Is education for a nursing elite? Some highlights in nursing education in Europe and North America

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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