Nursing by Degree

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?

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