Why do we need nurse education?
There have been a number of high profile accounts highlighting where standards of nursing care have been found seriously wanting. Safeguarding high-quality nursing care requires nurses who have the skills and knowledge to deliver care which is based on the best available evidence and which is also compassionate and caring. Therefore, high-quality pre-registration nurse education plays a crucial role in ensuring patients and their families receive this high-quality nursing care. And once qualified, nurses need to be supported in their new role and continue to receive education and development throughout their careers in order to further their knowledge and skills.
A short history of the changes in nurse education
The way in which nurses are educated has changed significantly over the past two decades, in response to advances in science and medicine and the increasing complexity of contemporary health services. Prior to the 1990s, nurse education was located in hospital Schools of Nursing and student nurses learned ‘on the job’ being taught by qualified nurses and more senior students. This is often referred to as the ‘apprenticeship’ model of nurse education. In the mid-1990s, this education became more academically rigorous as nurse education moved into universities and a Diploma of Higher Education became the minimum educational achievement to become a qualified nurse. Although there had been a number of universities delivering degrees in nursing since the mid-1960s, this number gradually increased during the 1990s and early 20th Century. The decision for nursing to become an all-graduate profession came in 2010 with the publication of new pre-registration nurse education standards by the Nursing and Midwifery Council (NMC), nursing’s regulatory body. From September 2013, all pre-registration nurse education now has to be at a minimum of a degree and universities have to meet requirements set out by the NMC for both initial and on-going approval.
So what does this nurse education look like?
Over the three-year degree programme, student nurses undertake a minimum of 4,600 hours of learning, equally divided between practice and university settings and have to achieve competency standards set by the NMC. Following successful completion of their degree they become qualified nurses, enter the nursing register and become personally accountable for the actions and omissions in their practice and must always be able to justify the decisions they make.
Transition to registered practice
While they are student nurses, they receive support from university lecturers and mentors in practice but, once qualified, this support is no longer present. So making the adjustment from being a student nurse to a qualified nurse can feel quite daunting, and there has been quite a lot of research done to explore these first, often stressful, experiences of becoming a registered nurse.
The most stressful issues appear to be the increased responsibility and accountability they face; fear of failure; unrealistic expectations from other staff; and nurses’ own perceptions of their lack of clinical skills. In short, the evidence suggests that some newly qualified nurses can feel unprepared for their role. Over the first three-to-six months following qualification however, this feeling decreases as their confidence grows.
One way to provide support to newly qualified nurses in their new role is by a system of experienced mentorship – called preceptorship – whereby new registered nurses receive structured support from a named experienced nurse for up to a year following qualification. Research on preceptorship shows it can be of tremendous benefit in helping newly qualified nurses feel more prepared for their role. Further, preceptorship may lower staff turnover rate, enhance the quality of patient care and reduce medication errors as shown by the study conducted by Tso-Ying Lee and colleagues in 2009. It seems self-evident that preceptorship has an important role in supporting the transition to registered practice (see further reading list below for more information). However, evidence from the Royal College of Nursing in the form of the Report of the Willis Commission on Nursing Education indicates that pressures in the clinical environment can often mean that preceptorship is not provided as systematically as it should be.
The heart of the NHS
Over the course of the 21st Century, the demands on the health service are going to become ever more challenging as the population continues to age and more people are living with long-term conditions. It will be increasingly important that patients and their families receive the right care, in the right place, at the right time. To ensure these high standards of care, it is paramount that the right people are recruited into nursing. Once selected, they must then receive high-quality education and support so that they are equipped with the knowledge and skills to be able to deliver safe, compassionate and evidence-based care. If we value the NHS and its mission to provide free and high-quality care, we need to value and support those who work at the centre of its service.
- Lee, T-Y., Tzeng, W-C., Lin, C-H. and Yeh, M-L. (2009) 'Effects of a preceptorship programme on turnover rate, cost, quality and professional development', Journal of Clinical Nursing, 18 (8), pp.1217-1225.
- NMC (2008) The code: Standards of conduct, performance and ethics for nurses and midwives, Nursing and Midwifery Council, London.
- NMC (2010) Standards for pre-registration nursing education, Nursing and Midwifery Council, London.
- RCN (2012) Quality with Compassion. The Future of nursing education. Report of the Willis Commission on Nursing Education, Royal College of Nursing, London.
- Robinson, S. and Griffiths, P. (2009) Scoping review. Preceptorship for newly qualified nurses: impacts, facilitators and constraints, National Nursing Research Unit, King’s College London, London.