Editorial: Nursing education: developments in the UK


  • Roger Watson,

  • Linda Shields

There has been a breakthrough in nursing education in the UK. The regulatory body for nursing, the NMC (Nursing & Midwifery Council 2008), has for the first time in the history of UK nursing agreed that ‘The minimum academic award for pre-registration nursing programmes will be degree’. The significance of the breakthrough is twofold: first, its novelty and, second, this brings the UK into line with nursing in much of the developed world. UK academics who visit other countries will be able, at least in terms of the education of nurses for the national register, to hold their heads high at last.

It should be noted as, indeed, it was noted by the UK Council of Deans of Health (UKCDH) in response to the NMC announcement (Murray 2008), that, while there was ‘broad support for this’ in the NMC there were ‘a couple of abstentions based on the view that the profession would lose ‘good nurses’ by setting the standard at this level’. It is slightly disappointing that the UKCDH reported this, as it is fuel to the fires of the opposition in the UK to graduate entry to the profession, and it would be of interest (if it were possible) to find out who those were who opposed this move. However, it is simply terrible that individuals within the NMC should be of this mindset. Two questions arise ‘just who are these people?’ and ‘who are the ‘good nurses’ we will lose. Sadly, the answer to the first question is that the abstainers at the NMC were almost certainly nurses themselves, raising the question ‘why?’ As to the ‘good nurses’, it is almost unfathomable who these would be but the implication is clearly that people who are unable to obtain a university degree can still be ‘good nurses’. We are sure that we are preventing many, potentially, ‘good neurosurgeons’ from becoming neurosurgeons by insisting that they earn a medical degree and, subsequently, an appropriate surgical fellowship. How much easier it would be for them and how much it would benefit the general population if we were able to set these ‘good people’ on the course to removing blood clots from the brain and suturing sub-arachnoid blood vessels through an apprentice-style training. After all, surely neurosurgery is just about manual dexterity?

The idea of ‘good nurses’ being produced through other than a degree level education holds some water, but many years ago, the UK decided to remove just those people from its workforce. Diploma and certificate educated enrolled and auxiliary nurses may have a place to play in health care systems stretched to the limit by the international nursing shortage (Watson 2005), but such levels of nurse must be accountable to the registered nurse, as in countries where they exist, their education does not lead to critical thinking and decision making abilities. Moreover, just such a deficit is entirely characteristic of the diploma education given to nursing students in the UK at present, therefore, a change in registration levels is required, so that those holding diplomas could be registered as enrolled nurses, while only those with a degree could take the responsibilities and title of ‘registered nurse’.

What is it that nurses do that requires a university education and a degree and how does this benefit the general population? The answer, frankly, in the UK is that we do not know. There is such overt discrimination against degree educated nurses, both in general and through the invidious way nurse education is funded (Shields & Watson 2008) which ensures a majority of diplomates and not graduates, and penalises those choosing to study for a degree, that graduate nurses have never had a foothold. While having a degree is of demonstrable benefit (Aiken et al. 2003), there is no fast-tracking of degree educated graduates in the UK National Health Service (NHS) and there is a reluctance to tie in educational qualifications to specialised, advanced and nurse consultant roles.

However, the preponderance of graduate level entry to nursing in many developed countries of the world and the unequivocal demonstration by Aiken et al. (2003) of the value of degree educated nurses – not just registered nurses – in saving patient lives and improving the quality of nursing care is largely ignored in the UK (Aiken et al. 2001). That there is prejudice against graduate nurses in the UK at the political, professional and public levels is beyond question and there is nothing the UK press, especially the ‘intelligent’ broadsheet Sunday newspapers like better than to fan the flames of public hostility. All the woes of the UK NHS are blamed on the fact that nurses are university educated or ‘too posh to wash’ (http://news.bbc.co.uk/1/hi/health/3701855.stm; retrieved 5 October 2008). Without doubt, this prejudice will continue and opposition will remain; in fact, at the time of writing, the public are largely unaware of the NMC proposals, such is the political climate in the UK. However, we predict some degree of ‘outcry’ when they become public knowledge, probably following an unbiased piece of reporting in the Sunday Times or similar newspaper.

It is clear from the deliberations of the NMC and reporting by the UKCDH that there is still a long way to go before these proposals become policy and that policy is translated into action. We hope that there will be a minimum of procrastination and attenuation with regard to the implementation and the substance of the proposals. We would also warn against a simple ‘re-badging’ of current UK diplomas as degrees, that the purpose and substance of degree level education for nurses is fully considered, and that there will be the concomitant changes that are required in UK university nursing schools to make them fit for the purpose of delivering degree level education. Another editorial would be required to do justice to all that is required in this regard but the government could begin by handing over the funding of pre-registration nursing education to the Higher Education Funding Councils in the four countries of the UK and away from the NHS, which is largely responsible for the current poor state of nursing education in the UK. The past, in nursing, has always seemed ‘rosy’ to many people (McKenna et al. 2006), without any recognition that the ‘good old days’ of matrons, military style discipline and talk of ‘vocation’ existed in a time when superbugs were not in evidence, when highly technological care was not demanded by the public, and when hospitals were comparatively simple entities with accompanying simple management needs, unlike the super-corporations they have become today. Let us hope that the same people can, in future, reflect on the present dark days of nursing education in the UK and realise that the future is, in fact, ‘rosy’.