Nurses need theory of practice

April 29, 2005

Nursing education must resist attacks on 'over-academic' training and focus on its successes, says Paul Turner

Nursing education has one of the highest political profiles of any area of higher education, as the headlines arising from this week's annual congress of the Royal College of Nursing demonstrate. But these headlines, often linked to anxieties about the wider health agenda, can sometimes obscure the fact that nursing is one of higher education's success stories.

It is ten years since nursing education was transferred from the National Health Service to universities. It has developed research rapidly from a low base. Student numbers have expanded by 60 per cent over the past five years. Nursing is now one of the largest subjects in higher education, with 88,000 full-time and 98,000 part-time students. Nursing and allied health professional education has made innovations in learning and teaching. It has also led on widening participation - 70 per cent of nursing students are aged over 21 on entry, and they come from a variety of socioeconomic backgrounds.

But such success has not protected nursing. It may even have contributed to periodic attacks over a perceived lack of consistency of care that detractors link to "over-academic" training. We should not have to defend programmes that develop the intellectual abilities of future nurses as well as their practice skills. The development of intellectual abilities that will allow nurses to acquire skills in future is just as important as the learning of vocational skills.

Such attacks, which are often based on anecdotal evidence about earlier education regimes, must be challenged. The first students to qualify from the most recent change, the Fitness for Practice programmes, have been practising for just eight months in most of the UK. It is too soon to obtain reliable evidence on their performance and skills.

There are certainly issues about the provision of high-quality learning in practice for the increased numbers of nursing students. Service pressures and targets can inhibit mentors from giving effective support to students in hospital and community care settings. The Nursing and Midwifery Council is undertaking a review of nursing students' "fitness for practice at the point of registration". The review should assist the expansion of modern learning techniques for clinical skills, as is happening in other health professions such as medicine. Universities must also resist pressures that may inhibit their autonomy, in partnership with the NHS, to design and deliver programmes that reflect their expertise, opportunities and facilities.

The other significant issue facing nursing and allied health professional education is the recruitment, retention and development of the academic workforce. Better salaries and prospects being implemented in the NHS as a result of the Agenda for Change will make matters worse. There is an urgent need to enable staff to move more easily between clinical, teaching and research roles. Nursing has established a new academic self-confidence as its role in higher education has matured. It must now ensure that the values of intellectual inquiry and evidence-based practice are retained and developed.

Paul Turner is executive officer, Council of Deans and Heads of UK University Faculties for Nursing and Health Professions.

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