Nurse education is in the news again

Over the New Year there was, once again, lots of discussion in the UK media about nurse education. Many (if not all) the issues relating to poor nursing care are, if the media is to be believed, the fault of nurse education. The current move towards a graduate entry profession in England is only fuelling the fires. As always, poor nursing care engenders a lot of discussion among the general public who seem to share the view that nurse education is at fault. I even caught two of my friends bewailing the state of nurse education at my New Year’s Eve party.

The Royal College of Nursing in the UK last year set up an independent commission to review nurse education. The recommendations were published in the autumn (1). These make it clear that educating nurses to graduate level is not the problem while acknowledging the contribution nurse education makes to quality care. The report states that the commission found no evidence of any major shortcomings in nursing education that could be held directly responsible for poor practice (p.43).

The report also identifies areas were action is needed, including:

  • Investment to strengthen the evidence base of pre-registration education.
  • Improving the quality of student placements
  • Ensuring practical learning is underpinned by relevant knowledge from clinical and social sciences
  • Regular assessment of the culture of health care organisations
  • The regulation of health care assistants
  • Implementing a period of preceptorship for new qualified nurses

The preceptorship of newly qualified nurses, appears to me, to be fundamental to ensuring that a good quality of care is provided and it is well established as a requirement in many countries. To an extent we still expect nurses to come out of university and be able to run the ward just as those of us who qualified in the good old days (pre-1990’s) did. It is perhaps time that a period of perceptorship became mandatory rather than strongly recommended. Investing in such a scheme would surely save money in the long term.

Politicians and managers also appear to ignore research demonstrating the impact of staffing levels on patient care (e.g. 2, 3). Indeed, having a higher proportion of nurses with a degree on a unit has been found to improve patient outcomes (4). Given the amount of data out there it is incredible that a nursing alliance has had to be set up in the UK, led by the Nursing Standard, senior nursing figures and the unions, to fight for this fact to be recognised and something to be done about it (see:

And finally don’t forget that the EBN Twitter Journal Club starts this week. For details of how to participate in this see:


  1. Willis (2012) Quality with Compassion: The future of nursing, RCN Publishing: London.
  2. Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M, Aiken LH. (2007) Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. International Journal of Nursing Studies, 44(2): 175-182
  3. Van den Heede K, Lesaffre E, Diya L, Vleugels A, Clarke SP, Aiken LH, Sermeus W. (2009) The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. International Journal of Nursing Studies, 46(6): 796-803.
  4. Aiken, LH et al. (2003) Educational levels of hospital nurses and surgical mortality, Journal of the American Medical Association, 290(12): 1617-1623.

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