Apparently nurses need degrees for 'critical decision-making skills'. But you don’t need to be a graduate for that.

A great debate this morning about whether nurses need to be graduates. In four years' time, anyone who wants to become one of the nation’s 400,000 nurses will need to have a degree. This is one of the biggest shake-ups of medical education in the history of the NHS. More than a quarter of nurses, incidentally, already have a degree and the level of qualifications has risen steadily in recent years. But this has caused an almighty row. And not for the first time, the nursing unions seem to be making a lot more sense than the representatives of the NHS.

There’s an awful lot of guff being spouted by the department about the need to 'meet the challenges of tomorrow' and for 'critical decision-making skills'. But I fail to see how the ability to learn how to make decisions is a graduate-only business. Unison and Unite have insisted there is 'no compelling evidence' that degrees would improve patient treatment, claiming 'the emphasis should be on competence, not on unfounded notions about academic ability'.

There is nothing wrong with having a degree in nursing, providing it teaches the correct things. A respondent to the Times this morning complains: 'Some of the degree holders see their main role as management and very little of it as nursing, creating the impression of a two-tier nursing system.

I have seen much of the most important work (maintaining patient dignity, providing compassion) fall to health care assistants'. There is nothing wrong with management. You’d hardly expect me to say otherwise. But the role of management is to make sure that the important work at the coal-face is done properly - and one sees and hears of far too many examples in nursing of the caring being neglected for the sociology and the paperwork. Here's another Times Online correspondent:

'I have found myself doubting the motivation of those degree-level students that I have worked alongside. In my last position within a busy Intensive Care Unit, I worked with both degree and diploma level students & found their contrasting attitudes remarkable. There was a definite gulf & almost snobbery between the two groups, with the diploma group being almost considered inferior to their degree-level colleagues. Unfortunately when it came to carrying out direct personal patient care (surely the essence of 'nursing') the gulf in attitudes was appalling. Whilst for the main part the diploma students were happy to roll their sleeps up & help with washing, toileting & mobilising patients. Indeed, I recall asking a degree level student nurse to assist me in cleaning a patient who had soiled themself, only to be met with the response:

'I don't really want to do that, I came here to learn how life support machines work'. I actually have some first-hand experience of this. Years ago I worked for a summer as a care assistant in an old people’s home. That’s about the lowest of the low in the nursing hierarchy, but I have to say it was one of the richer experiences of my working life. Not only did I carry a 95-year-old on my back during a fire scare down five flights of stairs – he was amused – but I did all the bum-wiping, bed pans and feeding.

I shall never forget the morning I clocked on at 7am and pulled back the bed covers of some of the residents, to discover that two-thirds of them had come down with a gastric bug. But mostly it was a lot of sitting around listening. Such things are actually a vital part of the care process and help people get better faster. And if they can’t be made better, it makes their passing more tolerable.

It might not be sexy like an action-packed episode of ER with portable chest x-rays, chem. 7s and CBCs, but it’s one of the vital roles nurses perform. You don’t need a degree to hold a hand, reassure and comfort. You can, of course, have a degree and still be good at these vital things - but a substantial part of any nursing qualification must be to emphasise their importance.

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