We hold Dr. Ann Bradshaw in the highest esteem. Her long and distinguished career in university nursing have left their mark, especially on the history of the various changes that have taken place in the last century and the way nursing education is delivered. One of us reviewed her book The Project 2000 Nurse for Journal of Advanced Nursing in 2003, saying that it “deserves to be read widely and will serve as a ‘gold standard’ in the history of nurse education”.
Views were exchanged before on the value of graduate nursing following a previous article she wrote in the Daily Sceptic. Her work has also been referred to in TCW Defending Freedom where criticism of university educated nurses is lapped up by a readership largely ignorant of the evidence in favour of graduate nurses and unwilling to consider it.
Dr. Bradshaw surely cannot be unaware of the evidence on the value of a graduate workforce in nursing and also the fact that nursing students in university spend 50% of their time in practice. We wish to offer a rejoinder to her recent piece on fixing social care in the Daily Sceptic. Here the usual tropes about how nursing has gone to hell in the proverbial hand cart are rolled out, and all because nurses now go to university. In support she cites Left of centre journalist David Goodhart and one article in the Daily Telegraph reporting a case of sepsis allegedly contracted as graduate nurse did not swab an injection site prior to administering an injection.
Dr. Bradshaw is, we presume, aware, as described in a Cochrane Library review of 2018 that “there has been no clinical impact of using or not using alcohol swabs on infections and infection symptoms calling into question the practice of using it prior to all injections”. The link between what the Telegraph – another bastion of graduate nurse criticism – reckons and the purported outcome is a spurious one.
Claims linking poor nursing care with the development of graduate nursing education have a long history. Sadly, for the detractors of university level education for nursing students, this has not been an evidence-based approach. The first Willis Commission of 2012 searched in vain for such evidence.
On the contrary, copious evidence is available for the effectiveness of graduate nursing education. A long line of work at the University of Pennsylvania led by Professor Linda Aiken provided evidence so convincing that the Institute of Medicine in the United States recommended increasing the number of graduate nurses in 2011.
Aiken’s work is not confined to the United States. The RN4CAST project showed in 2014 in a study of 300 hospitals, 26,516 nurses and 422,730 patients in nine European countries that every 10% increase in bachelor’s degree nurses was associated with a decrease in the likelihood of an inpatient dying by 7%.
Work from a different team from Qatar has shown a direct and positive link between graduate nurses and patient outcomes. Whereas the link between nurses and outcomes in Aiken’s work is indirect, in the Qatar study the link was direct and made possible due to the unique electronic records system available in the organisation studied. The study, originally published in Journal of Advanced Nursing, was summarised in the Conversation. In short, it shows that greater exposure to graduate nurses during a patient stay in hospital leads to a greater likelihood of survival.
The effect of the admitting nurse was controlled for in another study published by the same group in International Nursing Review. It mattered not whether the admitting nurse was a graduate or non-graduate, demonstrating that the effect on survival was not the patient pathway, and further demonstrating that it was the subsequent exposure to graduate nurses which positively influenced patient survival.
We do not claim that all is perfect currently with nursing. One of us wrote about our own brush with the NHS earlier this year, after collapsing at home, in TCW Defending Freedom and the Catholic Herald. The ambulance staff were great, the consultant was as caring and competent as any medical professional could be. But the nurses were truly shocking. Much is wrong, but we have never understood and can find no systematic evidence that this is because of nurses being educated in university.
We are not graduate nurses; we are of the old school. But we recall shocking examples of care when we were student nurses: patients tied to chairs with blankets; tea, milk and sugar in the same pot being given to patients with learning disabilities; pressure sores that you could put your fist into and some incidences of terrible patient abuse.
It is so easy to look back on the good old days of nursing through rose tinted spectacles. It is also so easy, as demonstrated above, to make spurious links between every incidence of poor care these days to the fact that all nurses are graduates. The crucial point is whether we are going to make such comparisons based on evidence or prejudice. We conclude with a question to Dr. Bradshaw: in light of the link between graduate nurses and inpatient survival, would she rather, when ill, be admitted to a hospital with high proportion of graduate nurses or a low one?
Dr. Roger Watson is Academic Dean of Nursing at Southwest Medical University, China. He has a PhD in biochemistry. He writes in a personal capacity.
Professor Mark Hayter is Head of Nursing at Manchester Metropolitan University. He writes in a personal capacity.
Dr. Ann Bradshaw responds:
Thank you to Professor Watson and Professor Hayter for responding to my article. I fear they may have missed my point (or I was not clear?) in that I was writing about the crisis in social care and offering a solution.
In response to his defence of degree nursing (which is neuralgic to the nursing establishment), as I argued in Times Higher Education, the North American study he refers to does not define what is included in the nursing ‘degree’ in any country, so is irrelevant to survival rates. ‘Degree’ is just a label. In the U.K. the nursing degree is not a medical degree and is not standardised. Professor Watson has admitted to me in the past his regret that there is a lack of anatomy and physiology taught generally in U.K. university nursing departments. Also, unpaid supernumerary placements are not the same as paid full-time apprenticeship training.
In response to the authors’ last question, as to whether I would like to be nursed by a degree level nurse or not, I will give my story. Several years ago, while working on my allotment, I developed severe abdominal pain. My husband took me to our local teaching hospital emergency department, where I lay on the floor in pain until my turn came. The degree level trained nurse came with her paperwork, looked at my drip (not at me), inserted pain relieving suppositories into my rectum and left. I vomited, no nurse present, my husband found me a vomit bowl. I passed out the contents of my rectum on to the couch I lay on. No nurse came. My husband cleaned me up. The nurse came and reluctantly changed the sheet, as if it was below her station, but left me in the soiled hospital gown and with soiling on my skin. I was wheeled to X-ray in the gown and felt very humiliated. When I told this story to a Royal College of Nursing conference, the degree level trained nursing delegates did not want to hear it.
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But this is the real problem:
February 2024
More than 700 Nigerian nurses under investigation for taking part in ‘industrial-scale’ qualifications fraud could be working in the NHS | Daily Mail Online
May 2024
500 NHS nurses from Nigeria could be struck off over ‘fraudulent or incorrect’ exam results | Daily Mail Online
Some DM comments from the public:
— “And yet you show a photo of a white woman lol”
— “They are the most dishonest people I have come across, they get these false documents as nurses and go and work in care homes exploiting them I have seen them all it’s time someone did some investigation on these care home nurses.”
— “I asked this question 8 years ago and my shifts were cancelled. The hospital know this happens but ignores it, not exactly patient centred care.”
— “It’s obvious when you have to work with them!”
For me the question would be purely an economic one. What is the extra cost to the nation of the training involved, and what cost savings does that drive for the NHS?
But there is the problem : When you have a Communist Health Service, the first thing they do is break all relationship to free market pricing. So answering my question is impossible. And that, of course, is deliberate.
What really happened in Amsterdam…
https://youtu.be/DvTyg1kJGzM?si=-PwR6ncKHSl9utD3
We must be extremely careful what we believe in media in this modern age of misinformation..
Question absolutely everything..
I wont bother saying it…….. Yes i will… I told you so..
Astounding. That confirms what I read about a few days ago, but couldn’t find the link again: that Israeli youths actually started shouting insults and attacking first.
Yep, we seem to now be living in a true post-truth world.
I have a theory, where I spin everything in the msm on its head…. It’s served me well over these years…
Once one accepts that all the msm is one big lie.. You start to think about what was the reason for the lie….
https://youtu.be/LJxBnSyH0T4?si=_rI1AGoLZMb2FYK0
The media is lying to us… Eric Weinstein, what a brain this guy has..
I “checked out” decades ago…
There is so much you could say about this you could write volumes on every avenue and people have done so for those who are interested. I read a study in the Nursing Times a while back, before the recent exacerbation of the crisis, and if I remember correctly a survey found that within two years of working something like eighty percent of nurses reported feeling that they had lost all of their compassion. There was some speculation about the reasons and an acknowledgement that this detoeriotation would inevitable affect patiernt well-being. It is a hard job even under the best of circumstances ie good funding, low patient numbers, high staffing levels. But if you have someone who needs to go to the toilet and you know that they are about number six in your list of priorities because of the workload then perhaps a defensive numbness develops. People from overseas, especially America, often remark when working or receiving treatment within the NHS that it has a military feel which is understandable given its roots. The armed forced send their nursing students to the same lectures and placements as civilian nurses and this works seamlessly. Regardless of the sociopaths and psychopaths the cream of British society work in these institutions. The rot is the deep rot that pervades everything. The Jeremiad stuff is just jive talk which is sometimes disingenuous and more often just naive.
I don’t understand why it is not possible to have both graduate and non-graduate nurses. That would open up more opportunities for people to nurse and deal both with shortages and importing nurses from countries which no doubt need their own.
The problem is that getting well from a substantial illness requires nursing: not just getting the necessary tasks done, but being reconnected with the living: a little TLC, even if it’s ‘tough love’.
When school leavers, aged 16?, went straight into nursing, and on the wards soon after, it was an apprenticeship that included strengthening this connection to other human beings. Now, with the greater emphasis on knowledge and technology, this connection is, in fact, weakened: life becomes driven by theory: yes, a medical theory, but it is still an ideology, impersonal, and not helpful to nursing the sick. It why there are separate doctors and nurses, and patients can tell there’s a difference, even if they are not conscious of it. And once the connections to the rest of humanity, or even the community, are lost, it’s so hard to reconnect. Just look at the current Cabinet, lost in their political bubble, being bewildered by aliens, like farmers, manufacturers, shop keepers, and anyone running a small to medium sized business.
Of course, you can have traditional nursing skills with technical skills, (both nurses and doctors with both are usually outstanding), but emphasising the technical, at the expense of traditional nursing for all entrants, discards so many with the skills lacking in the NHS, and turns it into a regimented outfit, whether Military or Marxist, who cares?
You missed out that the current Cabinet also struggle to define what a ‘working person’ is let alone whether or not they have a penis.
People don’t know and they don’t even make the effort to understand and yet they simultaneously feel entitled to comment on a situation. Nothing new there. It is just intellectual laziness. They wonder why they are so disenfranchised. Maybe if you dig your finger out of your arsehole you might gain some understanding.
Hi standards are what matters. But the mindset of many graduate nurses is of climbing the management ladder ro get out of day to day nursing. We need good front line people to stay in nursing , not ro bugger off to damagement the first chance they get. And the demand foe all nurses to be graduates and for all management candidates to be so, is utterly foolish and quite spiteful by the graduate class.
And, get most of the immigrant nurses out of our NHS
Obviously there are some distinct benefits in training nurses to degree level, but not at the cost of provision of excellent nursing care. The patient essentially depends upon the doctors to determine the treatment and the nurses to administer it safely in a caring and competent manner.
There has been a definite shift in this situation since nurse graduates became the norm.
My own personal experience is that many nurses now regard themselves as too well trained to care for the holistic care of the patient. My own experience of nursing care bordered on what I and the Care Quality Commission considered gross negligence because the nurses mostly ignored the doctors’ instructions choosing to determine their own preferences without any consideration of the considerable medical needs of me the patient. They acted as neither competent nor caring nurses, doctors or health care assistants.
I’ve just written a supporting past, but under another post. But I would like to add that there was a nurse who came into my ward and briskly tidied up anything not in it’s place. She did so, slightly blaming those who had gone before, not vinductively, but to clear the air. It only took a couple of minutes, but I did feel more at ease. She knew what was acceptable, and what wasn’t really tolerable, for long, anyway.
I gather she had been at least a senior sister, and had come back to work, possibly part time, though she could have been like those ‘secret shoppers’ that provide feedback to management.
Whatever, I knew she had been trained in traditional nursing, because she exuded it. In a similar manner, I was, in my youth, a silver service waiter, and those subtle skills learnt were so useful in my career, which was always very technical. In the land of the blind, the one eyed man is king, or at least he’s less confused than most.
Surely the answer is multiple routes to training.
those that want to be ward nurses only could train in the job and those that wish to specialise, such as theatre or paediatric nurses should do the degree first followed by specialist top up training like the doctors do.
So two heads of university nursing units say that educating nurses at universities is a great idea…..
The problem is a State-run, Socialist health care system. Until people come to terms with that instead of writing about what’s wrong – we know! – and offer solutions to solve the insoluble, nothing will change.
Remove the State monopoly, restore healthcare to the competitive, private sector whence it came before Government nationalised it… starting in 1911 by the way.
Am I right in believing that nurses used to be trained completely on the job but received a small salary and accommodation in a nurses home; then entered the profession as qualified but without any debt? If so, what was wrong with that? If more academic study is required then with day release it could be provided and, if necessary, the course lengthened.