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J R Soc Med. 2007 May; 100(5): 209–210.
PMCID: PMC1861416

Authors' response

We disagree that there was a ‘golden age’ of nursing in the 1970-80s. We hold memories of inappropriate care based on what was ‘always done’ with no recourse to evidence. When the first university-educated nurses graduated in the UK, they remained in practical nursing for longer then their non-university counterparts, worked in less popular areas such as care of older people while simultaneously contributing to nursing's knowledge through research and publication. LS is from Australia; there, the move of nurses to an all-degree profession has been hugely successful, and educational content always includes the idea that however highly educated the nurse, patient care at all levels is integral to the role.

We agree about the value of charge nurses, and indignities of unisex wards. But issues of sickness, absence and box-ticking have little relevance. Our point is that nursing has a distinct role and knowledge base, of which ‘pseudo-doctoring’ is not part. Nurses who pursue these roles emasculate nursing, but with adequate education will learn to critically evaluate such undermining.

Criticism from operating department practitioners (ODPs) of our thesis—that poor education of nurses lies at the heart of our professional demise in the UK—focuses on one paragraph. They ignore our legitimate claims that the current educational mode of pre-registration nursing, with its service-driven demands for increasing numbers of nurses with minimal entry qualifications and subsequent sub-university level of education, is retrograde, and damaging to both profession and patients. Indeed, claims from ODPs about content of their educational courses bear out exactly the point of our paper: that nursing roles are being given away by nurses. When local ENB courses for theatre nurses were stopped because such training was deemed no longer necessary, the job was given to ODPs. If ODPs are being appropriately educated to undertake the tasks described, then that is beneficial to patients. However, our essay1 was about the decline in nursing, and technicians in the operating theatre were one example. The evidence from your ODP correspondents suggests that the decline in nursing may be more advanced than we suspected.

We reiterate that no other health profession is educated to do what nurses are supposed to do, which is the provision of 24-hour care of patients regardless of which other professions have been involved. We would ask if health care assistants are providing psychological and physiological care, are they adequately educated to do so? If they are providing such care without appropriate education then we are very worried indeed. Moreover, in terms of all the other professions mentioned, where would they be without nursing? It is nursing that is in demise and we have seen nothing in any responses to our essay that even begins to suggest otherwise. To ask for a retraction, as several ODPs have done, is a ridiculous and unmeasured expectation and none will be forthcoming. Nor do we apologise for defending our profession.


Competing interests LS and RW are both Professors of Nursing.


1. Shields S, Watson R. The demise of nursing in the United Kingdom: a warning for medicine. J R Soc Med 2007;100: 70-4 [PMC free article] [PubMed]

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