Change continues to be the only constant factor in nurse education in the UK. In the 1980s traditional training courses became modular and schools of nursing, usually associated with large National Health Service (NHS) teaching hospitals, amalgamated to form colleges of nursing. In the 1990s a new scheme was introduced whereby nurse education became located exclusively in the UK higher education sector, i.e. in the universities. The above changes, all within recent memory, were forward thinking and, ultimately, designed to bring UK nurse education into line with other countries, such as the USA and Australia, where graduate entry to the nursing register has long been established. The Irish government is on the verge of introducing an all graduate entry to the nursing register ( The Commission on Nursing 1998), having studied nurse education in the USA, Australia and the UK ( Tyrrel 1998). However, the most recent changes in nurse education in the UK are, by contrast, a retrograde step, which suggest that, far from moving towards all graduate entry to the nursing register, we are moving in the opposite direction. The most recent changes in UK nurse education were heralded in the UK government report Making a Difference ( Department of Health 2000). The essence of Making a Difference is that university-based education has reduced the clinical competence of newly qualified nurses. There is much media hype about the technical inability of newly qualified nurses in the UK ( Griffiths 2000) but, upon inspection, it mostly reflects a lack of understanding of why nurses require a university education rather than evidence of an actual decline in clinical competence. There is a tacit assumption that an educated nurse will not be a caring nurse, far less a competent nurse. There is absolutely no reliable evidence to support this assertion. Indeed, there is ample evidence to the contrary indicating, for example, that graduate nurses remain in nursing longer, remain in clinical practice longer and have better decision-making skills than diplomate nurses ( Watson 2000).
Nurse education in the UK is not going to be returned to the NHS, although some would like this ( Smith 2000). It will remain in the higher education sector but the reasons for it being there appear to have been lost. The main recommendation in Making a Difference which will have an impact on nurse education is the shortening of the initial period of education – the Common Foundation Programme (CFP) – from 18 months to 12 months. As originally conceived, the CFP was designed to convey essential aspects of nursing along with a grounding in biology, psychology and sociology in order to prepare nursing students for the particular branch of nursing (e.g. adult, child or mental health) which they would then enter as students ( UKCC 1987). The newly conceived CFP is to be designed specifically to inculcate clinical competence in nursing students with little time for anything else. The branch programmes, while longer, are already concerned with clinical aspects of nursing. In one movement, the UK government have virtually removed the educational component of nurse education and replaced it with training in clinical competence. In the meantime, the academic base of the other professions allied to medicine and of social work – where degree as opposed to diploma level entry to the profession will become the norm ( Anonymous 2000) – continues apace. As Dame June Clark (2000) stated recently ‘How can we expect nurses to feel valued in the multidisciplinary team when they are educationally disadvantaged?’ This debate has also been aired in Medical Education ( Calman & Downie 1988) but there has never been the concomitant suggestion that doctors are too well educated.
There exist several undergraduate courses for entry to the nursing register in the UK. However, where these have coexisted for most of the past decade beside diploma level nursing courses in the same institution, there is now a directive to bring the courses together with common entry and exit points at diploma level and additional years of study bolted on for graduate exit. Clearly, there may be opportunities for economies of scale where diploma and undergraduate courses coexist. However, the idea that the highly qualified university entrant who wishes to take a degree in nursing will be happy being taught alongside diploma level students, many of whom gain entry with very poor qualifications, is erroneous. There is much more to undergraduate education than an additional year of study; undergraduate study should begin and end at a higher level than diploma level education, it should be challenging, self-developing and motivating throughout: not just a supply convoy for staffing NHS wards. On the other hand, any notion that the majority of diploma level students will be able to undertake undergraduate study, thereby having the standard of their education lifted by the presence of potential undergraduates is equally erroneous. The inevitable outcome of Making a Difference is surely the ‘dumbing down’ of nurse education in general. If we eschew the wide range of educational experience and development of individuals which university level – especially undergraduate – education offers, in addition to what properly educated individuals can offer the NHS and its patients, then, instead of creating horses for a wide variety of courses, universities in the UK will be forced down the road of merely designing courses for horses.