Is education for a nursing elite? Some highlights in nursing education in Europe and North America Winifred
Logan
The apprenticeship system of nurse training and its problems were shared, until very recently, by all English-speaking countries, and by others in all parts of the world. It has been widely recognised for many years that this system ‘nullifies any serious attempt to improve the training of nurses’ but it is only in the USA that sweeping changes have been achieved. In most European countries (including the UK) academic preparation for nursing practice is reserved for a minority. This paper questions the basis for both professional and public acquiescence in this situation.
During Strong, mary,
a public address in 1895, Rebecca matron of the Glasgow Royal Infirwas deploring
the inadequacy
’ . some still retain the idea that 12 months in
hospital
instruction sufficient duties
without
will enable knowledge
as a
to
nurse
any
a woman
theoretical to pick up
admit
undertaking
_. . this implies
nurse’s work is purely mechanical, little
mental
cducatipn is can
capacity
uttered nursing
many
that
they
be made
the
that
social
enormously
without
people
no special
circumstances
since
these
say point
it? Is it the
requires
almost a century ago, knowledge - including
a
requiring
will not make a nurse. The
solitary profession instruction . .?’ Although changed
..
-
has developed
out of all recognition,
the quote still has a familiar
ring.
of educ-
ation for nurses and protested:
spent
ledge
words
FROM INDEPENDENCE APPRENTICESHIP Most
people
nurse
associate
education
the
founded in 1860. Many
of formal
Nightingale
forget, however,
School that it
was an independent school financed by the Nightingale Fund (,C;44000) given by a grateful
nation
following
the
outstanding
contri-
bution made by nurses during the Crimean War. Commenting on this facet of the St Thomas’ experiment ‘the independence,
were
that
W Logan MA MN DipNS RGN RNT, Glasgow College of Technology, Department of Health and Nursing Studies, Glasgow
the beginning
with
have
and although health know-
TO
it
enjoyed
Nightingale underscored financial and otherwise,
owing
to
its
endowment’
(Seymer 1956, pp. 124-5). However, the products of the School were not destined to remain at St Thomas’ Hospital. Over
the last few decades
of the 19th century,
the nurses of the Nightingale School dispersed to many parts of the UK and indeed to far 5
6
NURSE
EDUCATION
away countries, Australasia, sought
for example
South
virtually
‘students’
employees.
The
schools
hospital place
this apprenticeship around
the growth
Europe,
the
receiving
it
same
period,
attention
were initiated;
the
noting
of
agencies
Catholic
and
commencement
quite
nursing
in-
of sister-
Protestant;
by
the too,
school was set up
of
a year prior
the
Nightingale
School. Nursing
did not develop
ever,
and
around
many
scientific in
Perhaps with nurses
changes
nursing
the
impact
the First
on
the
social
with develop-
nursing
World
War
helped
profession’s
how-
century,
dramatic
contribution
and these factors
attention
and
the
education.
status of women
outstanding
during
of
interacted and
the changing
in isolation,
turn
advances
and economic ments
the
coupled made
by
had most
to focus public concerns
about
nurse education. In the aftermath USA
that
were
tackled
Goldmark landmark.
the
of the war,
problems most
Report Among
facing
vigorously.
it was in the the profession The
wards,
Winslow-
published in 1923 was a its recommendations, the
existing three-year basic course was to be reduced in length by removing unnecessary repetition and non-teaching time on the wards, and it was also suggested that future leaders of the profession should be equipped for their task by university courses in nursing education (Committee for the Study of Nursing Education 1923, 26, 459-460). A few years later in the UK in 1932, the Lancet Commission’s report was not so revolutionary. There was
backwardness
high
hours of work,
wastage
the rigid discipline commended medied
within
Home
the
defects
existing
Nevertheless, UK.
In
Department were nursing
those
for
example,
which she published
1963,
who
were
problems
in the
Carter
gave
Commission
an educational
for Nurses’.
re-
(Scottish
[SHHD]
there
Lancet
re-
be
ring!
about
1931 to the
could
system
p. 5). Again it has a familiar more outspoken
on the
of probationers,
but the Commission
these
and Health
over-long
teaching
number
-
that
of nursing
rate,
lack of proper
the inadequate
put forward
also
the
the
was
be remembered in 1859,
about
evidence
with
in
nursing
Lausanne
wide-
concern education,
system in
by a number
and it should
that
the
of nurses
Developments
that an independent to
education
despite
from
struction
at La Source,
on
the students
is worth
preparation
both
depended
of this apprenticeship
roots.
Cross;
were
system were a cheap labour
different hoods
who
for finance;
to ‘service’;
Nevertheless,
spread
monies
to be associated
with
associated
Red
came
who
principles,
and
took second force.
Those
did not have access to private
hospitals
the
Israel.
the Nightingale
and most nurse teaching with
to North America,
Africa,
to emulate
however,
TODAY
and
scheme
had
for nurses
in 1939 in her ‘New Deal
She wrote
(quoted
in SHHD
1963,
p. 6): ‘The
medical
hospital
and
school
is separate
the difference
school and hospital
from
in aim
the
between
is clearly kept in sight . .
little progress will ever be made in the better training
of any
professional
grade
of nurse
education
sight of in a multiplicity good
nursing
is a
while
continues of routine
matter
her
to be lost duties . . .
which
concerns
everybody.’ But not much and
another
Crimean
War
enormous during public
was done to alter war
was
and
the
contribution
the situation
brewing. First was
As
World made
in
the
War,
an
by
nurses
the Second World War, and again the were ready to be sympathetic to the
concerns
of nurses about
paration.
One treatise on the subject
their educational
(1948,
p. 11) encapsulated
which
still
confronted
the
pre-
by Brown
the main profession
problem in
the
USA: ‘By no conceivable stretch of imagination can the education provided in the vast majority of the some 1250 schools be conceived as of professional education. In spite of improvements that have been made in most schools over the years, it remains an apprenticeship system’ and she recommended that effort be directed toward building basic schools of nursing in universities and colleges ‘. . adequate in facilities and faculty, and well distributed to serve the needs of the entire country’. She suggested the feasibility of a combined general
NURSE EDUCA’I‘ION ‘LODAY
and
professional
four
years,
although
ing hospital
schools
ledged
in the
Drpartment a working the
and
of
required
to
tained
equip
the linances
the
1947,
training Health
reiterated
the
thr
to which
present upon
they
are
to im-
(WHO)
nursing
around in
a
was
world
WHO
and
are
hospital
is ‘. . in reality
schools’
an employee
and
the
of nursing, long
with
the
by a nurse
‘. . . all
student
or apprentice’.
highlighted
the
1950s
about
nurse
education.
long
University,
New
as the
first
schemes
Congress Nurses,
had over
as
1901,
of
the
at
later
programme
President,
used
of
been
the
first
her
1963) in
the
mainstream isolated
going
a period
on in a
of years.
As
Quadrennial Council
of
enwick ( 190 1 ), the British address to make some
remarks:
‘With
a
nursing
few
notable
schools
do
not
exceptions, provide
. . .’
degree
in
some
links
ments
for
Escola
Portugal berg the
Tecnica
nursing
the
with
degree
of nursing universities:
of I.ouvain
of Brussels
de Enfermeiras
in
in
1936;
in Lisbon,
the University
of Heidel-
in 1953. Yet despite of university
enjoying education,
not
entirely
controlled
nor was a degree
granted
on completion
(SHHD
by
1963, p. 11).
In the
UK
number higher
were
in
to be the same
a number
University
were
establish-
courses
affiliation
in 1940; and
courses
nursing
there
education
basic
of the privileges
them,
of
a BA
So basic
at the University
in Germany
many
University
inaugurated
nursing into
have the
181). degree
the University
although
Admittedly
and
at the
did not seem
venture did
p.
nursing
a decade,
post-basic
to
nurse installed
1956,
basic
higher
urge
to held
are not new!
with
19OOs, there
was
(Seymer first
however,
early
came
world
eminent
(Nursing).
programrnes Europe,
of
affrli-
at Columbia
the
Canada
Science
time,
Nutting,
the
group
in 1907 in associa-
York;
and within
of Vancouver
a
seeking
in the
was organised
Minnesota,
the
however,
lnternational
Mrs Bedford-F
pointed
fact,
their
degrees
programme
professor
years
1928
SHHD
colleges,
of
for some Chair
Adelaide
two in Belgium
concern
inadequacy In
of countries ago
in
international
the
rxperimental number
(quoted
educ-
been
was established a post-basic
Two
ellorts had
first
tion with
In
FROM APPRENTICESHIP TO STUDENTSHIP Report
the
their
university
the who
universities
and
schools
WHO
need
endowed
their
after,
programmes.
The
I claim
nurses
their
nurses,
fruition
Report
iquoted in SHHD 1963, p. 10) saying that the majority of nursing schools in nearly countries
centres,
in Applied
education
the
ation chairs
educationist,
. . .’ By this time,
about
sentiment
Their
attempt
Organization
countries
is is
schools
serious
of nurses
information
many
‘What
question
when
ation
p. 55) main-
of nursing any
Minis-
task?’
in the running
has come
Not
training
the
of the hospitals
the
collating
for
ourselves
time
American
established
what
of Health
World
from
her
nullifies
prove
and
dependence
attached
and
keep
to
of Health,
Service
‘. . without
that:
financial
about
1946 to consider
nurse
(Ministry
p. 308).
was
for Scotland,
in
a
was acknow1966,
Ministry
National
party
task
report
the
of Health
try of Labour
time
the NHS
and
to
for continu-
Sewall
UK,
shortened
necessity
for some &
inaugurated
course
the
(Jamieson
Meantime be
university
7
itself,
as in mainland
of affiliations education
had
been
for the purposes
nursing
education
for
example
College
of Nursing
had
initiated
Europe, forged
a
with
of’ post-basic the links
(Royal) with
the
University of London for a sister tutor course as early as 1918 (Seymer 1956, p. 181) and a
modern a complete
number
of other
courses
followed
this lead.
For
system of nursing education and I doubt if it is possible for them to do so to enumerate
basic students, one of the early affiliations with higher education was at the University of
our
Manchester Diploma
most
nary wards;
pressing
education we
need
needs, before
we require entering
postgraduate
the
prelimihospital
teaching
to
However,
which in
inaugurated
a
four-year
Community Nursing in 1959. the first integrated basic nursing
8
NURSE
degree
EDUCATION
programme
1960 at the century
TODAY
was
not
University
after
the
established
of Edinburgh
University
until - half
a
of Minnesota.
It
was the first in Europe. Originally, Studies
the
In
Department
under
its
but
when
estabIished
in
became
part
1960
the
study
a Social the
and
take
the final Council
all the
requirements
University soon
of
after
Faculty, theory
subject,
and
3 were
accepted
year
graduating
as three
and
to read,
breakthrough
at
to a
must
provide
share
of
above
about
education
at the
(United
Science that
In order
to enhance and
the basic
subsequently
form first
of research Nursing
up with the
Research
the
help
Department
burgh.
Of
and
have
the
one-
diploma
have
developed
of private
progress
in
of
for
nursing
but
health
now,
Studies
there
are
degree programmes of nursing research in other
universities
and also in establishments such as polytechnics and where the degree is awarded the Council for National (CNAA).
the
realised in the was set
as part in
of
Edin-
around
20
in the UK units. They in the UK,
of higher education central institutions under the aegis of Academic Awards
higher
education
are
already
towards
making
a
the
entry
professions. long
ago,
ities
such
the domain as
diversional Nightingale’s Nurses about
of nursing,
that was,
and
a
their much not
indeed
diet
so
activ-
nutrition,
mentioned in 1859!
are still dragging
relationship
just
to
noting
in
moving
(not
‘profess’
mobilising,
in the UK the
esconced
quietly
therapy were Notes on Nursing
other
paramedical
degree
worth
would
that
the
qualification
paramedicals
a
of a
recognition
noting
are
basic
It is also the
This
firmly
and
diploma)
will gain
circles.
example
for
students
status
of academic
it is worth for
education
of what
where
education terms
groups,
professions, a
in 1971, the
monies
in higher
be
degree
in Europe
of Nursing
course
basic nursing and a number
Unit
and
programme
status
for
and
consultative
which
to underpin
was required
The
a three-year
2000
1986)
supernumerary
educa-
masters and doctoral degrees, it was that recognised academic scholarship
Council
is in its first stages.
will
discussion
is Project
will have
and
nursing
Central
latest
qualification
tion in the UK. programme,
its
1, 2
University
nursing
UK
is proposing
in
to attract
as a
it was a major
of basic
The
a recourse
compara-
be able
in
the
p. 32[1])
professions:
nurse
to qualify
recognition,
for other
to
years
nursing
mainstream
was easy to write
in academic
1964,
‘The
recruits.’
Kingdom
the Report draft
the
able
Twenty
education
General
and
advocating
education: professional
it is
in relation
(RCN
will nursing
Studies
the
but in f&t
in the history
of nursing
1967
review profession
field.
when
only
of the eight,
last sentence
form
to
Report
comparison
this way
recognised
required
degree
This
milestone
he
Nursing
Platt
the
practice
Social
and
the
in the health
provided
in
agreed
groups
ago,
brief
of its practioners
that
degree
the
should
subjects
Edinburgh. is easy
to
senate
the preparation other
very
ble with
and
However,
transfer
university
science
of the over
of this
to look at the nursing
in
had
necessary
Scotland
Edinburgh.
of nursing
social
They
context
drew
Initially
subjected
for an arts
graduating
a
were
examination for
the the
faculty.
the
was
Department
programme.
complete
Nursing
Faculty
the
new
students
five-year
nursing,
Science
the
interesting
Elsie of the Faculty of
1960s
of the
Nursing
Director,
was part
degree
formidable
of
first
Stephenson-Gardner, Arts
NURSES AS RELUCTANT STUDENTS
between
their
in feet
mainstream
basic nursing education and higher and most nurses are still prepared
education, in mono-
technic colleges whose qualifications recognised in the academic world.
are not Is practice
based
on
academic
klite?
Does
not
educated nurse? Strong is nursing that
requires
study
the
only
patient/client
for
a nursing deserve
an
In the words of Rebecca still ‘. . the solitary profession
no special
instruction
.‘?
NURSE
EDUCATION
TODAY
References Bedford-Fenwick E 1901 A plea for the higher education trained nurses. American Journal of Nursing, October Brown E 1948 Nursing for the future. Russell Sage Foundation, New York Committee for the Study of Nursing Education 1923 Nursing and nursing education in the United States (Winslow-Goldmark Report). Macmillan. New York Jamieson E, Sewall L, Suhrie E 1966 Trends in nursing history. (6th edn) Saunders, Philadelphia Ministry of Health, Department of Health for Scotland, Ministry of Labour and National Service 1947 The recruitment and training of nurses (Wood Report). HMSO. London
of
Royal College of Nursing and National Council of Nurses of the UK 1964 A reform of nursing education (Platt Report). RCN, London Scottish Home and Health Department 1963 Experimental nurse training at Glasgow Royal Infirmary. HMSO, Edinburgh Seymer L 1956 A general history of nursing f4th edn). Faber & Faber, London, pp. 124125 United Kingdom Central Council 1986 Project 2000: a new preparation for practice. UKCC. London
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