
November 24th, 2009 at 11:01 am
Healthcare workers polotics and the politicians are same globally. How a graduate nurse will participate in decision making process? It may help in better patient care from nursing point of view. let us hope for the best
Dr.Sudhir Dagaonkar
December 5th, 2009 at 10:28 am
I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Lucy
http://maternitymotherhood.net
Lucy
December 19th, 2009 at 9:41 am