The Standing Conference of the Workforce Development Confederations in England has recently circulated a draft document which, if implemented, will bang several more nails into the coffin lid of nursing research and research-based nursing practice. The primary goal of the draft proposal is to make the case for a national framework for assistant and advanced practitioners in a range of non-medical disciplines in the health service. The paper argues that Advanced Practitioners should be educated to Master's level but, before any real attempt is made to outline what the content of such programmes should be, very clear statements are made about what is to be excluded:
Such Masters programmes should be based on the needs of health care employers and aligned with the skills requirements rather than the traditional approach most HEI's have to such programmes with a large weight being given to research and a dissertation.
I can only imagine that this paragraph was written by someone who is ignorant, not only of higher education, but also of health care in modern industrial societies. The first problem is that you simply cannot have an MSc without a research component. I do not say this because I am a conservative academic with a vested interest in retaining traditional models of education and scholarship in higher education (although both of these statements are true), but because the Quality Assurance Agency (QAA) in the United Kingdom defines Master's level work in relation to research. Thus the Framework for Higher Education Qualifications (The Quality Assurance Agency for Higher Education, 2001) states that:
Much of the study undertaken at Masters level will have been at, or informed by, the forefront of an academic or a professional discipline. Students will have shown originality in the application of knowledge, and they will understand how the boundaries of knowledge are advanced through research. They will be able to deal with complex issues both systematically and creatively, and they will show originality in tackling and solving problems.
The difference between these two quotes relates not only to the relative weighting given by each to research, although this is important, but to a much more fundamental conception of what higher education is all about at this level. Where the Standing Conference of the Workforce Development Confederations emphasizes skills and the needs of employers, the QAA speaks of students understanding how knowledge is created and applied, and dealing with complex issues systematically and creatively. Of course, it is essential for professional staff to be skilled and to be able to meet employer needs, but skills and employer needs change over time and are properly addressed through training. The value of Master's level education is that it teaches people how to think. It is not primarily about amassing higher-level facts, understanding the latest fads and fashions in health care, or doing complicated things; it is about understanding and evaluating how knowledge is created, how it can be applied to the solution of problems, and how sense can be distinguished from nonsense. To my mind, this necessarily implies ‘a large weight being given to research and a dissertation’.
The thinking of the Standing Conference of the Workforce Development Confederations clearly contradicts the ethos of Higher Education, but it also runs counter to the direction of modern health care. The Research and Development Strategy of the National Health Service aims ‘to support a knowledge-based health service in which clinical, managerial and policy decision are based on sound information about research findings and scientific developments’ (Department of Health, 2001). This does not mean that all practitioners are required to be researchers, but it is difficult to imagine how this aim can be achieved if advanced practitioners, at the very least, do not understand how knowledge is produced through research and the difference its application can make to practice. When I was a student nurse it was common practice to put salt in the bath, egg white on pressure sores, and traction on fractured hips. All were justified on the basis of ‘common sense’, and all have now died away, having been found by research either to be useless or harmful.
I would like to put two questions to the Standing Committee of the Workforce Development Confederations. First, if practice is not to be based on the findings of research, then what is it to be based on? And second, if advanced practitioners are not to be taught how to understand the findings of research and how to apply them to practice, then who will be able to understand and apply them? The first line of defence that patients have against ‘snake-oil merchants’ and purveyors of potty theories is an educated professional workforce whose members do not take claims at face value but know how to evaluate them, and know why they believe what they believe and do what they do. All professional practice contains two essential ingredients: a high level of technical skill, and an underpinning knowledge base appropriately grounded in research. The former necessarily depends on the latter. That is why it is essential that professional students, and particularly those working at an advanced level, continue to be educated in research.