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Debate: Should universities lower entry requirements for nursing?

After a report exploring the barriers to studying nursing sparked a debate online, a nursing student and a lecturer discuss whether universities should relax entry requirements. 
 

YES

Lauren Mawson: Grades are not the only way to measure the suitability of applicants

The recent Open University (OU) report, ‘Breaking Barriers to Nursing’, suggested that entry requirements to nursing should be lowered to boost numbers - at least according to social media. I responded at the time by suggesting that breaking down barriers to the profession should not be about lowering the entry requirements, but rather assessing the potential of applicants.

In fact, ‘lowering entry requirements’ is not mentioned once in the report. Instead, the OU urged higher education institutions and employers to remove ‘unnecessary’ grade requirements. It highlighted that the equivalent of three A-levels above a C grade asked for by 91% (nine in 10) universities goes beyond the minimum requirements set out by the Nursing and Midwifery Council (NMC) to become a nurse, which are to have: ‘capability to develop numeracy skills’ and ‘capability in literacy to meet programme outcomes’. The report discusses the need to widen participation in several ways by offering solutions and improvements to the predicted workforce crisis, recruitment to courses and retention.

It is a shame that by altering the context of the OU recommendation, there were mixed and often negative responses on social media. Many were angry over the recommendation to ‘lower’ the entry criteria and suggested it somehow demeans nursing, implying that standard degree entry requirements are needed to maintain quality of the profession. There appears to be an underlying assumption that the achievement of target grades will lead to better nurses who are critical thinkers and able to cope with the rigours of the programme. This may be the case for many but has not always been in my experience as a nurse educator of 30 years.

As a point of clarification, I do believe that nursing should be a graduate profession. My own recent PhD study indicates that graduate skills such as critical thinking, evidenced-based clinical decision-making, and the ability to critically reflect on practice are needed for newly qualified nurses to hit the ground running. But in the past, I taught on nursing diploma courses and most of those students succeeded when entering with minimum requirements of English and maths GCSEs. Many of them have gone on to study post-graduate bachelor’s degrees and master’s degrees and are now senior nurse leaders or specialist nurses in the profession. They clearly had the potential to succeed rather than possessing advanced entry qualifications.

In the OU’s approach, I appreciate that they aim to ensure suitability and potential to cope with a nursing degree by using a carefully designed selection process rather than relying on A-levels. In fact, this hits other NMC requirements to become a nurse: have the capability to develop the numeracy, literacy and computer skills required to meet programme outcomes, and demonstrate proficiency in English language. The OU approach is to assess these capabilities in the selection process whereas the university system interprets these capabilities as formal qualifications in maths, English and specified A-levels.  

Before the removal of NHS bursaries and payment of tuition fees, universities could afford to be very selective because of the competition for tightly managed commissioned places, so asking for higher grades was a way of filtering out the ‘best’ candidates. However, we have seen that removal of bursaries has led to a fall in applications to nursing programmes, which in turn will add to the nursing workforce crisis.

The OU also suggests widening participation strategies in nursing because advanced entry criteria often excludes many of those from various backgrounds who have been deprived of educational opportunities but who could be a rich source for nursing with a vocation and talent for the profession.

Lauren Mawson is a principal lecturer at the University of Cumbria’s Department of Nursing, Health and Professional Practice

NO

Grant Byrne: Lowering entry requirements would be a step backwards

A recent publication from the Open University (OU) has sparked a debate around entry requirements into nursing. Their ‘Breaking Barriers’ report found 11% of young people aged 18-24 who had considered studying nursing were put off by the grades needed to apply, leading some to call for requirements to be lowered or for nursing to shift away from all-degree education entirely. Personally, I am tired of having to defend nurse education against those who would have us move backwards.  

The OU report actually identifies a number of barriers into nursing – of which entry requirements featured last. While one in 10 young people were put off by entry requirements, a quarter had concerns about the length and flexibility of working hours once qualified and a further third were put off by financial factors. It is odd then that some have seized upon entry requirements as a remedy to nursing’s recruitment woes.  

Can anyone be a nurse? That is what we must ask ourselves when we consider this issue. Regardless of how little we ask of applicants, there will always be those who do not make the cut. Nursing is by no means an easy degree and entry requirements go some way to establish whether individuals have the skills they need to navigate the course. Alternative routes such as access courses exist to allow interested parties who lack the grades to gain the requisite skills. Incentivising this route with improved financial support could go much further to boosting applicant numbers than lowering the bar to entry. Indeed, given the free-fall in applications following the removal of the bursary in England, it is high time the issue of student nurse support was revisited entirely. 

Of course, proponents would argue that asking less of applicants could boost recruitment at little financial cost, but they are only considering half of the equation. Retention matters too. The drop-out rate from nursing courses is significant; meanwhile, a third of qualified staff leaving the profession cite stress and work pressures. The OU report highlights that the factors that are pushing people out of nursing, such as money worries and job stress, are also those putting applicants off. Would it not be wise then for us to target our energy here first? Not only would such efforts improve morale, but could go a long way to making nursing more attractive to young people.  

The truth is that there is no quick fix for this issue, but it remains fundamental that we reject calls to lower entry requirements. Nursing is already undervalued in the eyes of our paymasters and debasing our education will do nothing to improve that. We are intelligent, safety-critical members of the healthcare workforce. We must celebrate our skill level and be clear that entry requirements deliver the best possible pool of applicants. Aspiring nurses must be supported, but I have little doubt that with improved support all who are willing to work hard will be welcomed into our ranks.  

Grant Byrne is a nursing student at Queen Margaret University, Edinburgh 

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