Nurses hit back at minister over university-based education ‘regret’

They hit out after skills and apprenticeships minister and former district nurse Anne Milton said the move to degree-level nursing had made the career unattainable to many would-be nurses.

“We have to be aware and understand our history but not try and replicate it”

Professor Paul Galdas

She said nurses like her who trained through the old hospital-based model had “regretted” the changes brought about by Project 2000 because she believed gaining skills on the job was beneficial.

The minister added that the new apprenticeship route into nursing was “in effect” a reintroduction of this old model and would help to widen participation in nurse education and fill workforce gaps.

“If the only way to become a registered general nurse is through a full-time degree, you are going to lose a huge pool of talent, and we have been losing a huge pool of potential talent that we can now take advantage of,” said Ms Milton, who trained as a nurse in the 1970s.

The comments attracted fierce backlash from the profession with many pointing to evidence showing the association between the level of nurse education and patient outcomes.

Dr Nichola Ashby, head of professional learning and development at the Royal College of Nursing, said: “It is not the existence of a degree that puts people off studying nursing.

“The NMC-mandated UK-wide degree level nursing in 2008 as they reasoned that nursing must become a graduate profession to meet the needs of complex care delivery in an increasingly fast-paced healthcare system that demands flexible, responsive and highly skilled practitioners.

“This required the transformation of nursing practice through better evidence, stronger professionalism, developments in technology, scientific advances and responsiveness to individual and population healthcare needs.”

The “real issue” was the loss of the student bursary for nursing degrees in England, said Dr Ashby, calling on the government to reinvest in higher nurse education.

Professor Paul Galdas, head of nursing and midwifery at the University of York, said the assertion by Ms Milton that the move to university-based education had made nursing unattainable to people who would have made good nurses was not based on evidence.

“I would suggest that on the contrary by talking down what the benefits are of a university-based nursing education, we are losing a pool of talent of people who would choose nursing were they fully informed about the fantastic opportunities that are available for a career and the uniqueness of what a degree in nursing actually involves,” he said.

Professor Galdas said he was concerned that a “false dichotomy” was being created between nurses who were educated through the university route and those who completed an apprenticeship, noting how actually the academic and practical requirements were the same for both.

“In the end, nothing can make up for proper investment in the workforce”

Professor Peter Griffiths

He stressed that universities were already working hard to widen participation into nursing through initiatives such as access courses and highlighted how universities worked in collaboration with employers to deliver apprenticeships.

While he believed the apprenticeship route into nursing was a “positive” one as it allowed employers to grow their own workforce, Professor Galdas said it must be used to complement, not replace, the university route.

“I don’t see any benefit to looking back to a time when the role of the nurse and the complexity of patient care was completely different to what it is now,” he added. “We have to be aware and understand our history but not try and replicate it.”

Professor Peter Griffiths, chair of health services research at the University of Southampton and executive editor of the International Journal of Nursing Studies, said he agreed with Ms Milton that a variety of entry routes into nursing were needed.

While he did not oppose the idea of apprenticeships, he said he feared the emphasis on them could allow leaders to get away with not investing in nursing education and lead to the belief that a high level of education for nurses was not “strictly necessary”.

“In the end, nothing can make up for proper investment in the workforce,” said Professor Griffiths.

“We can’t do it on the cheap and demanding a high level of qualification of nurses is not about preventing ‘able’ candidates from entering the profession it is about ensuring that nurses have the knowledge and abilities that are needed to properly care for people in the health system of today and tomorrow not that of yesterday or the 1970s.

“It seems almost pointless to keep saying it, but time and time again evidence tells us that the best outcomes come when we have more and more highly qualified registered nurses.”

Leanne Patrick, final-year student mental health nurse and chair of the Scottish Health Students Council, said university degrees equipped students with the skills needed for modern nursing such as critical thinking and appraisal of evidence.

“Throwing more people onto the pile won’t fix some of the more systemic issues”

Leanne Patrick

“We should be demanding high standards from the future workforce,” added Ms Patrick.

“If we want to attract people into the profession and keep them there then we need to better communicate what an impressive and rewarding profession modern nursing actually is and address workplace conditions.

“Throwing more people onto the pile won’t fix some of the more systemic issues like workplace incivility which is a leading cause of staff absence,” she added. “I don’t think we can reasonably expect to achieve that by consistently undermining each other on the degree vs no degree battleground.”

She highlighted the importance of acknowledging the history of nursing while respecting the importance of the need for future growth and change to adapt to modern challenges.

“We’re all agreed that we need more staff, better working conditions and skilled staff – let’s keep moving forward as a profession as we work toward solutions,” said Ms Patrick.

Meanwhile, primary care nurse lecturer and Queen’s Nurse, Ellen Nicholson, said the “resounding” evidence base showed that graduate nurses provided safer and better patient outcomes.

“It is therefore concerning that a minister with these responsibilities is unable to relate the evidence base to current practice,” added Ms Nicholson, who is also chair of RCN General Practice Forum.