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Elevated status

Will nursing degrees create capable ward managers or caregivers who are 'too posh to wash'?

A young woman in a graduation hatThere is one group of people that you do not mess with. They are tougher than granite and have looks that can dissolve stainless steel. They can have an acerbic edge and, with one word, they could reduce the Taliban to tears.

Do not mess with the nurses – or the midwives.

In another age, I chaired a nurse-grading appeals panel. This was a product of a Whitehall wackiness that wanted to arrange all nurses into a neat hierarchy, based on what they were doing during a narrow 'qualifying' period. It was rough and ready and gave rise to endless appeals against the grading decisions. Most groups who felt collectively aggrieved were prepared to have their appeals rolled into a composite and what was effectively a class-action: one hearing covering everyone.

Individual hearings
Not the midwives! They insisted on their right to have individual case hearings. I sat, for what seemed like years, listening to the graphic and gory detail of what a midwife might have been doing during the window period.

No man should know what I know; waves of nausea waft over me at the very recollection. Birth can be a spiritual experience. I just reach for the spirits.

Now the roles of nurses are in the news again.

Speaking on the BBC's flagship Radio 4 news programme Today, the Chief Nurse, Dame Christine Beasley, gave a very poor performance trying to explain why nurse training is to become an 'all-degree' affair.

Easy ride
The interviewer was John Humphrys. Normally no stranger to the acerbic, he gave Beasley an easy ride. He asked, simply, why nurses need to be educated to degree level – a requirement set to become law in 2013.

Perhaps it was the simplicity of the question that threw Beasley. She is too used to dealing with the complex, perhaps? The nation's top nurse argued it was about the changing nature of the job. "It is no longer enough for nurses to be selfless, compassionate and hard-working; increasing demands are made on their knowledge and skill."

True, but does that add up to a degree-only entry? And she didn't seem able to answer questions such as:
• Are a nurse's skills really academic?
• Should the majority of skills be learned on the wards?
• How many good people might be excluded from nursing by the requirement to get a degree?
• Why is it necessary to make the qualification compulsory?
• Is the idea to make nurses more like doctors?

I have learned that it is important not to be condescending about nurses – they bite. So we have to be sure that we don't only see nursing through the prism of a thermometer, a bed-bath and a kind word. However, in a poll of health bosses, conducted by, 90 per cent thought all degree nursing was a daft idea.

As NHS Networks put it: "The fear is that by messing with the strange alchemy that has somehow managed to produce generation after generation of dedicated nurses, the spell will be broken; that nurses all over the country will be trading in their souls for a 2:1 in Callous Professionalism or a PhD in Flagrant Disregard of Patients' Needs."

Are we swapping technology for tenderness? Are nurses too posh to wash; too clever to clean?

Most of the coverage missed the point that the nurse training curriculum was to be broadened to include practical time spent working in the community. This is becoming very important as we all descend into a dribbling old age: la-la but fit as a butcher's dog.

The words 'academic', 'professional', 'caring', 'callous', 'bright', 'hard' all roll into an uncomfortable confusion. Thus, I turned to a bright nurse for answers. She said the Royal College of Nursing (RCN) submission to the Prime Minister's commission on nursing adequately painted the picture of how modern nursing needed to be developed and I should go and read the RCN website. Ouch!

She said the RCN had evidence to support the fact that a rich skill-mix resulted in better outcomes. Ow! Why do nurses always beat me up? There was more; "Who on earth can capably manage a busy ward, full of desperately ill patients, if it is not a capable, competent – and, yes – educated nurse?" Bam! I was reeling.

Knockout blow
The knockout blow? "Society is different, nursing has to be different. A degree is the current currency – hairdressing, golf and, ye gods, media studies, not to mention drama. Why not nursing? Otherwise it will end up attracting the unemployable." I was on the floor. Referee, please ring the bell!

In a moment of nursey compassion, she quoted Florence Nightingale: "… give me the character, I can make the nurse." Then she added some words of her own: "Nursing is a noble and intelligent art and science at its very best and, for the sake of the nation's health and well-being, we should be determined to promote such an attractive career to our brightest and most noble potential nurses."

Why isn't she the chief nurse? I'm battered and bruised, in convalescence and therapy, but I remain unconvinced.

I'm sorry to say nursing is finished. High-end care now requires a technocrat, not a nurse. Care at the other end of the scale – washing a bottom and help with feeding – requires a healthcare assistant, not a nurse.

Technology, cost pressures and changes in social demography will redefine nursing, just as electricity redefined the work of the lamp-lighter.

Care closer to home will define a new participant: the domiciliary-nurse-specialist-social-worker-matron-boss, who is trained to diagnose, treat, care and follow through. Doctor-like.

I think Florence would be pleased. At a time when many doctors were hostile to her ideas, she took the position that a nurse was never a doctor. I like to think, secretly, she knew, much of what doctors did could be done just as well by a nurse.

Were she alive today, I think she would 'get this' big time and probably give me a whack for good measure.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.

To comment on this article, email

29th December 2009


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