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Nursing graduates: too clever to care?

Marilyn Eveleigh
Consultant Editor

The announcement that nursing is to be a graduate profession from 2013 has fuelled wide debate from within and outside the profession. The media had a field day and I listened with interest to opinions and criticisms that seemed to attract extremes. Then I just got plain irritated! 
"Too clever to care" and "Too posh to wash" tipped it for me! What ignorance to think they are mutually exclusive. Are parents or children with degrees less caring than those without? Are graduates associated with less compassion and concern for their fellow human beings? (44% of school leavers now go to university). Are the most considerate and caring members of society also the least educated? The questions are derisory and ridiculous. The need and ability to care and empathise with others is often associated with background and personality - most people entering the caring professions have a leaning towards wanting to use these core attributes.  

There was a strong underlying suggestion that because nursing uses feminine caring skills and is dominated by women, then less education is needed as "anyone can do it". Ann Keen, Health Minister and registered nurse, considers there is sexism in the criticism of graduate status. It's patronising to a profession that has pioneered clinical standards, embedded accountability and is the organisational heart of healthcare.  

Nursing today and our society is very different from 30 years ago - and it needs a new set of skills to add to the caring element. Clinical assessments, critical decision-making and judgement call for a higher and more analytical education.
Technological advances in diagnosis and management, plus new medications and regimes in our multicultural, diverse society pose practical and moral challenges that affect nursing. One in 10 nurses prescribe; and the majority of walk-in centres and maternity units are run by nurses and midwives. Patients and carers have higher expectations, multidisciplinary health and social care requires greater record-keeping and liaison, and the responsibility of registration is more complex.  

Caring has never gone away - but it has been hijacked by staff shortages and greater demands alongside funding and training cutbacks. In addition, a third of the 600,000 registered nurses are over 50 years old, being the most experienced and working part-time towards retirement. However, the workforce bonus is the 118% rise of healthcare assistants over the past 10 years, evidence of the symbiotic relationship between nursing and HCAs to meet the wide range of patient needs. 

As care moves from acute to the community, confident empowered practitioners who use intiative and networks are vital to ensure care across pathways. To date, only 16% of qualified nurses work in the community - there must be a rapid increase in this if patients are to receive their care closer to home. Might nurse graduates be the answer?

Other clinical professional groups that became graduates saw an increase in numbers attracted to the elevated status of the profession. Except in Wales, nurse training has offered a diploma or degree choice of entry; interestingly, there has been an increase in the degree route, despite the added burden of a student loan.  

Are readers thinking these are the graduate nurses that have unrealistic expectations and refuse to wash patients or deal with bedpans - those very few that seem to give nursing a bad reputation in the professional and lay press? If so, it is our nursing responsibility in the workplace to make the theory of patient care real. The theory of empathy becomes the holding of a hand, the importance of dignity are the clean dentures, and cold academic ethics become real support to carers making difficult choices. The application of learnt knowledge must be matched to experience, for which there is no substitute. Inexperienced degree nurses need the vast experience of traditional nurses.

Although a degree has not been a requirement of nursing, one in four nurses on the Nursing and Midwifery Council register has one, and 4% have a postgraduate degree. Why? In my experience, the biggest impact a degree has on a nurse is confidence - confidence in decision-making, to question and to initiate. The biggest barrier for graduates is when they are not welcomed by others. Let's not criticise this step the profession has taken - let us embrace it and help our graduate colleagues make the nursing workforce fit for even greater future challenges.