Once upon a time...
In 1873 an editorial in the British Medical Journal urged the readers to consider how the nursing workforce would be enhanced by the introduction of a professional certification and urged the newly formed schools of nursing to raise the standards of nurse education:
"... hospitals professing to
train nurses must give a more thorough and systematic
education. Not
content with merely teaching them to dress a wound, put on a bandage,
or to deliver a woman-arts which require but a small amount of imitative
skill to attain unto-they must admit them to the lectures, to
teach them the reason for
and the value of what they do, so that in
their sphere they be no automatic servants of,
but rational fellow workers w
ith, the physician."
What I find so interesting about this short passage is that, apart from the wonderful Victorian prose, it could have been written at any time in 140 years that have passed since.
What is this extract saying to us? That if nurses want to attain a status equal to that of the medical profession then they have to have a comparable education; an education that is based upon learning not just to do, but also to understand why you're doing it.
But it's funny how the idea that nurses and doctors could be considered equal in standing (although not necessarily doing the same job) is still a thorny subject, and often met with snorts of derision by members of both professions.
As a newly qualified nurse in the early 90's I worked on a medical ward with a girl who had a nursing degree. She was the first such nurse that I had met with a nursing degree and I was slightly in awe of her. She was an exemplary nurse. She seemed so knowledgeable and had the most inspiring way of managing herself and the ward; and yet was kind and caring towards her patients. But, some of the other nurses were suspicious of her, feeling that she was "a bit snooty" and would tell me that she "thinks she's better than everyone else".
One one night duty I got talking to her about her nursing degree. Seeing that I was genuinely interested, she spoke at length about her course, the exams, essays and dissertation that she had to write. When I asked her about her experiences in practice placements, and whether she felt she was treated differently her face changed, she explained that most of these placements were "absolute hell". So, often she would go home from her shift in tears because she had been singled out for criticism where her fellow students on the certificate course had not.
It was made clear that her status as an undergraduate was interpreted as meaning that her practice had to be more advanced than than other students.
In a tutorial recently I was discussing what it means for nursing to be an all-graduate profession. Now, considering that all of these students were enrolled on a BSc(Hons) programme, you would be forgiven for thinking that there would be a consensus that an all-graduate profession is a good thing. But surprisingly, there was a large contingent of students who felt that the attainment of a degree was not essential to become a nurse, and that being caring and compassionate are the only essential pre-requisites for entering the profession.
There is still a resistance and a deep suspicion in some quarters about nurses being educated to degree level, with the feeling that this might attract people into the profession who are intent only on 'collecting pieces of paper', without possessing the desire to care for their patients.
I have never really understood this argument. Surely, if your only desire was to get a degree then surely you wouldn't become a nursing student? The student nurse's life is hard by comparison to many other undergraduates.
As one student put it to me today "I feel like I have two masters, the university and the NMC". And this is a good point. Not only do our students have to fulfil all of the academic requirements of a Bachelors Degree, but they also have to complete the necessary practice hours; comprising weekend and night shifts. Furthermore, they are assessed on their practice whilst working. To survive the rigours of a BSc Nursing programme, you have to really want to be a nurse.
This is not a new issue and it is not going away any time soon.
The recent Francis report urged a reform of nurse education that would see potential candidates for nursing programmes to work as a health care support worker before being allowed to commence their undergraduate programme. This idea has been supported by Jeremy Hunt as a way for nurses to learn the core attributes of caring and compassion.
Not surprisingly, this idea has been met with resistance and anger. Today, it was cited as being unworkable and a waste of money by the RCN.
Another recommendation (183) proposes that "there should be an increased focus in nurse training, education and professional development on the practical requirements of delivering compassionate care in addition to the theory", and additionally that there should be a system in which a "selection of recruits to the profession who evidence the [...] possession of the appropriate values, attitudes and behaviours".
This is not only illogical but is also based on two erroneous and conflicting assumptions:
1) that caring and compassion are learned behaviours.
2) that caring and compassion are amenable to evaluation at the point of recruitment.
So, is caring and compassion learned? Can it only be learned in practice? Can you measure a person's caring and compassion?
There are divides in the debate about these questions. But clearly Lord Francis QC is sitting on both sides of the fence and has decided that you have to have it before you come into the profession AND you have to learn it whilst on the programme too.
But pointing the finger at nurses' caring and compassion is a bit of a cheap shot. It's our Achilles heel. We have spent so many years defending the caring and compassionate aspects of the nurses role that Caring and Nursing have become synonymous.
But our insistence that nurses should be caring and not clever will only serve to destabilise our position. It is no big secret that there is an agenda to replace many qualified nurses with cheaper healthcare support workers. And if the logic holds that it is not necessary to have a degree to be caring and indeed that caring is an attribute that people have prior to becoming a nurse, coupled with the perception that caring and compassion are absent from the nursing workforce, it is only a small leap of faith to remove qualified nurses all together.
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