Last December, I attended the graduation of occupational health (OH) nurses and technicians who completed the Diploma in Occupational Health from the University of Glamorgan. Proudly donning their caps and gowns, their hard work was rewarded. It is disappointing that this level of study is not recognised by the nursing regulatory body, the Nursing and Midwifery Council (NMC), but not surprising, given the move towards an all-graduate nursing profession (Wales already is) to be on a par with other disciplines such as paramedics, occupational therapy and physiotherapy.
While there is a need for a level of underpinning theoretical knowledge to deal with the complex nursing issues faced today, are we in danger of devaluing vocational type training, and moving it into the realms of a forgotten era, when in it did in fact produce highly skilled, capable practical practitioners?
Pre-registered nurses tell me they want less theory and more practical placements, and post-registration nurses moving into other disciplines want the same practical structure. They want education that prepares them for the rigours of ‘doing the job’, and a clear post-qualification framework dependant on the route they wish to take. They also want a pathway leading to a higher level of education once they have mastered the basics and wish to further their career. I am not wholly convinced that we have the balance right, and believe that it has swung too far towards academia.
To illustrate the point, we have fast-track schemes into nursing (for those already holding a degree) enabling students to exit with a postgraduate diploma leading to regulation with the NMC, after 18 months. On them will be placed an expectation that they will be capable and competent enough to provide a high standard of nursing care, when the reality may be very different.
If we are not careful, the result will be an academic workforce, with limited practical skills and experience for dealing with patients and managing their complex care needs.
Education v experience
Current educational courses are a minefield for registrants and employers to understand. In the past it was easy to comprehend what they all meant – for example, the old ENB 100 Intensive Care. However, the demise of the English, Welsh and Scottish National boards has left universities developing numerous post-registration nursing courses independently. This has resulted in programmes varying hugely in quality, content and delivery.
Some specific educational programmes such as the post-registration Specialist Community Public Health programme are regulated and approved by the NMC. But with their well-documented internal problems, is it really best placed to determine educational standards in discreet specialities such as OH nursing?
There are other anomalies in postgraduate nurse education. For instance, registered nurse 12 months post-qualifying with a BSc (Hons) Nursing, embarks on a Specialist Community Public Health Nurse (SCPHN) programme. She has limited experience as a registered nurse and no experience of school health nursing, and yet commences the programme at Masters level. In the same group, a school health nurse with more than 25 years’ experience in the job, is admitted for the BSc SCPHN, as she did not have the academic credits for Masters-level study. The result is a nurse graduating with an MSc in school health nursing with limited experience, and a very experienced practitioner with a BSc. In addition, the incongruity in the level of study meant that the practice teacher supporting the student through her MSc had lower academic qualifications than the student. It doesn’t take much imagination to consider the disquiet among the students and practitioners involved.
Surely what we need is skills to do the job underpinned with knowledge, rather than the other way round?
In one way, we are fortunate that OHNs tend to have worked in the specialism for a number of years prior to studying. This inevitably places them at an advantage to other public health colleagues such as health visitors. However, with the new challenges faced by OH practitioners, it could be argued that they need education as soon as they move into this discipline to prepare them. But as many are self-funding, this may not be possible.
Our medical colleagues also face similar challenges however they have clear pathways in their specialism, clear titles and a clear route to consultant grade. The same cannot be said for nurse education, where confusion abounds with career progression routes and titles. What are the criteria for becoming a specialist nurse, advanced nurse practitioner, or consultant nurse? Does studying for two years for a degree in occupational health make us a specialist, or should it be 20 years practical experience?
The NMC considers education is key to progression, and confers the title of ‘Specialist Community Public Health Nurse’ on graduation. I believe there is a requirement for a combination of the practical skills and education, but in the right balance. There is no doubt that following a period of study students are more confident in their abilities and have more knowledge with which to draw upon, but equally they need ‘hands-on’ experience, and you will only get this by working in a specialism for a number of years. Let us hope that following on from the NMC review of post-registration education we will have a clear educational pathway linked to career progression, but balanced with recognition of the value of vocational training.
Caroline Whittaker, senior lecturer, public health (OH), University of Glamorgan