A catchy title, but I wasn't expecting the authors to show such astonishing lack of insight into the causes of this decline (JRSM 2007;100:70-74). Their main premise seems to be that what is wrong with UK nursing is that not everyone has a degree, and therefore nurses are unable to understand how to do their jobs! I can't speak for others, but I suspect I am not alone in believing that it is exactly that switch from an ‘apprenticeship’ form of training to the academic regimes we have now that has ruined UK nursing. Healthcare assistants have always taken on much of the basic care of nursing, but in the ‘olden days’ they were called nursing auxiliaries, and they were also closely supervised by the Ward Sister or Staff Nurse, who seemed to manage pretty well without a degree. In this ‘golden age’ of nursing, probably back in the 1970s and 80s, the SRNs and SENs who ran the wards spent their time actually looking after patients, administering drugs, sorting out social problems, and yes, making sure the place was clean. The ‘tick-box’ culture of today means no-one can check a urine dipstick unless they have completed a ‘point of care’ testing assessment (reviewed annually!).
I am sure that Professors Shields and Watson will get their wish—and indeed, why shouldn't nursing be a degree course, as much as medicine, physiotherapy and radiography? My difficulty is with their assumption that this will be the foundation stone of a new era in nursing. I suspect it will be, but for the wrong reasons.
What about medicine? Whatever criticism we can all make of Modernising Medical Careers, it is a genuine attempt to restructure medical training to retain many of the strengths that we have been losing in our own abandonment of the apprentice system. The next five years will show us if it is going to succeed.
