As more of us are funnelled into uni than ever before, it feels you can – and often need to – get a degree in almost anything. Brewing and Distilling? You could get a BSc in this – with honours. Taylor Swift? You can study her at none other than Harvard. Speaking of Taylor, Folklore Studies also exists. But nursing? Now deemed necessary. Careers that were traditionally taught on the job have been brought into this push for qualifications. But with applicants and retention rates to nursing courses reaching new lows, people could be missing out on their career, while we are missing out on their support. How long can we keep prioritising degree practice over patients before it really is critical?
Exhausting shift patterns, high rates of burnout and an almost offensive salary are not motivating factors for many to study at uni. But for nursing students, an affinity for care seems to outweigh the many harsh realities of the profession, and in some cases, the degree. Being expected to work and study while some of your mates have about five contact hours a week, the stresses of a nursing degree can easily become too much.
This resonated with Maddie Whitehorn, 25, who began studying nursing at Kingston University in 2021, after working in care settings from the age of 17. “Being on the ward for 12 hours at a time, not always having a clear routine and spending hours in the library was mentally and physically draining for me. I would go days, sometimes weeks without seeing my friends. Night shifts made it hard to communicate with people outside of the particular placement I would be on,” she says. “The patients were always so lovely, but I could still feel really lonely.”
Despite her previous experience in healthcare settings, physical, personal and financial struggles did not pair well with such an intense course. Suffering with chronic migraines, stress and facing funding complications after deferring some of her studies for her health, Maddie never graduated. “I was eight weeks from qualifying and I’m gutted I couldn’t as I do believe nursing is my calling. I gave up everything to finish and it still wasn’t enough. I had to draw a line for my own headspace.”
So here’s the diagnosis: since 2010, anyone wanting to be a registered nurse in England has needed to complete a higher education programme of study. While some degree apprenticeships are available, the majority of nurses qualify through a traditional university route. Half of the degree is currently structured around academia, while placement hours across different healthcare settings cram the rest of the busy schedule. Dr Owena Simpson is one of the UK Heads of Education at the Royal College of Nursing (RCN), and is strongly in favour of nursing degrees. “The skills that you learn from doing a degree are around critical thinking and being able to analyse. We’re a profession in our own right, and we have to make clinical decisions, so we have to have the knowledge, the experience, the ability to critique and question. That comes with being educated,” she says. “Having a degree is absolutely essential to meet the needs of the role.”
But many of the qualities needed in nursing, like care and compassion, are honed through experience, not essays. Dr Simpson says: “My gut feeling is that these values are almost innate. You can learn skills, but you can’t learn to be nice. That is in you.” These attributes led to Kirsty Light’s passion for nursing. But after leaving school without any qualifications, Kirsty knew she would have to retrain to do this. Completing an access course alongside her English and Maths GCSEs, at the age of 37, the newly single mum of five studied nursing at the University of Surrey. “I think if you had a really good placement, the practice would work really well. One of my placements was in Outpatients and I felt like I was basically in an admin job. I spent my time getting files together. One good thing about Outpatients however was the experience I got from being around consultants. I learnt a lot from their expertise, so I think for a teaching placement it was good, but for practical skills it was really poor,” she says. “There was a lot of support with essays and exams, but I still definitely learnt most of my skills through my placement.”
One of the justifications for sending nurses to uni is the upskilling of the role. Dr Gill Coverdale, another UK Head of Education at the RCN, says: “The care has been delegated down, so things that doctors did, nurses now do. This requires assurances and confidence that those people are prepared educationally to be able to do that safely. You cannot practice as a student nurse and not have the academic background, and you couldn’t be academically brilliant but be hopeless in practice. Nurses have to make decisions in a finite amount of time that can save somebody’s life or not. To be able to prioritise all of that care and delegate, you need a degree.”
So if nurses are doing what doctors used to, shouldn’t they be getting the same pay? Without them, it would be terminal for our healthcare system. Dr Coverdale says: “The demographic of patients we see has changed hugely. People are sicker than they were before. We are not handmaidens anymore. You will be an independent caregiver, and you have your own accountability and responsibility. Any other profession within healthcare is a graduate profession. Why should the biggest group of professional caregivers not have a degree to do their jobs?”
The real value of a nurse comes from seeing patients. Speaking of value, let’s talk money. Kirsty was given a full bursary when studying, so did not pay any fees. She says: “There were some other courses available without the focus on uni, like an associate practitioner course, but that would have left me on a band four income, which was not feasible for me and my family. I had no other option but to go to uni. I was so lucky to do the course when I did with the financial aid, because there is no way I would have been able to do it without that. They should at least reduce the fees for nursing students if they are going to send them to uni, if not make it free, because you are working. Regardless of what they say, it is free labour. I definitely think apprenticeships would now be a better route, especially with how desperate we are for nurses.”
As of September 2020, eligible nursing students have been entitled to at least £5,000 each year to go towards their studies through an NHS bursary. But this barely scratches the surface. Maddie had a part time job alongside uni to afford to live in London, around 170 miles away from her family home. Managing placements with the required academic knowledge regularly put Maddie under more strain. “I did really enjoy the academic side of the degree and you needed to have placements to really apply this and see everything you were learning in action,” she says. “Some assignments were difficult but necessary, like exploring theories of care or medications. At one stage, I had a placement full of night shifts and three assignments due all within a week. I passed them all but this was really difficult to juggle.”
The degree structure clearly has flaws, and even industry professionals have acknowledged this. Dr Simpson says: “Feeling burnt out and undervalued on placement can definitely be seen as a problem. There are large numbers of students on placement, and they need to feel like they belong, like they are looked after, that they have a mentor. It can be difficult for the student if they don’t feel they’re getting the attention or support they require.”
So is it finally time to reassess how we treat nurses? A full review of the practice learning environment for student nurses is currently being conducted by the Nursing and Midwifery Council (NMC). Their role is to regulate, set standards and quality assurance of education programmes for nurses and midwives in the UK. Anne Trotter, Assistant Director of Education and Standards at the NMC, and a registered nurse for more than 40 years, says: “It’s important that universities and their practice partners continue to champion nursing as a rewarding profession that plays a vital role in health and social care delivery. Nurses and nursing associates are lifelines to communities across the UK, often providing frontline care. Their commitment, compassion, and expertise make a significant difference in people’s lives every day, and students should feel this sense of purpose throughout their education.”
Her negative uni experience has not completely discouraged Maddie from qualifying. “I would still love to be a nurse, but I would have to look at other options,” she says. “An apprenticeship would probably work better for me if I could manage my time while earning. But I still don’t feel ready to go back yet.”
Admittedly, the degree has its strengths. With the role of a nurse becoming even more vital – both in terms of their responsibilities and our needs as a society – a well educated workforce is obviously needed. But with our hospitals crumbling (literally) and waiting lists feeling longer than the degree, other options to qualify as a nurse must be championed. It’s not just nurses who are getting burnt out – it’s the entire healthcare system. But it’s not rocket science – stop sending our nurses to uni.
