In Sweden, medicine and nursing are equal partners. Australian nurses are educated to similar levels as doctors. Registration requires a degree, specialisation is through postgraduate study and, commonly, nurses in ordinary positions hold at least a Master's degree. Nurses confidently advocate for patients as they possess critical thinking and life-long learning skills which ensure they can effectively find, use and generate evidence. Doctors at first felt threatened by this, but now acknowledge nurses as equal partners, able to work autonomously and drive their own profession. Currently, nurses hold many positions previously held by doctors: some chief executive officers of Australian health facilities are nurses; health portfolios at government executive level are held by nurses; and nurses chair important national committees. In the Republic of Ireland, all nursing education is now to degree level. Plans are afoot for the same in Scotland and Wales. Why has this not occurred in England?
Two important journals are published in Britain: Journal of Clinical Nursing
and Journal of Advanced Nursing
. Most of their submissions come from overseas. The UK content is from a handful of universities and health services, exemplary places where real evidence generation is prized and encouraged. However, in most nursing journals, much of the ‘research’ published in the UK is audit, evaluation of programmes, or initiatives driven by the NHS. A recent report from the Higher Education Policy Institute8
confirms this: ‘It is striking how little the study of nursing appears to have been “academised” by its move to the Higher Education sector’ (p. 6), and ‘research is a much less prominent feature of academic life in nursing departments than in academic departments generally’ (Annex B, section 15).
Nursing education in England is funded by the Department of Health; in contrast, other disciplines are supported by the higher education funding bodies. This leads to nursing students being recruited to local universities to serve local health needs and the local community with no recognition of the global community and invaluable knowledge that international and wider national experience can bring to local health problems.
Any practice discipline educated at university has two masters—the university, and the registering authority; for example, medicine has both the university and the General Medical Council. Because of the way it is funded, nursing has three entities of control—university, NMC and NHS. The NHS is driven by the need for personnel to care for patients—the ‘bums on seats’ (in wards) approach. In NHS nursing education, research is considered ineligible for funding. Such total disregard for research is echoed in the NMC's Code of Professional Conduct, where research is mentioned only once and that is in relation to ‘deliver care based on current evidence, best practice and, where applicable, validated research when it is available’ (p. 9). Of more concern is the complete omission of research from the document Competence for Entry to the Register (18 October 2005). This is directly opposite to codes of ethics and professional practice from the International Council of Nurses, who say ‘Research-based practice is a hallmark of professional nursing. Nursing research, both qualitative and quantitative, is critical for quality, cost-effective health care’. Research figures prominently in policies from, for example, Canada, Australia, Singapore and Thailand. While research is mentioned in some NHS documents, examination of NHS supported research done by nurses demonstrates that it generates little new knowledge, and other professions regard research done by nurses with disdain.
Another negative influence on nursing education in the UK is the three trimester, rather than two-semester university year with multiple intakes of hundreds. Because the government wants qualified nurses quickly, as many students as possible pass through universities. Lecturers finish marking student assessments one day and start a new round of lectures the next, delivering the same lecture up to four times a year, leaving no time for their own development and research. Would other disciplines, such as historians, scientists or doctors, tolerate these conditions and poor standards for students?
Entry levels to nursing in many universities across the UK are low. Oxford and Cambridge refuse to engage with nursing education, and the University of Sheffield has discontinued pre-registration programmes. Many nursing courses allow students with only five GCSEs to enter. ‘Widening participation’ is laudable, but only if it provides support and extra time for students who would not normally be able to enter university. To allow students with low entry criteria to undertake the same classes as high achieving students without appropriate support is patronising, and sets them up for failure. It commonly occurs that the level at which the classes are taught is decreased to that of the poorest student. The cadet nurse initiative, rekindled in the wake of Making a Difference
(DoH 1999) was meant to widen access and increase the intake to nurse training of a wider range of minority ethnic groups and people with nontraditional educational backgrounds. However, this has failed.20