I’ve some fond memories of a group of hospital nurses I knew in the Midlands in the early 1960s but they all needed a string of O-levels to be accepted into training – and recall that O-levels were set for the top 20 to 25% of the ability range. There are hazards ahead from overlooking the fundamental changes in the opportunities open to young women nowadays – more than half undergraduate students at our universities are now women. Sadly, it was never like that when I was a student.

My question was more fundamental – are we so caught up in using the term nurse that we have ignored the possibility that it covers a multiplicity of roles? I do not doubt we need degree-trained nurses, but do they need to provide all the nursing care? I have no particular axe to grind, just floating ideas.

Nurses need university degrees because – as A&E charge nurse has pointed out @19 – “acuity and complexity are far greater compared to admissions of even 20 years ago.” One major cause of this is increasing longevity with our resulting ageing population so that more patients will have developed chronic ailments, perhaps several.

We don’t just need more nursing hands but also more educated, trained and knowledgeable brains to go with the hands as well.

Btw on the claimed need for more Hattie Jacques matrons, the CEO of our local hospital trust is a young woman who started out her career as a trained children’s nurse. She looks nothing remotely like Hattie Jacques. As reported in our local press, she has recently become a single mum with the birth of twins but is now back at work.

Perhaps we need something different than a single class of nurses then? Is the entire current system not working due to competing issues such as these pulling it is different directions. After all, if we asked what does a nurse actually do, would the resultant picture show just one job description, or a variety with hugely varying responsibilities and levels of education. And if the latter (which I am certain is the case) is classing them all as ‘nurse’ not just merely a historical relict which is confusing our ability to discuss the evidence?

Oh, it’s very simple, and has virtually nothing to do with the reincarnation of a
50′s-type Hattie Jacques figure.

Nobody expects a barrister to prosecute 20 cases at the same time.
Nobody expects a surgeon to perform 20 operations simultaneously.

Yet nurses are expected to manage a ward with ratios of 1:20 – it’s so common place that hospital managers expect no difference nowadays;
http://militantmedicalnurse.blogspot.com/2010/02/what-actually-happens-when-we-are.html

Don’t forget nursing is labour intensive (especially for the 25%+ of patients in hospital who are cognitively impaired) while acuity and complexity are far greater compared to admissions of even 20 years ago.

Has there been ANY hospital scandal recently (in the NHS) that did not arrive at the the self-evident conclusion that there were not enough nurses at the coal face?

If you visit acute hospitals – as I often do for healthcare reasons – you’ll find that not only are most of the nurses women, but so are a majority of the technicians and administrative staff too. Around where I live, the CEOs of several hospital trusts and PCTs are women – and I’m not complaining. There are male nurses and technicians, of course, but they are in a minority.

In practical terms, for the most part recruiting trainee nurses means attracting young women away from the many alternative and attractive careers now open through the greater employment opportunities created by higher education when girls are leaving schools with better achievements in the school leaving exams than boys.

The majority of medical school graduates are now women – which rather diminishes all the stuff here about bringing back the old hospital matrons with their nursing qualification. Senior hospital administrators are now quite likely to have a MBA in addition to medical qualifications.

Face the facts.

Failing to make nursing a graduate profession will result in nursing becoming a career option for those who can’t make the standards in the school leaving exams needed for university entrance. In only a few years time, the majority of new GPs and hospital doctors will be women. Nurses will need to be graduates for status reasons.

Mind you, it perhaps dates from the era of matrons. The problem is that a matron was a manager, and to wield that sort of power in a modern system requires also filling in a lot of paperwork etc to show why and how power is being wielded. I doubt titles are a problem – good managers are good managers regardless of title – but rather a culture where managing requires paperwork. Tends to take your eyes off the ball a bit does a pile of forms…

SIR – I would suggest that anyone interested in how hospitals were once run should try to get hold of a copy of Matron of Guy’s, the autobiography of Emily MacManus. She was Matron when I was training at Guy’s during the war. She was a formidable woman and her knowledge of running a hospital efficiently was remarkable.

In those days, nursing was looked on as a vocation. The staff were, in most cases, single women, not juggling home and family commitments with their work. Care and compassion for patients was their main priority.

We can never go back to those days, but I think it does explain the difference in attitudes and efficiency in our hospitals today.

Glennis Leatherdale
Bradford on Avon, Wiltshire

I’m not having it bothways.

What I’m saying is that there are now many more career oppotunities open to young women through higher education routes than there used to be decades ago. Nursing has to compete against all the other opportunities when girls are leaving schools with more and better exam grades than male students.

Unless nursing is made a graduate career, there’s a real risk of recruiting as trainee nurses only or mostly those who can’t make the grades needed for university entrance. And that would be a shame – especially since nursing requires more professional knowledge nowadays as well as the ability to deal with increasing use of technologies.

Btw I’ve a friendly argument going with a highly computer literate personal friend who is almost a decade older than I am. He says that on the basis of his (long and wide) career experience using computers, women are constitutionally averse to handling computers. I say that’s nonsense and that IME women technical advisers in Indian call-centres are often much better than their male colleagues – and my son agrees and he has management experience in India.

Yurrzem @3: I couldn’t agree more about the RCN. One bit that got edited out of this briefer version at LibCon from my original post was:

“Even more perniciously, though, the shift towards degree-based nursing removed nurses from the immediacy of a workforce-based relationship with the nursing trade unions (originally NUPE and COHSE, then combined as UNISON), for whom a key issue in the 1980s had been the maintenance and improvement of ward staffing levels.

The Royal College of Nursing (RCN), which sometimes describes itself as a trade union but is not one in the terms that I understand, became the more ‘normal’ membership organisation for many degree nurses, but has never to the best of my knowledge campaigned for decent staffing levels on wards. Rather, it remains bound up as it is in its own insular world of professionalisation and a pandering to the ‘health elite’, to the extent that I even take great exception to its definition of what nursing is (there’s another full post to be had here when I feel angry enough about the RCN’s betrayal).”

This was challenged in the comments by the RCN press office (see http://thoughcowardsflinch.com/2010/03/03/labours-manifesto-the-need-to-commit-to-nursing/#comment-5630). Fair enough, that’s as you’d expect them to do, and as a courtesy I added the note to the bottom of this piece, as recognition that staffing levels are at least on their agenda. It’ll be interesting to see who has the biggest impact on Labour’s manifeso – this tiny piece of mine or the ‘campaign’ of a 400,000 member organisation.

Apologies to all others – got to go out now and help get elected a Labour government who may put this commitment in its manifesto – more replies later but thanks in advance for v good engagement.

The trouble with your analysis is that it has absolutely no regard for the much wider range of career options open to young women nowadays when more than half the students taking undergraduate degrees are women:

“Women students outnumber men across the board”
http://www.timesonline.co.uk/tol/news/uk/article1074003.ece

Decades back, the London teaching hospitals could demand and get A-levels as entry requirements from applicants for nurse training places.

Nursing was a hugely respectable and hugely respected career option for young women but times have moved on and young women now have many alternative challenging and interesting education opportunities and career options open to them. If there are no higher education opportunities to qualify for a nursing qualification, why would any bright young woman opt to choose nursing as a career? Besides, a degree provides greater job flexibility later on.

Let’s be honest very little will ever change as long as the movers and shakers remain far, far away from the reality of the patient’s situation.

At the very least any new policies should be withheld until it can detail specific time, cost and training implications for staff on the ground (none ever do, of course).

The DoH is like a gargantuan life support machine pumping out a steady stream of gibberish designed to irritate front line workers who have barely had time to digest the telephone book issued just 5 minutes ago.

As Bob B [5] succinctly points out – lessons will NOT be learnt.

The customary cliche surely applies: Lessons will be drawn. Mind you, some of us have been warning for years about the way targets distort resource allocations and the recurring failure of the NHS hierarchy to learn from Soviet experience reported as far back as the early 1960s – see the late Alec Nove’s book: The Soviet Economy. One of our problems has been a succession of ignorant and stupid health ministers, starting with Frank Dobson.

How about surcharging Patricia Hewitt for the fiasco of that £12.4bn programme to create a national database of personal medical records – despite numerous warnings from healthcare professionals about the risk to patient confidentiality and from IT people about technical issues?

Government regulation regarding patient / nurse ratios can always be pushed upwards just as they have by management chasing “efficiency”. It started under Thatcher but New Labour’s extra funding largely went on increased wages (justifiably), consultants and management (questionable) and poorly negotiated contracts with GPs and consultants. The creeping privatisation of the health service pours millions of public money into PFIs and ISTCs as well as the extra admin for privatisation-ready bitesize PCTs, polyclinics etc.

Perhaps exposing the facts to public scrutiny would be the best way to prevent this happening again, but with the half-witted nature of our media I have little hope of it happening.

He doesn’t mention Thatcher anywhere, he simply states that union power has dissolved since the 1980s. Why do you keep bringing up this agenda where it’s not relevant?