Monday, 15 August 2011

Degree education for nurses

This posting appears as an article in the Times Higher Education of 28 July 2011 in a slightly edited format.  You can leave a comment here or on the blog in THE at

Nursing in higher education

Degree education for nurses has been available in the UK since the 1960s, and other countries long ago made the transition to an all graduate profession.  Nursing in the UK has completed the transition, with the move to degree entry to the nursing register, but the questioning in the press, by politicians and by many in the profession about the necessity for this, and the view that university educated nurses are ‘too posh to wash’, has muted the celebrations.
Perceived incongruence between being a caring professional and being academically qualified is uniquely applied to nursing – not to medicine, clinical psychology or any of the therapies.  The ridicule heaped on nursing degrees, generally, and doctorates in nursing especially, outweighs any of the opprobrium that is directed at degrees in media, tourism, and leisure studies.

Sunday broadsheet columnists such as Minette Marrin correlate declining standards of care in the NHS with the rise in degree educated nurses and has suggested that young girls who are ‘not particularly bright’ need something to do – and nursing is perfect; why saddle them with having to know anything?  Nursing is viewed as only as skilled caring work by many; indeed, a great deal of what the general public understands to be nursing can and is done by non-professionals.  Confusion arises because nurses also do some of this work and many people think that is all there is to it – wipe a few bottoms; make a few beds…report to the doctor.

Nursing is a complex subject reflecting the complexity of the job.  Biology, psychology, medicine, pharmacology and – to the horror of many – sociology, all contribute to the unique mixture that is nursing.  Clearly, nurses need to know how the body works in health and illness and how it responds to treatment; nurses – as do doctors – need to be able to contextualise their work, thus the sociology.  Nurses need to understand why children with a chronic illness living on a sink estate have different needs in terms of health education than the children of middle class parents.  Are they stupid; don’t they care, or do they just have competing pressures and fewer role models?  The more you know, the less judgemental you will be.  The less judgmental care is, the greater its effect.

If the need for sociology in the curriculum is not compelling, then work from the USA by Professor Linda Aiken at the University of Pennsylvania should be. Aiken unambiguously demonstrates the positive relationship between rescuing deteriorating patients and the number of graduate nurses employed in a hospital.  Also, Australia has had an all graduate entry to the register for decades and, while this is in danger of being eroded on economic grounds, the principle has never been questioned inside or out of the profession.

How does nursing fare as an academic subject?  In the UK in 2008 we rose from the foot of the Research Assessment Exercise table and demonstrated that some of our top schools of nursing were conducting world leading research; in some universities, nursing outstripped medicine.  My own journal, the Journal of Clinical Nursing, amongst others, publishes research that is picked up regularly by the BBC Health pages, Reuters and UK broadsheet newspapers.  This research is directly relevant to patient care and uses sophisticated designs and analyses akin to any research in the medical and social sciences.  Nursing research is cited in medical journals such as the BMJ and The Lancet.

The view that university educated nurses all aspire to be ‘high flyers’ and move away from direct patient care or work in more ‘glamorous’ areas of nursing was dispelled many years ago in follow-up studies of the early graduates from Edinburgh, Manchester and Hull.  Largely, they remained clinically focused and frequently worked with older people and in the community.  However, those who comment freely and negatively on nursing operate in an evidence-free zone and prefer to perpetuate, rather than dissolve, these myths. 

I entered nursing following a BSc in biological sciences (Edinburgh) and a PhD in biochemistry (Sheffield) long before degree education was the norm.  I found the study and the work mentally, physically and emotionally challenging.  I don’t recall my ability to care being impeded by my university degrees but I know that my knowledge of the biology of the skin helped me to treat pressure ulcers and my understanding of research enabled me to design a study which helped inform the management of urinary incontinence.  All nursing is skilled work; good nursing requires academic ability as well as skill.

Roger Watson is Professor of Nursing, University of Sheffield and University of Western Sydney.

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