Inconsistent training has left nurses lacking in compassion and basic skills, a report by the NHS Future Forum claims.
The independent advisory group found "huge variation" in the access and quality of nursing and midwifery education and training in the UK.
"Selection in nursing was a particular issue, with a sense that the focus has moved away from selecting students on their ability, capacity for compassion and caring and desire to work in nursing," the report says.
"This has led, in some cases, to significant dropout rates and issues with basic skills such as numeracy."
Access to post-graduate training for nurses in specialist areas was also found to be "declining significantly", due to, in part, employers reluctance to release staff from practice.
Immediate training and inductions were also lacking for nurses in the post-registration period – a failing the forum described as a "missed opportunity".
From September 2011, nurses are now obliged to become degree-educated as part of the Nursing and Midwifery's Council's (NMC) education standards.
It is feared the cold academic setting may strip nurses of their caring skills.
Rita Newland, the NMC's Director of Education, said it is the regulator's "primary concern" to ensure such degree-educated nurses have the knowledge, skills and personal qualities required to "deliver safe, effective and compassionate care".
The Future Forum's report also found training experiences on the ground were conflicting with the government's health reforms message of promoting community care.
"The lack of community placements means nurses and midwives are forced to rely on "virtual" training experience," says the report.
"This is a clear mismatch between the intention and capability and capacity within the system."
The forum calls for employers to be made accountable for the quality of training in their local area and has recommended the NMC develop "structured processes" to support individual nurse and midwife development.
"To ensure the safest services and so that women and their babies receive high quality care it is crucial that midwives have access to on-going professional development so that their skills are up-to-date," said Jacque Gerrard, England Director of the Royal College of Midwives.
"Too often, the pressures of inadequate midwife numbers and the demands on maternity services mean that this does not happen, so the recommendation to support this is very welcome indeed."
While the report welcomed the development of a code of practice for healthcare assistant workers, it holds concerns over how robust the voluntary regulatory system will actually be.
The Royal College of Nursing continues to put pressure on the government to establish a statutory regulatory framework for HCAs.
Your comments (terms and conditions apply):
"No, I think degrees for nurses are progressive. BUT we are nurses and a nursing ethos must be taught and adhered to. Those with little or no compassion after 1 year must be monitored. An earlier placement for interaction with patients is advisable at the beginning of training and tutor monitoring on the wards reaps benefits for patients and nurses. Paperwork will always be a problem so possibly dictation per shift on the care of the patients to be written up, i.e. secretarial work, and then signed off after reading by the nurse responsible. Just a suggestion - I have many more suggestions." - Margaret Hughes, Penarth
"Of course it won't - why do people think education strips human beings of compassion? If the right people chose to come into nursing then they will have the well-being of the person as their prime concern. My worry is that it is the stresses and strains of practice environments that often make practitioners play a survival game that gradually erodes caring and compassion. The emotional toll is too much so they just get on with the job/tasks…" - Sue, County Durham
"Yes. In hospitals today the most caring, efficient and safe nurses are those who trained in the old system of training in hospital based Schools of Nursing with a good mix of education and ward experience. We started at the bottom and worked up, building up confidence, experience and competence. A nurse at the end of her first year in training had more experience than a newly qualified nurse has now. It really worries me for the future of nursing and nursing care. It is the nature of today's training that is causing the problems, not the nurses themselves. There were degree nurses in the 70's when I trained and they had no idea how to run a ward when they qualified. We used to feel sorry for them as they were totally lost, and their academic knowledge was useless in helping them. Very few of them stayed on the wards - they moved onto something else." - Janet Ross, Gloucester
"I do indeed, I work with a wonderful HCA in her early 40s whose role extends into what I would have considered years ago as a nurses role. She has tried to get on to a nursing course in a local college but they have turned her down based on academic qualifications. With the right support and nurturing she would do very well academically but more importantly she would be a fantastic nurse this is shortsighted. To put this into context I started nursing over 35 years ago and have worked steadily over the years to increase my academic standards, however my caring and compassionate standards did not need academia to instruct me, I would not get on the course now." - Susan Low, Bucks
"It is not the training so much as the selection process focussing on intellect rather than aptitude. Also peer pressure has a major impact on a nurse's compassion." - Rita Fellows, Clare Rd Medical Centre
"As a nurse who started out as a Licensed Practical Nurse in Canada and then went on to get a Bachelors degree, Masters degree and now working on a Doctorate, I firmly believe that obtaining a degree education does not take away from the persons compassionate nature. There is opportunity for further understanding and development of greater caring, it depends on the individual. I also teach in the Diploma of Nursing program. Students can learn the need for great care and consideration of their clients. Teachers have the opportunity to create a fun and rich learning environment where life skills can be incorporated and then watch the students grow. It is a wonderful journey." - Corrine Jones, Melbourne
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