Don’t throw the baby out with the bathwater: Preserving children’s undergraduate nurse education in the move towards genericism in nursing

Approaches to nurse education vary internationally. Our approach in the United Kingdom (UK), together with countries including Germany, Italy, and Republic of Ireland is unusual, where field-specific undergraduate nurse education programmes are standard. This approach allows nurses to register as children’s nurses without undertaking generalist training beforehand. Recently, arguments have been made for a move back towards generalist nurse education (Purssell and Sagoo, 2023). This has been met with passionate refutation from children’s (Fallon, 2023), learning disability (Cogher, 2023), and mental health (Warrender, 2022) nursing colleagues.

Internationally, generalist nurse education is standard (van Kraaij et al., 2023). In most countries, nurses wishing to specialise in the care of babies, children or young people, or other specialities undertake post-registration, postgraduate training (Clarke, 2017). Arguments for generalised education surround the universality of this approach, where all nurses are trained to meet the needs of people across a lifespan. Purssell and Sagoo (2023) suggest that removing general elements of nurse education in the United Kingdom has resulted in an inflexible British nursing workforce.

In 2018, the UK nursing regulator, Nursing and Midwifery Council (NMC) launched new education standards, designed to tackle the health of the UK population, following national inquiries and reports, including Prime Ministers Commission (2010), Francis (2013), and Keogh (2013). These Future Nurse Standards (NMC, 2018) have led to a move towards ‘a model, constructed on quantifiable skills and competencies’ (Connell et al., 2022:473) that are applied to all pre-registration nursing students, regardless of field. This approach undermines elements of a children’s nurses’ role, owing to the generic, skills-based design. Our question is should our children’s nursing baby be thrown out with associated bathwater? As children’s nursing academics involved in providing care and educating future children’s nurses, we strongly support the preservation of field-specific nurse education. We are outlining the value of field-specific education and why we think that undergraduate children’s nursing should be maintained and enhanced.

A raft of legislation strives to safeguard children through multiagency working (Laming (2003) and HM Government (2023)), vetting (Bichard, 2004), and the development of a child-centred system (Monro, 2011). In addition to vast legal protections, a wave of research that followed the inception of the National Health Service considered ‘harm’ in a broader sense, focusing particularly on attachment, separation, and loss (Bowlby, 1988), and the emotional suffering of children in hospital (Clarke, 2017). The need for a child-focused, family-centred approach to nursing children forms a fundamental principle of modern children’s nursing (Tatterton et al., 2023). Despite these measures, risks to children and examples of poor care delivered by nurses who were not specifically trained to care for children remain (Platt, 1959; Clothier, 1994; Kennedy, 2001). Field-specific nurse education recognises that children’s nurses require field-specific training, skills, and competencies in order to provide safe, effective, responsive, and appropriate child-focused care within family-centred settings.

There is a paucity of evidence related to how UK higher education institutions (HEIs) developed their curricula in line with Future Nurse Standards (NMC, 2018). It has been suggested that these standards promote a move towards greater degrees of shared learning across all four fields or specialisms of nursing, often referred to as ‘genericism’ (Glasper and Fallon, 2021). This has raised concerns amongst HEIs that newly registered children’s nurses are not adequately prepared to safely care for children, young people, and their families. This forms part of an ongoing debate, which highlights the threat to specialist education due to increasing generic components, in children’s (Glasper and Charles-Edwards, 2002; Glasper and Fallon, 2021) as well as other fields of nursing (Cogher, 2023; Warrender, 2023), sharing the opinion that pre-registration education standards are contributing to a dilution of field-specific nurse education, replaced by genericism.

A philosophy of child-focused family-centred care underpins children’s nursing. This recognises the importance of a child’s family unit, not only in terms of dependency and functioning but also partnership, compliance, and concordance (Hoeeg et al., 2018). Children’s nurses are equipped with knowledge and skills of how these can be established and maintained, as well as how to manage instances in the absence of ‘family’ and the impact of this on children in our care. Nurses caring for children need to be equipped to care for babies, children, and young people across a wide range of age and developmental phases, balancing and respecting their dependence on carers with their evolving right for autonomy and independence, requiring advocacy, communication, mediation, and diplomacy. In addition, children’s nurses take responsibility for caring for family members and caregivers (Bagnasco et al., 2019).

The Fit for Children and Young People (‘Fit4CYP’) project was established to determine how the structure and content of pre-registration educational programmes influence the readiness for practice of newly registered children’s nurses (Carey and Neill, 2022). A national cross-sectional survey was undertaken to map the structure of curricula offered to pre-registration children’s nursing students by HEIs following the introduction of the NMC (2018) Future Nurse Standards. Pre-published data shows a disparity in the types of programmes offered to undergraduate children’s nursing students, with varying degrees of content related to the field. Early findings suggest children’s nursing programmes are generically focused, with programme leaders reporting a dilution of field-specific content. Data indicates that Future Nurse Standards proficiencies (NMC, 2018), which represent the skills, knowledge, and attributes that all UK nurses must demonstrate in order to register, are not all easily achievable by children’s nursing students. Criticisms include that Future Nurse Standards are too focused on illness and adult nursing. This is supported by Warrender et al. (2023) who recognise that current proficiencies offer little opportunity for mental health students to practise the physical health skills they are required to demonstrate within mental health services that are not set up to address physical health needs. Similar concerns are reflected by colleagues outside of the United Kingdom. An Australian study sought experiences and perspectives of mental health nurse academics on the adequacy of field-specific content to prepare graduates to work in mental health settings (Lakeman et al., 2023). The study found that field-specific content, theory, and clinical hours were insufficient to prepare graduates. Furthermore, students were dissatisfied with the generic approach to nurse education. These findings are synonymous with those of the Fit4CYP survey, highlighting the challenge of recruiting and retaining relatively small numbers of academics needed to deliver these programmes.

The Royal College of Paediatrics and Child Health (RCPCH) highlighted significant challenges facing babies, children, young people, and their families in the United Kingdom (RCPCH, 2017; 2020a). Challenges include rising inequity, infant mortality rates, and incidences of those living in poverty, with growing prevalence of mental health concerns in childhood. A complex backdrop in relation to the children’s nursing workforce exists, with significant geographical variation in nurse numbers across hospitals in the United Kingdom, as well as in more specialist roles including school nursing, community children’s nursing, and health visiting (RCPCH, 2020b). Projects such as the Fit4CYP are vital to be able to meaningfully evidence the impact of new standards of education for children’s nurses, appreciating their preparedness to meet the 21st century demands.

As children’s nurses, we recognise and champion the knowledge, skills, and experience of children’s nurses, specifically trained to meet the specific needs of babies, children, young people, and their families. Alongside the Association of British Paediatric Nurses, we wholeheartedly support the preservation of safeguards for babies, children, and young people by retaining undergraduate nurse education programmes for children’s nurses.