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Fancy nursing? Better pass those A levels quickly! ...

(20 Posts)
Draylon Sat 18-Mar-17 17:32:51

EU nurses quit in record numbers?

My fear is that even if the UK can persuade enough non-bursaried people to train as nurses, there'll be rather a few 'lean' years in the NHS!

twofingerstoEverything Sat 18-Mar-17 18:27:03

Applications to nursing degree courses down 27% this year because of withdrawal of bursaries.
This government doesn't do joined-up thinking, does it? NHS on its knees? Let's cut bursaries and deter foreign nurses!

I'm seriously worried about the NHS.

taytopotato Sat 18-Mar-17 19:22:38

They will be replaced by Nursing associates aka state enrolled nurses

Plus, the NHS has historically recruited nurses and doctors from abroad.

Draylon Sat 18-Mar-17 20:18:00

OK, so Registered nursing positions are being filled with nursing associates? Is that right?

Do we all think The Public is aware of this?

Peregrina Sat 18-Mar-17 20:26:46

I notice that Hull are offering posts to Filipino nurses - once they have cleared the visa process. Meanwhile, nurses from nearby countries, who don't need visas are being made to feel unwelcome in the UK. Madness.

On the other hand, if the scheme does allow people who don't have A levels a way into nursing, via a foundation degree and a salary, it is not necessarily a bad thing.

Draylon Sat 18-Mar-17 21:03:50

Peregrina- we usually agree, but on this we must disagree, re: nursing.

What is 'a nurse'?

"a person trained to care for the sick or infirm, especially in a hospital"
"a person formally educated and trained in the care of the sick or infirm".
"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations."

Drawn from the first reasonably succinct responses on Google.

For the record, Filipina nurses who meet RCN standards, have been employed in the NHS for decades. (Unfortunately for the Philippine population, but, hey!)

'If the scheme does allow people who don't have A levels a way into nursing, via a foundation degree and a salary, it is not necessarily a bad thing'. YOU define what you mean by 'nursing'.

You seem to treat 'A' levels like an option. Like 'Oh, for me, it was a plastering apprenticeship or 3 solid 'A' levels; on balance, weighing up the options, I chose plastering'. (no offence to plasterers. You try getting a good one and be prepared to pay them appropriately! grin)

For some capable people, circumstances drove them to the 'plastering' direction, not academia; but for most, academic inability drove them away from '3 solid A levels' into Tech/vocational futures.

'via a Foundation degree'. Foundation degrees are offered as a step where a person has failed to meet the minimum A level requirements for a course. They come post 'A level', pre-full degree. You need A levels, albeit 'very poor results' to be admitted into a nursing 'Foundation degree'. At the moment.

Be careful what you wish for.

To be paid appropriately as 'professionals', nurses, like other HCPs. suddenly had to move away from 'in house' qualifications, like Auxiliary Nurse (Band 2?); State Enrolled Nurse (Band 3-4) To State Registered Nurse (Band 5+).

You, joe public, wanted this. Nursing (and all the other in-house HCP professions) recognised the need to go 'everyone to uni!'. So off they went. A levels ahoy. In order to be recognised, and much more importantly, PAID as 'professionals'.

This 'non-uni' approach looks great to everyone who feels 'nurses think they're too important to wipe bottoms'. BUT once you start offering a base pay of Band 4, guess what? Those academically cleverer people will go 'Sod that'. And you'll be bitching on MN why no one noticed that DD had gone into arrhythmia?

Registered Nursing, degree holding nursing, is difficult. You carry a huge weight of responsibility on your shoulders. You can be the only HCP degree holder on that ward, tonight. You may look, unless everything is, predictably these days chaos- calm above water. You assess your patient. You notice changes; more laboured breathing- how much has she drunk? Let's look at her obs. Hmm. Don't like this. ACT.

The enrolled nurse of that past might've gone 'Nurse!' *(meaning 'RN nurse'), 'could you have a look at this?'-... so RN nurse will calmly walk up, assess calmly, Act. Because underneath the water, she's been assessing, monitoring, comparing this experience to another experience, and decided how to act,

What will your 5 GCSE and foundation 'degree' nurse make of it?

FTR I am not a nurse.

Peregrina Sat 18-Mar-17 23:30:30

Draylon, I said what I did because I have a relative who I believe could make a good nurse. She left school with few qualifications, but has developed since. Giving up a job to get A levels and then 3 years away doing a degree isn't really an option for her, in her circumstances - she lives a long way from any universities or teaching hospitals - but I think if there was an on the job apprenticeship scheme, properly funded and thought through, it could work for her. The key I think, is the properly funded and a clear career path.

The problem as I see it, is that this is just a way of doing things on the cheap. It's only relatively recently that we have got rid of Enrolled Nurses, and now we are turning the clock back. But hey, we are just the plebs, so we don't matter.

Draylon Sun 19-Mar-17 00:43:41

Yes, I agree with you, peregrina, but I'd add 'being qualified to access the course'. Do they have A level equivalent qualifications? Genuinely, seriously. You've told us not.

So, imo opinion, she'd need to to equivalent access courses for A levels, before thinking 'nursing'

There are many caring, lovely people out there who we might think would be 'great nurses'; but can they read The Bigger picture? The laboured breathing? The drop in blood pressure? The unexpected temperature spike? The potassium overload? The egfr compromise? Hb what? Jesus, that isn't right! etc

You're going 'Whaaa?' right now.

But that's what distinguishes 'a nurse' from a bottom washer. The NHS needs both. But please don't think one, with a 6 months' tech course, can be the other.

Caveat: I am not a nurse.

Floralnomad Sun 19-Mar-17 01:06:27

Can I just point out out there are lots of nurses still working who do not have a degree but the old RGN qualification , pre nurses being trained in universities and that most of them are just as capable of assessing patients / managing wards / knowing what blood results mean etc ,as the nurses who have degrees . IMO too many nurses with degrees are not prepared to be 'bottom washers ' and that is an issue , because however much responsibility a nurse now has in a modern NHS , they still need to be able to do basic care for patients - the clue is in the name .

BBCHypocrits Sun 19-Mar-17 06:26:07


Peregrina Sun 19-Mar-17 08:06:19

I do partly agree with Floralnomad - I didn't say a six month tech course - I talked about a proper apprenticiship, so I was thinking more in terms of at least 3 years for the qualification like the old SRN/RGN, but probably more like 5 if done on a part time basis.

whatwouldrondo Sun 19-Mar-17 08:32:04

I know quite a few degree level qualified nurses now living in Australia. It is not because they were not prepared to wipe bottoms. It was because they felt that they could no longer care for their patients adequately and safely. As an example as a newly qualified nurse having the care of five critically ill babies was stressful but everyone mucked in when there was an emergency or procedure that needed more hands. However five years later being asked to care for ten critically ill babies with only the help of an unqualified assistant meant knowing that inevitably a baby would die as a result of not having enough knowledgable nurses available to cope with a crisis. In Australia the ratio is one nurse to each critically ill baby, regarded as a sacrosanct because of the infection control risk.......

Draylon Wed 22-Mar-17 20:48:25

Floral "Can I just point out out there are lots of nurses still working who do not have a degree but the old RGN qualification , pre nurses being trained in universities and that most of them are just as capable of assessing patients / managing wards / knowing what blood results mean etc ,as the nurses who have degrees.."

With respect, no you can't grin.

The people who accessed RN level course had A levels. What they studied was what would be measured by today's standards, 'degree level'- as in you can now get a degree with rather lower a less enhanced level of academic attainment.

'Degrees', back in the RN time, were more or less purely academic, as there were Polytechnics, Further Education Colleges, Teacher Training Institutes etc . If you were going to uni, it was for 'Physics', 'Geography', 'Politics', 'English'. Not necessarily 'civil engineering'/'environmental science'/' teacher training'. Those people went to other colleges, many of which turned out graduates with very similar levels of social acceptability, and pay, as the universities of the time.

But the Public Mood changed (or was swayed for them). Suddenly, anything less than a degree was considered worthless, thus practically all of those professional areas of study became degree subjects. So that those graduates would be considered 'professionals'. New definition of 'professional'? Thus nursing, most HCP, teaching, engineering etc etc became degree courses. Some to their benefit, some less so.

Do not, for a second, think I am stating that 'degree nurses are better than RNs'. Because my initial qualification is a Diploma in an HCP subject, gained, post 'A' level and a 2 year in 1983 (but after a 120 week course, over 2.25 years... as opposed to a 105 week course for a modern 3 year degree...).

I do have a degree (upgrade), more or less forced on me because Australia fell for the Degree Myth before the UK did.

I am not attacking non-degree qualified professionals who qualified back when' words like 'Diploma/HCD/HND/RN/City and Guilds' and so forth meant qualified and competent.

Peregrina Wed 22-Mar-17 22:18:32

I do have a degree (upgrade), more or less forced on me because Australia fell for the Degree Myth before the UK did.

I think it's a good question for a lot of professions to ask as to whether going down the degree route was necessarily the best one or whether a rigorous apprenticeship model would have worked better. It's not comparable but some large accountancy firms are now going back to taking on A level students and putting them through training contracts of a few years (5?).

The problem with the Govt plans is that they are trying to do it all on the cheap. Which is not acceptable.

Draylon Mon 27-Mar-17 21:22:23

Peregrina I can answer that one:

It really depends what we mean by 'degree' and 'apprenticeship'. We all have 'a thing' in our mind's eye. So you'd need to define 'degree route', and 'apprenticeship route', in your mind's eye.

I turned 18 in 1980. Back then, very few people did a degree. Alternatives, post A level, included Diplomas, Certificates, HNDs, professional qualifications (like in accountancy, banking and engineering).

Apprenticeships were vocational, for plumbers, bricklayers and all those other jobs we need people to do with some skill. You did them post-16.

However, over many decades, the British public (as opposed to, say, the German one...) were taught to disdain any job, (now henceforth to be known as a 'profession'), that didn't have 'a degree' as its entry point, and, furthermore, that had to be taken at a university, not a polytechnic, let alone a College of Further Education or Teacher Training College!

So, what to do? How about making all post A level entry courses degrees, and all institutes providing them, unis? Few objected when suddenly they had a DC who was (gasp) going to uni, first in the family! Etc. Especially before it cost £30,000. Min.

Now, why was that 'necessary'? Because The Public wanted to believe that somehow its teachers and its nurses, to name two were top-of-their-game. And, calling a spade a spade, you needed to be in a degree-qualification job in order for it to be classified as a profession and get paid accordingly.

I have first hand experience of this: (in Oz). We underwent an Agenda For Change process before the NHS came up with it, called Job Redesign in Qld (don't we all love the fudging? Change? Redesign? How about 'Pay you less?')...

Whilst radiographers, physios, music therapists all had degrees, by this stage, initially radiographers were denied 'professional' status (and commensurate pay banding ) because 'they cover 24/7 duties, like a piece-rate factory worker does, therefore they're not professionals' .. radiographers fought, and swiftly won, but that was the thinking.

Also, the reality is, modern nurses need to know far more than was needed 30 years ago. Radiographers, today, have had to have delved far more into psychology, drug prescribing, image interpretation, the politics of ageing, the sociology of different service users, research etc etc than was ever required, 30 years ago, when we effectively were 'apprenticeship trained'. They need to know far more as the HCP professions have evolved exponentially to increasingly fill the gap left by fewer junior doctors. HCPs are cheaper in the long run.

I'd like to add 'Don't be fooled' by thinking 'Why does that nurse need to know about this and that drug reaction?' (they do, their professional registration relies on it!). 'Why is that radiographer questioning the suitability of the imaging my GP has 'ordered'?' (Because that radiographer has a greater knowledge of what is most likely, in the most non-invasive way, diagnose your problem. You'd be shocked at how many GPs send patients with programmable heart-valves to us for MRI, even today...).

The government, as you rightly guess, is appealing to its late middle aged heartland, that of barrow boys and left-school-at-15-got-an-apprenticeship (and look how well I've done, clever me, as the house I bought in 1970 for £5000 is now worth £500,000...) -brigade by labelling cut-price, lesser qualified HCP training as 'apprenticeships'. You can bet your rear end it won't be 'rigorous'. That comes from being taught from primary sources by well-qualified teachers, then passing proper national exams; not a bunch of 'assessments', conducted by last year's graduates.

Peregrina Mon 27-Mar-17 21:59:23

You can bet your rear end it won't be 'rigorous'.
I can certainly agree with that. It's annoying that when the have finally got rid of the SEN qualification, they want to bring something worse in, instead.

(BTW the old apprenticeships used to be a at two levels - 'craft' apprenticeships and ones which were more degree equivalent.)

Draylon Mon 27-Mar-17 22:47:55

Peregrina - I see we're on the same page, but which 'Old Apprenticeships' were considered the equivalent of a degree?

Regarding nursing (the OP!):

Auxilliary nurse (CSE entry, not 'no qualification' entry)
SEN ('O' level entry)
SRN ('A' level entry')

Now we have :
A) HCA (health care assistant)- who is whatever that Trust deems them to be. Many have no formal qualifications at all, apart from really basic maths and English (as in 'functional English for NES people). Many have no further formal, recorded training. They are paid Band 2, possibly 3 with additional skills.

I have no issue with this, hospitals/care homes need HCAs. But imo they should be given formal NVQ training, maybe level 2, if not 3. They are our Auxilliary/low SEN nurse.

I also think there should be a SEN level, maybe your '5 good GCSEs inc Maths and English'. This is where you might sell 'Apprentice nursing' to me. And where I can see 'entry-progression' from the 'HCA with NVQ level 3 plus two years experience' being wholly acceptable.

Band 4?

B) Then there need to be solid A level entry, degree-qualified, academic nurses. Should we call them SRNs?... Band 5, rapid progression to Band 6. This should be accessible to what I've called 'SEN', but with x years documented experience, and extra skills.

Note: the documentation needs to be properly externally scrutinised. Too much is being assessed by 'last year's graduates'. Too many 'external providers' are 'passing' people who really don't make the grade, as there is no incentive not to; every incentive to. Especially when you have a government desperate to keep a lid on NHS salaries.

Peregrina Tue 28-Mar-17 02:32:18

Which apprenticeships 'degree equivalent'? This is going back a long time, but BIL (now in his seventies), did an engineering apprenticeship which seemed to enjoy the same prestige, and not many years later new recruits in his field were graduates. A level maths or equivalent required - so definitely not a push over in terms of an entry qualification. (Unless I completely mis remember!)

Draylon Tue 28-Mar-17 19:53:30

TBF, Peregrina, when your BIL was doing this post-18 'apprenticeship', that would be in around 1960, when only the very clever (GS 'scholarships') and well connected (Old boys at top public schools) got anywhere near a uni, and that those degrees opened doors effortlessly, even 'thirds' in the case of Oxbridge!

We really would have had to have 'been there' to see if his qualification was held in the same regard as a -ahem- 'proper' degree!

Interestingly, my DF, who went to GS in 1945, gained many engineering qualifications over many years, rising to a chief engineer of Plessey R&D by the time of his (well remunerated, early!) -retirement used to say, throughout his working life, that he regretted doing his National Service instead of taking up his degree place, aged 18, but feeling 'too old' at 20 to do so. So he never did.

He felt that lack of degree hindered him all through his career.

Peregrina Tue 28-Mar-17 21:00:17

BIL did get to GS. As far as I recall, in his field, his apprenticeship was considered just as good as a 'proper' degree. It depends what you mean by degree - solid experience of engineering work was much better than a degree in say Physics or Maths, because that lacked the practical element. I am not sure how many 'sandwich' degrees were available - they were definitely considered better than straight degrees. I don't think he has regretted not getting a degree. Alternatively my Grandfather, a civil engineer did begin to regret it towards the end of his career.

However, that was then, and basically we are agreed that the current silly games that the Government is playing is just not the way to go about staffing a health service.

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