The trojan horse of nurse education

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Since the mid 1990s nurse education in the United Kingdom (UK) has been wholly located within the higher education sector. This move completed what began in the late 1980s with the closure of traditional, hospital based, schools of nursing and their merger across several hospitals, into colleges of nursing. The move into higher education took place because there was evidence that those nurses already educated in the higher education sector were good value for money. Nursing had long been exhorted to develop its own research base and it was felt that exposure to the higher education sector proper – where teaching and research went hand in hand – would be sufficient stimulus to effect this on a wide scale. Therefore, in the past decade many UK universities old, established and new have found an income stream from the education of thousands of nurses and, in this process, many hundreds of staff formerly employed in the colleges of nursing have been grafted in to the UK university system.

There has been an element of duplicity in all of this which has barely been mentioned due to the fact that, while all UK pre-registration nurses are now university educated, few nurses receive degrees: the vast majority of nurses continue to receive diplomas and only 10% receive degrees. In fact, these are the same 10% who received degrees prior to the wholesale incorporation of nurse education into higher education and they receive these degrees from universities such as Edinburgh, Hull and Manchester, amongst others, which pioneered graduate nurse education. The cry is often heard that university educated nurses cannot care for patients and that this lies at the heart of the present malaise in the NHS. This is not only demonstrably not true it is a non-sequitor because there are barely enough university educated nurses, in the proper sense, working in the NHS to make a difference. However, despite the mistaken impression of how nurses are currently educated, the changes which have been brought about in nurse education pale into insignificance compared with the changes which have been brought about in universities as a result of their incorporation of nurse education on a large scale.

Many universities which once knew better are now talking a language they barely understood five years ago including such concepts as ‘widening the entry gates’ in order to make up the numbers and accreditation of prior learning or even of ‘experiential’ learning to circumvent traditional educational qualifications. Another aspect of the changes was the intake of staff, often by the 100, who had no capacity for research largely because, while they had considerable expertise in nurse education and training, they had no interest in research. Indeed, many were hostile. There is little evidence that being in universities has significantly changed these former nurse tutors. However, the universities have had to change on a massive scale in order, first, to incorporate them and secondly to continue employing them in a UK climate where research competitiveness is all important. Is it possible to imagine a conventional department in any university employing hundreds of people not active in research and, years later when they are still not research active, seeking to retain them in the present climate? Yet this is precisely what is taking place in many UK universities which now have nursing departments which are formed by the incorporation of former colleges of nursing into established academic departments of nursing.

The problem is compounded by an explosion in the number of chairs in nursing which now exist in higher education. The earliest chairs in nursing in the UK in the late 1960s and early 1970s, at Edinburgh, Manchester and Hull, for example, were not filled by researchers. This reflected the poorly developed state of UK academic nursing at the time. However, nursing grew as an academic discipline, more nurses graduated with higher degrees and doctorates and research became more accepted. Professors of Nursing, as in other disciplines were expected to be researchers. Now the tide seems to be turning back to the situation in the late 1960s and early 1970s. Many recently appointed professors are not professors in the traditional sense: they have little or no research record, few publications and little to profess about. They have been given chairs because they were in the right place at the right time. In addition, another breed of senior staff has been grafted into several universities to help run the show. These people are not academics but have been employed for their management skills, usually at salaries which would make many academics blush. In the meantime genuine academics, including those nursing professors who were honed and nurtured in the traditional academic environment are being marginalised – especially if their views do not accord with the NHS management ethos which now prevails, due to the way in which nurse education is financed.

In addition, we are hampered by the continued reference to ‘nursing research’. Nursing research is an entity, the definitions of which include: research into nursing and research done by nurses, with several variations incorporating elements of both. That seems reasonably simple but the above also describe situations which many would not consider to be nursing research such as: research into nursing by non-nurses and research (or data collection) done by nurses, but not into nursing. Both of these situations describe research governed by other disciplines such as psychology and medicine.

The extent to which any of this matters will, naturally, depend upon the perspective from which it is viewed. However, nursing research seems to have currency: there are books and journals on nursing research, bodies described as nursing research units and individuals who are styled professors of nursing research. Without any intentional insult or injury to any of the last group it is a fact often acknowledged that, while there are specific research bodies with discipline specific prefixes (e.g. Medical Research Council), there appear to be no professors of any other kind of research. In this respect, professors of nursing research are unique.

We are not concerned with the existence per se, of professors of nursing research; on balance we are glad that they are around. Nevertheless, we question what this tells us about our profession – nursing – and what signals it sends out to other disciplines.

One message that comes across is that there are professors in (or of) nursing who are not engaged in research. This, sadly, is the case: some gain the title of professor, in nursing, without any track record of research (indeed, in some instances and in all fairness, the title-holders do not attempt to hide this); some gain the title in an honorary capacity – usually with little merit and for reasons of personal aggrandizement – under the same arrangement and proceed to abuse the title (which should only be used in connection with the business of the institution which awarded it and by the institution which awarded it). Others, still, gain the title based on a research record and then proceed to do no research – the title appears to have been the goal. We contend that while other disciplines are not perfect, the situation described above is far less common outside of nursing.

The other message that comes across is that only professors of nursing research do nursing research. Thankfully this is not the case but it could (and does) lead colleagues from other disciplines to question the average professor of nursing, given the existence of professors of nursing research, and to ask what kind of professors the rest are.

Our point is that the use of the title professor of nursing and the existence of an entity such as nursing research, suggests a discipline or profession immature or not at ease with the concept of research. If we were at ease with the concept then it would not have to be boxed away and labelled. When someone was described as a professor of nursing it would be assumed that they were actively engaged in research and when a person was described as a nurse then it would be assumed that they were part of a research based profession. However, we are very far from that situation.

In fact, there is still considerable hostility to research in nursing, the education of nurses in university and the development of nurses in a research-based profession. Turning the clock back, while many would like to do it, to having nurse education located again in the NHS is out of the question. However, if universities, the government and the NHS are honest, we are not currently offering the majority of people who wish to be nurses a proper university education nor are we offering them a proper university experience. There are widespread complaints about nursing students not being properly integrated into university life – often because the places where they receive their education are not on university premises. We are offering nothing more to the vast majority of nursing students than further education with the appropriate diploma level award at the end. In the meantime UK universities are being side tracked into taking students who are not suited to study at university and at the end of this education the award of a qualification not normally associated with university education. We even have to administer elaborate entry schemes which are the direct result of widening the entry gates – which have lowered the level at which many people gain entry to university. The solution is obvious: shift the major portion of nurse education out of universities and into the further, non-university, education sector where it belongs. Leave the universities to pursue graduate education, including graduate nurse education and research, freeing the universities and their professors of nursing to pursue excellence across the board.