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Nursing degree debate continues

Introducing new rules that require NHS nurses to have degrees could increase staffing problems for the health service, a specialist healthcare recruiter has warned.

Last week the government announced that, from 2013, the minimum level for pre-registration courses for nurses will be raised from diploma to degree level, meaning nurses will need to carry out three or four years of training.

The Royal College of Nursing welcomed this as "an important and historic development", which the Department of Health said would make nurses "better equipped to improve the quality of patient care".

However, James Parsons, Director of recruitment specialists Arrows Group, says that, with specialist nurses already in critically short supply, narrowing the criteria for those wishing to enter the profession will lead to a drop in the number of people becoming nurses, making this problem even more acute.

"This is a commendable move - the government says that these new rules aim to improve the standard of patient care, which of course is of utmost importance," he said.

"But it runs contra to the most pressing issue, which is nursing skills' shortages across the NHS. By introducing these stricter requirements, the NHS may in fact find itself with lower standards of patient care, because it will struggle to find the talent it needs."

Mr Parsons added: "An increasingly high percentage of nurses working in the NHS are foreign nationals, and raising the bar at entry point would have to be communicated clearly and rolled out internationally as the NHS is staffed by an international resource pool.

"There are critical staffing shortages across the NHS and the most pressing issue is looking at options that solve this rather than complicating it."

Arrows Group

We asked if you agree that this change could result in fewer nurses. Your comments (terms and conditions apply):

"I truly feel that nurses having to study at degree level would be good for the profession; however, I do not feel it will help to raise standards. My own training was hospital based (1981- 1984), and I still uphold and work to the standards instilled in me then. I feel that the decline in standards started when they took nursing away from the hospitals/wards, and schools of nursing became obsolete. Why not bring nurse training back to the hospitals - but bring the universities too?" - Helen Gregory

"The main reason that current nursing students are choosing diploma over degree is the bursary being non-means tested. Change the funding and you will see an increase in people wanting to do the degree. Both courses run over 3 years full time, and 50% practical 50% theory. The level studied only increases in the final year. Nurses are individual people, it isn't the qualification that makes them" - Tracy Heys

"It is interesting that some nurses here express concern regarding the current clinical skills of nursing students, particularly when programmes of study involve 50% clinical practice that is assessed by mentors in practice. Perhaps it is not the level of academic study (degree or diploma) that is the problem but the lack of effective mentorship and assessment of student nurses in practice!" - Jude Lomas, Greater Manchester

"I studied on the diploma for adult nursing, worked on the community for 5 years then decided to study for a degree. In my opinion if this government want nurses to have degrees then there should be more career opportunities. There should still be freedom of choice for nursing students as not everybody has academic skills but would be excellent nurses. I know of good and bad of both diploma and degree trained nurses so this is yet again management in ivory towers that know nothing about the the real work happening on the 'shop floor'" - Mary, Bolton

"All this will do is help to exclude people with genuine caring skills, not necessarily academic skills. Often people who have had to leave school as young carers and later have the opportunity to go on and train will find its just too 'exclusive' and hard to get in. Will nursing just be for people from affluent middle class families who can afford the debt they will accrue? A bit like Occupational Therapists maybe - how many of them are from socially deprived backgrounds? A few yes - but an awful lot of people who would tend to head for nursing instead will just go and look for careers elsewhere. What a short sighted a strategy this is. Heroes lead by donkey's springs to mind!" - Clive Tannant, Leeds

"Whether you are at studying at degree or diploma level, you need to 'want to become a nurse' in the first instance to have the chance of becoming a good nurse. Your attitude has to be right for you to become a good nurse. Studying at diploma level does not make one a better nurse and studying at degree level does not make you a less effective nurse. If anything, it may make more aware of your responsibilities and the values the profession should demonstrate at all times. Maybe this research is needed now, but I bet you, for every 10 nurses that were rude to a patient, seven are more likely to be trained at diploma level or below. I have worked with brilliant nurses who are either trained at diploma or degree level. Common sense is what every practitioner requires first and foremost. I know lots of people who opted for the diploma level for two reasons: bursary is non-means tested, and secondly, they are worried/afraid of doing the dissertation. With the introduction of new ways of working, some of the less clinical roles presently undertaken by nurses could be done by healthcare assistants. If you need to be an all rounder in the profession (clinical, therapeutic, management), having a degree will better prepare you for the intellectual challenges involved" - Geoffrey Okeke, London

"I totally agree and really can't see how holding a degree makes a better nurse. When I trained 3 years ago as a diploma student the vast majority of the study time was actually spent with the degree students - we had the same lectures and even the same essays just a slightly different marking criteria, I really cannot see how the ability to write a good essay makes a better nurse. In my experience most diploma students have worked as HCSWs previously and therefore tend to have more hands on practical skills - surely its practical skills rather that essay writing skills which lead to good patient care" - Name and address supplied

"In a world where paper certification counts, a degree is a must. What's most important is what do we do after we have that degree. The nursing practice is not getting any better than what it was years ago. What's lacking is that instinct to help others who are strangers to you. We keep saying about others who are not performing well, not a team player, not a good manager and on and on. But have we asked ourselves what we had done; we show others that we are simply doing what others have doing, ie, they have not been doing well.
What's lacking in the nursing curriculum is the emphasis on culture building of what nursing truly represents rather than leaving it to nursing students and nurses to think and analyse what nursing is to them. Finally, we are saying unanimously what nursing is globally in one voice" - Sim P Cheng, Singapore

"Yes. I believe the training as it stands NOW leaves much to be desired, let alone if all nurse training becomes degree level. We are getting some very academic students in community but the majority are lacking in practical skills. These skills are vitally important. A degree doesn't make a better nurse, it can help you to progress up the career ladder I suppose but then I trained as an SEN, District Enrolled Nurse (at University) RGN Open learning Conversion, and I am now a District Nurse team leader who has over 30 years' PRACTICAL experience in caring for patients. This experience is far more important than any degree. There will be many people who won't apply for training if this change happens who would probably make first class nurses, this is a very sad state of affairs" - Nicola, Greater Manchester

"Having a degree does not make you a better nurse; I don't agree with the training at present. Where I trained we have more practical skills as well as the theory, I feel there the degree students have less time in hospital while they are students, and diploma students have more time in hospital patient care. The importance is are you good in practice, and this practical skill will be lacking to degree students and once they are qualified they will not be able to manage or care for the patients better. I feel if a degree is only allowed in future then these students need more time in hospital before they qualify otherwise I feel they will struggle. Once you are qualified it is very difficult and sometimes due to shortages of staff in hospital I have seen fresh starters end up managing the ward themselves and it is scary and risky to patients. I also feel the students when doing community need to be more hands on. So degree or diploma, you need practical knowledge too before qualifying" - Lincy Godwin, Manchester

"I am an Italian degree level nurse. In my country we only have the degree option. If you really want to become a nurse, having to study for a degree is not an obstacle. I started 3 years ago at 30 years of age, and now at 33 I am proud to be a nurse. I know I lack experience but that's normal as I have just started working, and I have a lot to learn from my colleagues who have a diploma and years of experience. I don't agree with those of you who think that degree level nurses do not have sensitivity. Sensitivity is something you have or you don't, it's not given to you by a diploma or a degree. During my training as a student I have met excellent
diploma level nurses as well as bad ones who were rude to patients. Probably the number of people who will study nursing will decrease with the degree level option, but maybe they will be more motivated. If things get more complicated, but you still want to become a nurse, why should you be a bad one? During the past three years I have followed classes, studied, worked day and night in the hospital without getting paid and without receiving a meal, actually I had to pay taxes for my degree level, and now I am offended by those who don't even know me and think I am superb just because I have a degree" - Sara Guandalini, Italy

"Having a degree does not make you a better nurse; in fact most of those with a degree lack common sense and sensitivity and I feel there will be a decline in people wanting to train as nurses" - Name and address supplied

"There are brilliant, experienced and practically skilled nurses who are not academically gifted who would not want to pursue a degree - the profession would lose this band of truly gifted and dedicated staff and this would be a travesty. A degree does not mean you can sit and communicate with a terminally ill patient or a grieving relative. A degree will not make an academically gifted nurse recognise when a patient is hungry when the plate is still there at the end of meal times. A degree
will not assist the bedpan emptying and the thousands of other personal tasks that need to be done everyday by trained staff, able to recognise when there are problems! Do not undervalue the army of staff who are intelligent, experienced and dedicated by insisting they progress to degree level - it is an insult to their intelligence, professionalism and their experience/willingness to do a very demanding job. If we choose to progress that is fine, if we are happy to continue providing excellent hands on care with the diploma granted at qualification level that should be enough - we are not all high fliers - there are some of us who simply want to nurse and to do good. A degree won't guarantee that!" - Sandra Ward, Oldham

"Yes I do. I trained in the hospital system 20 years ago - a four year certificate course, not diploma. These beginnings have not deterred me from advancing to Manager and Clinical Coordinator roles, in fact I believe it helped. The majority of voices I hear on this page are from like-minded nurses. There are a few weak arguments based on the assumption that higher education will enhance patient care delivery - well why don't we research this theory? University nursing degrees have been around for some time - could we say the standard of patient care has improved? Someone mentioned the word 'vocation'; you've got to want and need to be a nurse, and you can't decide that in a classroom. Many other professions have gone down the same path - Teaching and Engineering for instance - you would think we would learn from the past. In case you're wondering, I am studying at Masters level, having by-passed degree, apparently life experience and a dose of common sense does count for something...perhaps that research project needs doing now" - Name and address supplied

"I am currently undertaking my Diploma in Mental Health Nursing and I do believe that there will be a shortage of people wanting to qualify as nurses in general or mental health. I know that from personal experience I am not the strongest person when it comes to writing essays in order to obtain the Degree which is why I have chosen to stay at Diploma level. A lot of other people I know feel unable to undertake the Degree programme and yet will be superb nurses due to their experience and dedication to the profession" - Sharon Venables, Yateley, Hampshire

"I agree, fewer people will apply to nursing, as there are no bursaries available on degree courses. Also just because someone is good at writing essays doesn't make them a good nurse. A diploma is just as good as a degree in the real world of nursing!" - Katie, Wisbech

"I agree that limiting the level for pre-reg training to degree may reduce the number of entrants. I disagree with those who see the diploma as being equivalent to the old SEN. In practice it is impossible to tell if a registered nurse has a diploma or a degree as both undertake the same role. I trained eight years ago (as a mature student) at diploma level, at the time I would never have applied for degree level study. Having worked in practice for four years I was then able to go on and complete my degree over three years while working full time. However, opting to do my degree after gaining sound hands on experience meant that I was able to tailor the modules to suit my personal learning needs and they were appropriate to my field of nursing (paediatrics). From my perspective as a mentor to students I find that often the diploma students are those more able to offer holistic care with better communication skills and a greater awareness of their learning needs" - Janette Platt, Stockport

"Well, I think this is a step in the right direction for we nurses, though, as this is another opportunity for nurses to prove again to the policy makers that they can do whatever it takes to propel nursing profession to a greater height. Now to the question, my answer is no, because there are more nurses out there looking for employment. If they are employed then the feared reduction in the number of nurses providing care for the
masses would be bridged" - Obiageri Uwakwe, Leeds

"As a 3rd year student nurse, I was disappointed when I first heard of these plans. I am undertaking a diploma programme which runs over 3 years, as does the degree. I have achieved excellent grades for my academic work and have had some brilliant comments made about my practical skills during placement (and I just gained a staff nurse position with an excellent organisation). During this time, I have had the opportunity to work with some very highly skilled members of staff that have been trained at both diploma and degree level. Unfortunately, I have also worked with those that are not so skilled (including those with degrees!) I have read the comments that have already been made here, and I am starting to think that those of us with a diploma are not being recognised! Just because I do not hold a degree, can I not display the same high standards of care that people seem to believe only degree nurses can? I do believe that there will be a huge reduction in the number of nurses entering into the profession if the degree is the only option, because of the requirement of higher levels of education/qualifications. I agree with the comment that was made that life experience is worth so much more than what it is given credit for" - Leanne, West Midlands

"I agree entirely that there will be a decline in both recruitment and practising RNs. Degrees do not replace clinical experience and there will be a gap in the workforce. Already a lot of British nurses have left and gone overseas where their expertise is valued" - Anne Beswick, Lancashire

"Why do many people think that gaining a degree is going to improve the standard of nursing care? Degrees prove only one thing, the ability to study. They do NOT make a good nurse" - Marie, Oldham

"The most impressive nurses and health visitors I know don't even have a diploma. Their ability to provide exemplary care is obvious to all who observe them or have the fortune to be at the receiving end of their care. The aim of improving the quality and standard of care will not be achieved by elevating and credentialising nursing more, because 1/ there is a shortage of nurses in the first place and nurses are often overworked and undervalued by the nursing management who stand by as standards slip and nurses leave, especially where it matters on the wards and 2/ nurses need to be hands on in order not only to plan good care but deliver it. I believe nurses will become too posh to wash, which may make some lazy nurses happy, but not those who believe the biggest attributes of a nurse is still to care, but of course that will change. I know at first hand that degree nurse qualification does not mean good care, often they are fast tracked and have the wrong motives for coming in and staying in nursing. I did 26 years before I became a lecturer, and am still in practice. I believe strongly that improving standards depends on bodies on the ground and nurses who are motivated to care and remain at the bedside, that means registered nurses. Those who disagree are maybe far removed from hands on care" - Bruce, North west

"Yes I agree. I have worked with nurses who are academic and they refuse to do some nursing tasks as they feel superior. I was appalled, as a good nurse does not mind what they do for a patient. I have nursed for 38 years and I was the only nurse answering the bells as patients wanted bed pans. The other nurses just talked at the nurses station. When I trained we had matrons and she was the watchdog for the patient. So many patients are not spoken to and many fed by volunteers. Bring back the SEN nurse" - PA Beeden, Lincoln

"Why can we not have both degree & diploma level courses for nurse training, instead of just degree level?! If I had to do a degree course to become a nurse when I trained 13 yrs ago, then I wouldn't be a nurse now. Academia does NOT mean they will be a good CARING nurse!! The old SENs weren't trained with lots of academia, yet I have learnt a lot through meeting and working with them. Working with newer nurses now, I notice a BIG change and the quality of care, and the caring side is greatly reduced. I feel that there will be a greater shortage of nurses in the NHS if ALL have to be degree level only. There is a big enough shortage already (in England definitely) - why lose out on more nurses coming in?! It will deter those who want to truly be nurses, yet don't have the academic skills to gain entry onto the courses" - Kieranne Page, North Yorkshire

"No, I think it is a very good thing that all nurses should qualify to at least a degree level. Maybe patients will have a better quality of care and the nurses will be properly qualified, so both sides will win. I am also doing a Degree level in Adult Nursing at the moment" - Fouzia Warsame, Milton Keynes

"Degree will not give the love and care to patients but rather lead to shortages in angels providing care to sick and vulnerable patients" - Jide Aju

"This change is good and it is what nurses need. I do not believe that this could result in shortage or fewer nurses. It would raise the standard of care as well as the image of the profession. Please let's embrace it" - Esther, Cambridge

"In the olden days you had a choice of SEN (more practical) and SRN (more theory). The SEN qualification was we have the option of doing Diploma (more practical) or Degree (more theory)" - Lucy Crowther, West Yorkshire

"No change within nursing in the past 20 years has been for the better, and the old adage of 'If you cant fix it change it' is continually applied. Nursing is a caring profession. Nurses are very privileged in that they are given permission by a family to care for their loved one, in the hope that we will be compassionate as well as being totally professional. A process of identifying a prospective student's ability to interact with a wide range of people, and a standard of education set that will not prevent those with a vocation applying. Yes, vocation, it is not a dirty word but essential to producing a first class nurse and that nurse staying in the profession" - Guider, South Wales

"I do, but why is it that the governing bodies of nursing don't listen to what the experienced 'hands on' nurses are saying? Whilst I do not wish to undermine those that study at degree level - I feel sad that we will lose out on many people who could bring a lot of talent in to a nursing career - during my early years of nursing, it was from some of the SENs that I learnt skills. Academic ability does not always produce good nursing care or bedside manner. The government really are blind!" - SB, East Midlands

"Yes. Nursing is suppose to be a caring profession. This can not be learnt at university. I think life experience is more important. Training on the job is the best learning experience a nurse can get. I think its the government's way to save money. Not everyone can afford to do a degree" - Emma Henfrey, NE England

"It will most certainly prevent people from entering the profession, the emphasis for universities will be on recruiting those who have achieved multiple high grade 'A' levels allowing them to be able to pass the university academic examinations. This will not take into consideration other qualities which nursing requires - there is a balance in nursing of art and science - the 'art' side cannot be quantified in the ability to write an academic essay. The result may be that we will have nurses that the government cannot afford to employ under their deserving grade - and so patients will be nursed by HCAs or whoever comes cheaper. It won't improve the standard of care for patients if these nurses aren't employed to give the care. Many trained nurses go on to study for a degree (and further Mphil, Masters, PhD) which they feel will enhance their practice and job promotion prospects, but that in no way denigrates those who decide not to and who continue to deliver excellent nursing care and skills" - Claire Leathem, Belfast

"Yes. We have lost sight of what nursing is really about. If it is sitting at a computer for most of the day, ignoring patients' requests for the most basic care, then God help us" - Name and address supplied

"I do, I am currently a mature student nurse, studying at diploma level on an extended programme which runs for 4 years, 4 months. This course was never offered at Degree level and has now been scrapped, mine is the last cohort. The benefits of this extended course are that students with families and other working commitments can become fully trained, intelligent, and competent nurses. We have the benefit of a bursary, but then most of us still work part time and have other time constraining and financial commitments. To take the course to degree only, and means tested bursary will realistically only be open to younger students, straight from A levels. This will mean that the profession is missing out on the life experience and skills that mature student nurses can bring to the table. I am planning to top up to degree once qualified and earning, and I believe that is what most diploma students aim for. The NHS needs to weigh up the gains of this programme against the loss of a damn good resource in the mature student nurse" - AJ, Essex

"Yes, it certainly will. I don't agree with the training at present. In my post I have the students when doing community, they need to be more hands on; in my opinion we should return to the training before degrees" - Jeanette Peacock

"I applaud this and any move which aims to improve the standard of nursing care; however, it is inevitable that raising the minimum level to degree will prevent and deter a large number of 'would-be' amazing nurses. I suspect that this is the first step on a long journey towards a return to the RN and SEN two-tiered nursing levels. Although, obviously new and exciting job names would be created to disguise the fact" -  Sarah Greswolde, West Midlands

"No I don't think this will affect the turnover of qualified nurses as there is certainly no shortage of nurses in the West of Scotland. Many newly qualified nurses at degree level have been unable to get a full time position with the NHS" - Lorraine Farnin, Lanarkshire