The purpose of this essay is to explore the current change in nursing pre-registration programme in England, which aims at raising the educational status from diploma to all-graduate level. This will be accomplished by critically analysing the rational that Department of Health (DH, 2009) and Nursing and Midwifery Council (NMC, 2008) given for the recommendation of all-graduate profession, based on the evidence. The essay will begin with the introduction of The Bologna Declaration (1999) and its impact for nurse education in the European Union and England.DH (2009) and NMC (2008) rational of all-graduate profession for nurses then will be critically analysed, identifying strengths and limitation of the new policy.
Finally, the changes that were put forward will be discussed, analysing barriers to change. In November 2009, it was announced that all new nurses in the United Kingdom of Great Britain (UK) will have to be educated to a degree level by 2013 (Lepper, 2009).This recommendation came from the government after the four UK health departments asked the NMC to carry out a consultation and review of pre-registration nurse education (Lepper, 2009). This idea was initiated as a response to the movement known as the “Bologna Process”.
The Bologna process was launched in 1999 when representatives from 29 European Union (EU) countries signed the “Bologna Declaration” and committed themselves to reform their countries’ higher education system (Bologna Declaration, 1999).Six action lines to achieve this strategy were set. These included: adoption of a system of easily readable and comparable degrees; a system of two-cycle (undergraduate and graduate) degrees; a system of credits to promote widespread student mobility, such as the ECTS (European Credit Transfer and Accumulation System); promotion of mobility; promotion of European co-operation in quality assurance and lastly promotion of the European Dimension in Higher Education (Bologna Declaration, 1999).Consequently, the “Bologna Process” provided the impetus to raise the educational level up to graduate with a unified platform of pre-registration programmes across the EU (Spitzer and Perrenoud, 2006b). The International Council of Nursing (ICN), the European Federation of Nursing Regulators (FEPI) and the European Nurse Directors Association (ENDA) have all been very favourable to this changes which indicated that the framework can be implemented to recognise the value of the education for nurses across the EU (FINE et al, 2007).
It is believed that “Bologna Process” will create a great opportunity for nursing education at the bachelor’s degree level as the entrance level, followed by master’s and doctoral academic recognition in all EU countries, thus increasing the opportunities of nurses’ mobility within the EU (Zabalegui et al, 2006). The most important fact is that the Bologna Process offers possibilities for the career development in nursing training programmes which promote scientific research work and the development of nursing as a scientific discipline (FINE et al, 2007).The Bologna process has been taking place within the European world of higher education in the last thirty years and affected lives of millions of nurses in practice, education and research, who work in countries that make up the European Union (EU) (De Raeve, 2005). Many countries have already implemented the changes recommended by “the Bologna Declaration” and offer degree only programmes to their candidates.
Spain offers first, second and third level degrees as well as the development of an inter-university network between universities for the promotion of research, teaching and student exchange (Zabalegui et al, 2006).Australia and New Zealand have had graduate entry nursing programmes for many years now (Karstadt, 2009). Wales introduced graduate only entry programmes in 2004 (Watts, 2010), Scotland and Northern Ireland offer degree programmes (BBC, 2009). So England had a little choice but to implement an all-graduate profession as well (Snow, 2007). This plan has been welcomed by the The Royal College of Nursing (RCN, 2009).
They believe that England needs an education system that encourages the best entrants to pursue a career in care.Furthermore, NMC (2008) and DH (2009) strongly supported the move believing that raising the minimum level of nursing education to degree level will also bring the UK in line with other countries of the EU, who already implemented this strategy. DH in “Modernising nursing careers: setting the direction” (2006) stated that health care reform in our rapidly changing health care environment has created major changes affecting registered nurses.They identified 4 key areas for improvement as: development of competent and flexible nursing workforce; update of career pathways and career choices; preparation of nurses to lead in a changed healthcare system; modernisation of the image of nursing and nursing careers (DH, 2006). This is due to rapidly changing structure, organization and financing of health care where the length of hospitalizations is decreasing dramatically, which means that patients are returning to their home settings sooner than ever before.
Patients still require non-acute care after these shorter stays, and this means that home health care, long-term care, hospice care and other community-based care will continue to grow. This, in turn, means that the patients that are in the hospital are more acute and require intensive nursing care (DH, 2006). The role of the registered nurse must now include greater professional judgment, management of complex systems, and greater clinical autonomy (DH, 2006).The pressure to contain costs and meet the needs of the rising levels of severe illnesses of inpatients make it imperative for hospitals to seek ways out to redesign delivery of care without compromising quality of care (R).
Patients previously hospitalized are now treated on an outpatient basis, relying on care through different delivery systems. These changes demand knowledgeable and confident nurses who can work independently and take an active role in adapting practice to meet the complex needs of patients.According to Shields and Watson (2007), graduate nurses possess such qualities as critical thinking, problem solving and life-long learning, which enable them to fulfil these challenges. The first step towards achieving the modern, competent and knowledgeable nursing workforce in England which is a combination of proficiency in practical nursing competencies as well as the ability to utilise research and evidence based practice was strongly supported by the NHS (DH, 2009) and the NMC (2008) by a shift to move to an all-degree workforce at the point of registration, which is regarded as one of the key actions in modernising nursing.Department of Health (2008) stated that in order to ensure a flexible and competent nursing workforce, it is essential to move the education to all-graduate to recruit and retain the best candidates.
It is emphasized that nurses must possess the managerial skills needed to understand and improve quality of care as well as higher levels of judgement and critical thinking (DH, 2008). Chief Nursing Officer Christine Beasley (DH, 2009) also argued that there are more than ever young people who study for a degree; and nursing can become more attractive profession when offered as an all-graduate.The NNRU (National Nursing Research Unit) diploma cohort studies showed that 25% of nurses graduated with the diploma had begun a degree within three years of qualifying (NNRU, 2007). They also identified that the main motive for further studying was career advancement. Swindells and Wilmott (2003) showed that 86% of directors of nursing staff admitted that a degree was required or advantageous for certain posts in their own trusts. It is also pointed out that all the staff will have rewarding job training and good development opportunities to provide high quality, safe and effective care (DH, 2009).
By September 2013, there will only be degree level pre-registration nursing programmes offered in the UK (DH, 2008). This date was set to allow the universities to change their curriculums and prepare new pre-registration programmes. The NMC (2008) made a number of decisions concerning the future framework for pre-registration nursing education. They decided that, in future, programmes would have a blend of generic learning and learning which is specific to the chosen specialism.
There will also be opportunities for shared learning with other healthcare professions.These will give students a chance to meet the required generic and field competences in a wide range of practice settings. Consequently, adult and children’s nurses will be better equipped when dealing with patients who have mental health problems, while mental health and learning disability nurses will give better care for people with complex physical needs However, it is important to assess the potential impacts that this change might have on the profile of the workforce and the quality of care, identifying not only possible advantages but also the risks it can bring.A global deficit of registered nurses has been well documented in literature and has received wide media coverage (Beres, 2006). Arnold et al.
, (2003), Robinson and Bennett (2007) suggest that some potential candidates for nursing might be deterred from undertaking a degree course. These include people without formal academic qualifications, candidates who have children living at home or those who has been in full time employment (Clinton et al. , 2004).DH (2008) stated that they predict that there will be smaller supply of graduate nurses who will provide leadership and supervision in nursing care delivery and robust number of well prepared health care assistants to provide basic personal care. Unison and Unite said that there was “no compelling evidence” that degrees would improve patient treatment, claiming that the plan [graduate entry] was more about raising the status of nursing.
However, 2008 Nursing Standard’s survey found that students are less likely to leave three-year degree courses than diploma courses.Furthermore, both teaching (1980s) and social work (2003) recruitment numbers increased when transferred to degree entry workforces (General Social Work Education Board, 2008). Social work, allied health professions such as physiotherapy, occupational therapy, ophthalmology, pharmacy, speech and language therapy have all made the transfer to degree entry professions. Improvement in the educational base of nursing will also bring it in parity with other professions.
