Feature

A loan on the wards

Changes in nurse training and education have led to a crisis in recruitment and morale, says John Yorston

Problems in nurse education? As a student steward for the Royal College of Nursing, I could unfortunately talk at great length about the myopia that has plunged the nursing profession into its present educational crisis.

Readers of healthmatters will be no strangers to the gamut of problems the NHS has been facing for years. Although this rightly has a high media profile, the fate of nurse education has been disappointingly under-reported.

To many within and without nursing, it is axiomatic that you need to invest in the youngest members of a profession if that profession is to survive and evolve. Furthermore it would not be contentious to suggest that, as providers of 80 per cent of care, the nursing profession is not a group that should be undervalued. But it would appear that neither view point has been central to government thinking. As far as nursing students are concerned the last government cut and trimmed until our backs were against the wall then watched as we bashed our heads against said wall. So why has this been the case?

At present there are two routes into nursing: a diploma or a degree. Both qualifications follow the European guidelines, the rough philosophy of Project 2000, and lead to registration as a staff nurse. Although the degree and diploma had been taught in universities and nursing colleges respectively, government pressure encouraged the universities to tender bids for local nurse education. This meant that local nursing colleges, with their own specific identity and culture, were swallowed up by large institutions. If the process of integration had been researched and costed properly, then the students wouldn’t be so lost and the nurse lecturers would feel less insecure.

The diploma students receive a non-means tested bursary (approximately £4,000 per annum) whereas degree students apply for student loans to top up a means-tested grant. Neither group enjoys traditional student benefits—long summer holidays and study leave—but must still achieve high academic standards while slogging away on the wards. The result is that the diploma students struggle through to qualification with debts, and the degree students struggle through with huge debts.

The Dearing Report into higher education, which will publish its findings soon, is likely to recommend that the grant system be abolished and replaced with maintenance and tuition loans. Estimated figures suggest that after three years an ordinary degree will burden graduates with debts of £22,000. The diploma bursary is also considered to be under threat.

Those who support student loans state that higher education is a worthwhile investment because it gives students improved job prospects and higher potential earnings. Does this sound like a staff nurse post to you? Of course it doesn’t, which is why there are chronic recruitment problems. Since the 1980s the numbers entering nurse education have fallen by a third, a trend forecast by the RCN and ignored until recently.

Before long we will have a white, middle-class, female nursing workforce caring for an ethnically diverse population; it has taken a century to rid the UK of that anomaly.

The RCN has supported students, and given them the opportunity to determine their own future. As the RCN’s single biggest membership group, the Association of Nursing Students is a powerful group with influence in every area of the organisation. Although it is known as an RCN group, the ANS works tirelessly for all students of nursing.

In the winter of 1995, a number of Scottish nursing students met to discuss some of the difficulties specific to their own area. From that first meeting a national forum was developed that provided a meeting place for students to trade solutions to small problems, and to campaign nationally on issues that affect us all. Unlike many other groups which are little more than talking shops, the RCN Scottish Nursing Student Forum acts. In addition to producing a national newsletter (soon to become a magazine), the students have orchestrated a media campaign, and organised a national conference which will include a cross-party political question time.

The work that has been carried out by the forum is down to the total commitment of a large number of motivated students. The process of establishing and supporting a national group is labour intensive. From Inverness to Ayr, Aberdeen to Edinburgh, students have spent hours photocopying, speaking to other students, dealing with the press and attending meetings; all in addition to struggling through their courses. Why? Because we believe that, like healthcare, education should be free at the point of delivery. We know that change is hard fought, but change must happen if nursing is to survive.

For information on the forum contact John Yorston, School of Nursing, Robert Gordon University, Kepplestone, Aberdeen.