by Karen Reissmann

The tabloids have greeted the news that all nurses will soon go to university by declaring we will become “too posh to wash”. But such backward comments ignore the real problems with the plan.

While it sounds good to give nurses more education, the reality is that this is the latest step in a long history of deskilling. It will lead to fewer nurses on the wards and work getting shifted onto less trained staff.

In the 27 years I have been a nurse I have seen many changes. Nurse training has become increasingly academic.

Some of this is to be welcomed. We want to be able to understand how to judge research on care and consider ethical issues, and we need to be able to have the skills to assess what really works.

Yet most student nurses will tell you that current training provides little help in teaching you to do the actual job you have to do – like putting up drips. Too much time is spent “academising” practical skills.

We should encourage nurses to think critically about their job. But it is frustrating to then throw them into an NHS where they have little control over that work.

Instead, nurses are expected to look at “research evidence” for non-controversial aspects of care, such as the fact that people feel better if you explain what is going to happen to them.

This trivialises the real critical thinking that should exist in university education. The danger is that this pseudo-academia will be extended with degree-level training.

Struggle

I have worked with nurses who have many qualifications but struggle with building a relationship with patients so they can trust you. Similarly, I have known nurses who do not seem to understand what they are doing.

This increasingly market-driven system prioritises the numbers of students passing courses rather than the quality of what they have learned. Wards are so short-staffed that nurses don’t have time to spend with students going through the application of how academic theory relates to practice.

Lots of work once done exclusively by doctors is now done routinely by nurses. Work previously done by nurses is now done by healthcare assistants.

These changes are reflected in the ward staffing levels. When I started, each acute ward had only one healthcare assistant. Now they are the majority. The proportion of qualified nurses is reduced, as is the amount of time spent with each patient.

Nurses today may assess what a patient needs and write a care plan, but it is for others to implement. We spend much less time with the patients – that keeps getting pushed further down the chain to less skilled, lower-paid workers.

The new NHS pay structure is supposed to recognise this shift in responsibility at all levels of the NHS and reward health staff for what they do, rather than their job title.

Some did get a pay rise. But virtually no nurses get doctors’ pay – and no healthcare assistant gets nurses’ pay.

And most learning takes place after you qualify. As medicine and care moves on, we all need ongoing training.

Yet as the government makes cuts, training has been the first thing to go.

Mandatory training like fire, moving and handling are kept – but not the useful things relevant to your area of work. Often you are expected to pay for courses out of your own money and do them in your own time.

I’m lucky – I’m currently on an NHS-funded course in NHS time. It will make me better skilled at my new job. The course is not currently validated by a university, so it won’t make me any better qualified academically. But my care will be better.

Nurses will be better nurses when they have time to nurse, reflect and learn at a variety of levels – and time to share that learning with the new generation.

Karen Reissmann wrote in todays Socialist Worker Newspaper dated  Tuesday,28th November, 2009 Issue 2179