Further details of themes It is all about the course

This theme focused on the comments that three respondents made in relation to the design of the programme itself. N04[A] suggested that,

The nurse will be as good as the course prepares them for and this is also dependent upon the quality of the experience offered and what the student is prepared to put into it, no matter what level of the course.

N11[MH] focused on the balance between theory and practice and suggested, “Many people do not appear to appreciate the amount of time spent by students in the practice setting and the role this has in their overall learning (both positive and negative).” N08[A] focused on recruitment to the course and suggested, “It is important that recruitment of nurses onto the course takes account of not only

The changing face of healthcare

Complex nature of healthcare (8) Leadership (3)

It is all about the course (3) The nurse

Academic ability and attributes (5) Critical thinking and clinical reasoning (8)

Personal and professional development (1)

The profession

A seat at the top table (2) Mature students (4)

One size does not fit all (3) Other healthcare opportunities (3) Professional (1)

Vocation (1) Welcomed (4)

163 academic ability but of the qualities that nurses should possess - such as professionalism, motivation, enthusiasm, compassion and commitment.”

The changing face of healthcare

Respondents commented on the impact of the complex nature of healthcare in the twenty-first century. N04[A] suggested, “as a qualified nurse taking on responsibilities that are inclusive of some former medical and higher managerial roles requires this person to have a much more complex range of knowledge and abilities, which a degree will prepare them for.” N07[A] referred to the ever-changing nature of healthcare; “This move is required to develop nurses who can problem solve and deliver care that is complex in an environment that is constantly changing both at practice level and a political level.” N05[A] wrote,

The move to all graduate training is about the nurse being able to function autonomously in a high tech environment and having the ability to be able to make decisions that influence, guide and support the appropriate decisions of patients where required.

N09[A] discussed nurses being better equipped to respond to on-going demographic and social changes,

The UK, like most of the developed world, is witnessing an increase in an ageing population. This phenomenon has the tendency to carry with it people with long term conditions or diseases which are often intractable and chronic in nature. The nursing profession needs to respond to this demographic and social trend and educate pre- registration nurses to graduate level to tackle the multi-layered complexity of nursing and medical care.

Leadership was also discussed. N06[C] suggested, “The role of the nurse in modern healthcare is complex. Nurses are often leading and managing care and need high order skills to do this.” N14[LD] suggested, “We [Nursing] need strong knowledgeable nurse leaders. The degree is a starting point,” and N15[C] wrote, “Nurses without critical thinking and leadership abilities will flounder in the face of the pressures on the NHS and this will impact on patient care.”

164 The Nurse

This theme focused on the attributes required by the individual nurse. Some respondents discussed the balance between personal attributes such as being caring and compassionate, and academic ability. For example, N09[A] suggested, “A degree may never generate caring and compassionate nurses, but, I would argue, that degree status will enable them to become aware of such important values in the caring process.” N10[A] stated, “Nursing is a multi-faceted profession where academic creditability, caring and compassion do not need to be mutually exclusive,” and N15[C] wrote, “Whilst I do not believe that having a degree is the only quality that makes a good nurse, I think all nurses should have a high level of knowledge and be skilled to undertake the role in the current climate.”

Several respondents focused on the issue of critical thinking. N01[LD] suggested, “Going to graduate level is not about gaining a degree to me it’s about getting people who can think through the complex issues that nursing creates.” N19[A] felt that, “Having developed critical analysis skills and the ability to engage in critical discussions nurses will be better able to engage with decision making with and on behalf of patients within the interdisciplinary team.”

Finally, N08[A] referred to the on-going professional development of the nurse and stated that the move to an all graduate entry will, “encourage nurses to be independent learners and hopefully for them to take responsibility for keeping up to date with their CPD [continuous professional development] which I believe is paramount for a nurse to do.”

The Profession

The final theme highlighted the perceived impact on the nursing profession as a whole. The move was generally welcomed. N01[LD] felt that, “moving to degree level is excellent for nursing,” N02[A] wrote, “This move can only result in benefits to the profession and to patients,” and N16[LD] saw the move as, “An essential requirement for the future of nursing - essential for delivering high quality care meeting the expectations of all sections of society.” N09[A] discussed a caveat to their endorsement of the move suggesting, “from an academic and caring perspective, I

165 highly welcome an all graduate status for the nursing profession providing patient care is demonstrably improved with recourse to evidence-based practice regardless of where care is located.” However, some concerns were expressed. N04[A] suggested,

My feelings are that nursing needs differing levels of knowledge and that there is room for nurses with and without degrees … I do feel that an all degree profession will exclude the mature nurses that have not got the relevant qualifications in some circumstances.

N01[LD] also discussed the plight of ‘mature students’, “I however do feel that steps have to be taken to ensure that mature students without qualifications are encouraged to step up to the required level and a good mix between intellect and skill is essential.”

Two respondents provided a different perspective on this issue. N10[A] suggested, “Nursing is a vocation and anyone who truly wants to be a nurse will go and gain the qualifications required for entry,” and N12[A] acknowledged that,

Yes, some non-academic capable individuals that would make excellent nurses will be excluded however they can still have an important part to play in the delivery of care through HCA status for example. I also think we have to consider that by having all graduate entry we will attract people with excellent potential that may never have applied if we did not have all degree entry status – ‘swings and roundabouts.’

N08[A] suggested that the move would, “provide the recognition on a par with the other allied health professionals,” and N12[A] felt that the move was required, “if we are to ‘professionalise’ nursing and help develop its status as an independent professional body of experts.”

166 5.10 Qualitative data: Allied Health Professional (AHP) educator questionnaire

(Question 21)

Question 21 asked respondents to ‘Please add your own views on the move to all graduate entry to nursing’. Eleven of the fifteen respondents (73%) provided a free text response. Respondents represented all the additional health professional courses taught within the School, midwifery (Mid), occupational therapy (OT), operating department practice (ODP), physiotherapy (Physio) and podiatry (Pod). The respondents are identified as Allied Health Professional Lecturers by the prefix AHP, followed by a randomly generated number between 01 and 15 and an abbreviation of their health professional qualification as shown above.

5.10.1 Phase one analysis

First impressions indicated that many of the respondents were supportive of the move to an all graduate entry to nursing, citing equality with other healthcare professions, and the need for a nursing workforce with improved critical thinking and clinical reasoning skills. As with the nurse educators, the changing nature of healthcare in the twenty-first century also featured. Concerns were expressed by one respondent (AHP8 [ODP]) that the move to an all graduate entry would not, in itself, improve the standards of care delivered to patients, although no further rationale or evidence was given to support this. Two other respondents, both representing podiatry (AHP1[Pod] and AHP15[Pod]) expressed serious concerns about the actual academic level and standards of the Nursing degree programme and how a ‘dumbing down’ of standards may influence recruitment for other graduate programmes.

5.10.2 Development of codes and themes: AHP educator questionnaire, Q21