30th Anniversary Invited Editorial reflecting on Smith J.P. (1978) Higher education and nursing. Journal of Advanced Nursing 3(3), 219–220
Two key questions raised in James P. Smith's editorial over 25 years ago are still highly pertinent today. ‘Do degree-level studies in higher education lead to more highly skilled and better nursing care?’ and ‘Should graduate nurses engage in different types of activities rather than ‘basic’ nursing care?’
Higher education (HE) certainly has absorbed a significant proportion now of nurse education across the world, with English-speaking continents largely leading the way with Diploma and Degree programmes as the preferred (or sole) form of preparation for initial registration as a nurse. Several factors have accelerated this development, not least the aim of making nursing an attractive career option, thus boosting recruitment in the face of many competing options, as well as contributing to the political goals of ‘widening access’ to HE. Consistent evidence from early degree programmes, demonstrating longer careers in nursing for graduate nurses, certainly also encouraged the major expansion of nursing's links with the university sector that took place progressively in the United Kingdom (UK) through the 1980s. However, the picture across Europe as a whole is still very mixed with several large nations such as France, Italy and Germany still sustaining some traditional hospital-based Schools of Nursing for first-level nurse preparation. Related to this is concern now about consistency of standards of care across Europe with the ever-increasing opportunities for nurse workforce mobility, particularly from accession countries to those countries where nurses now have longer and more advanced educational preparation. In order to address this, a self-assessment competency instrument, which incorporates 11 dimensions of care and is derived from available national benchmarks and competency frameworks, may assist individual nurses and the process of standardizing and adjusting to different aspects of the nursing role across Europe [see European Health Care Training and Accreditation Network (EHTAN) 2005]. These new challenges arise from persistent inequalities in the rate and extent of nursing's movement into HE, a situation that perhaps was not envisaged when James P. Smith wrote his original Editorial.
What he did envisage very clearly, however, was that higher education for nurses would improve both the quality of nursing care as well as the standing of the nursing profession. And, indeed, the evidence on the value of university preparation of nurses is generally positive, with studies from the UK and United States of America (USA), for example, continuing to provide supportive evidence. In general, the higher the proportion of well-prepared staff in the nursing workforce, and the more extensive their educational preparation, the better are the standards and outcomes of care (Aiken et al. 2003).
However, perhaps the greatest challenge for nurse managers of today – all around the world – is to retain the nursing workforce, however well-prepared. High attrition rates and vacancy levels are causing great concern in most developed countries, and also now in those designated as the ‘developing countries’ in the world. As an aid to nursing workforce retention, universities can offer support and motivation for qualified nursing staff through the provision of post-registration or postgraduate educational programmes. Indeed, this is increasingly being seen as a prerequisite for many specialist and advanced nursing roles. At this level of practice, which includes both comprehensive and ‘basic care’, Master's degrees are required in the USA and now preferred in the UK. Programmes that combine clinically-based study as well as teaching and learning in the university setting are seen as ideal because neither element alone is sufficient to provide the analytic and practical skills that are both required in advanced nursing role. Evidence from studies of this higher level of practice demonstrates that nurses spend more time in sustained patient care; and their style of intervention, holistic assessment and patient- and family-centred care are enhanced by higher degree studies (Wilson-Barnett et al. 2000).
That central debate – about the balance between practise and theory – continues to challenge us, and with regard to all levels of nurse education. Teachers and practitioners alike now realize that new knowledge and skills are both required at all stages of professional education. As James P. Smith always upheld, it is the partnership and complementary contribution from both sectors – education and practice – that enriche the outcomes for students and, ultimately, impact on the standards of nursing care.