We need the IV leaguers

Criticism of graduate nursing is an evidence-free zone, Roger Watson argues: mastering the job requires academic ability as well as skill

July 28, 2011

Degree education for nurses has been available in the UK since the 1960s, and other countries long ago made the transition to an all-graduate profession. Nursing in the UK has completed the transition with the move to degree entry to the nursing register, but questions in the press, by politicians and by many in the profession about the necessity for this - and the view that university-educated nurses are "too posh to wash" - has muted the celebrations.

The perceived incongruence between being a caring professional and being academically qualified is uniquely applied to nursing - not to medicine, clinical psychology or any form of therapy. The ridicule heaped on nursing degrees generally and doctorates especially outweighs any of the opprobrium directed at media, tourism and leisure studies qualifications.

Broadsheet columnists such as The Sunday Times' Minette Marrin correlate declining standards of care in the NHS with the rise in degree-educated nurses and have suggested that young girls who are "not particularly bright" need something to do. Nursing is perfect: why saddle them with having to know anything? Nursing is viewed only as skilled caring work by many. Indeed, a great deal of what the public understands to be nursing can and is done by non-professionals. Confusion arises because nurses also do some of this work and many people think that is all there is to it: wipe a few bottoms; make a few beds; report to the doctor ...

In reality, nursing is a complex subject reflecting the complexity of the job. Biology, psychology, medicine, pharmacology and - to the horror of many - sociology all contribute to the unique mixture that is nursing. Clearly, nurses need to know how the body works in sickness and in health, and how it responds to treatment. Nurses - like doctors - need to be able to contextualise their work, thus the sociology. Nurses need to understand why children with chronic illnesses living on sink estates have different health-education needs than the children of middle-class parents. Are they stupid? Don't they care? Or do they simply face competing pressures and have fewer role models? The more you know, the less judgemental you will be. The less judgemental care is, the greater its effect.

If this argument for the need for sociology in the curriculum is not compelling, then work from the US by Linda Aiken, professor of nursing and sociology at the University of Pennsylvania, should be. She unambiguously demonstrates the positive relationship between rescuing deteriorating patients and the number of graduate nurses employed in hospital.

In addition, Australia has had all-graduate entry to the register for decades. While this is in danger of being eroded on economic grounds, the principle has never been questioned inside or outside the profession.

How does nursing fare as an academic subject in the UK? In 2008, the discipline rose from the foot of the research assessment exercise table. The RAE found that some of our top schools of nursing were conducting world-leading research: in some universities, nursing outstripped medicine. The Journal of Clinical Nursing, of which I am editor-in-chief, publishes research that is picked up regularly by the BBC Health pages, Reuters and UK broadsheets. This work is directly relevant to patient care and uses sophisticated designs and analyses akin to any medical study. Nursing research is cited in medical journals such as the British Medical Journal and The Lancet.

The view that degree-educated nurses all aspire to be "high-flyers" and want to move away from direct patient care was dispelled many years ago in follow-up studies of early graduates from the universities of Edinburgh, Manchester and Hull. Largely, they remained clinically focused and frequently worked with older people and in the community. However, those who comment freely and negatively about nursing operate in an evidence-free zone and prefer to perpetuate, rather than puncture, these myths.

I entered nursing following a BSc in biological sciences (the University of Edinburgh) and a PhD in biochemistry (the University of Sheffield), long before degree education was the norm. I found the study and the work mentally, physically and emotionally challenging. I don't recall my ability to care being impeded by my degrees, but I know that my knowledge of the biology of the skin helped me to treat pressure ulcers and that my understanding of research enabled me to design a study that helped inform the management of urinary incontinence.

All nursing is skilled work; good nursing requires academic ability as well as skill.

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