Healthcare workers who want to become nurses but who lacked the qualifications to go to university will be able to train as nursing apprentices, says health secretary Jeremy Hunt. This is bad for nursing and bad for patients.
For good reasons, we long ago stopped this style of training. Nursing students were being used as “pairs of hands” and they were not being prepared well to work in the modern NHS. Anne Marie Rafferty, professor of nursing policy at King’s College London, described the reinvention of nursing apprenticeships as “an act of historical amnesia”.
I do not see the point behind apprentice-style training for nurses. According to the proposal, apprentices will be able to study at university while they are paid to work in the NHS. They will not be part of the nursing workforce, but will get a degree and become registered like other nurses. However, the university route to becoming a nurse is already open to anyone, if they have the right entry qualifications. Why do we need another route? If these healthcare workers lack the right qualifications, how will they cope with university education? How many will drop out, damaged and disillusioned? And why would it be attractive to the NHS to fund these apprentices when from 2017 it will no longer fund nursing student bursaries or pay fees? These questions need to be answered.
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Smart people need not apply
The idea of nursing apprentices is bad for nursing because it says that you do not have to be very clever to be a nurse. If you do not have to be very clever then you do not have to be educated, and you can learn about nursing on the job. Of course, much of nursing education is learned working with patients. But that is after a lot of time learning about how the body works and how people behave when they are ill. Nursing students also practice with special manikins which can react almost like real patients. They meet patients early in their course, but are watched closely by qualified nurses. As they learn more they take on more important jobs.
Nursing students spend half of their time in clinical practice and half of their time in the classroom. If nursing apprentices learn mainly “on the job” and not in the classroom, then they will lack the skills of other nursing graduates. These skills are mainly about how to learn and how to apply what is learned, how to make connections and how to react in situations that are unusual. This is often called “thinking outside the box” and it could be what makes graduate nurses better at saving lives than nurses who are not graduates.
Graduate nurses are so valued in the US that in 2010 the Institute of Medicine, a division of the US National Academy of Science, said their numbers should be increased from 50% to 80%. In the UK all new nurses are now graduates of mainly full-time university courses.
Nursing apprentices will earn degrees, but the kind of degree will be different from the established degrees because these courses are designed for people without the right entry qualifications. We cannot be sure that nursing apprentice graduates will be as good as other graduates. The benefits of graduate nurses may be reduced with the introduction of apprentice-style training.
Allowing nursing apprentices to work with patients if they are not being prepared like university nursing students is a risk. They may not know what they are doing. To reduce this risk, they would have to be watched closely by qualified nurses. But qualified nurses already look after large numbers of nursing students. They will have little time to look after apprentices.
This reinvented route to a nursing qualification is unnecessary, ill-considered and dangerous. It creates two tracks to becoming a nurse and risks creating a two-tier system of nursing. Nurses qualifying by the nursing apprentice-style training may be looked at as being second rate. Unless Hunt can tell us what the value of apprentice nurses will be to nursing, to the NHS and to patients, universities currently providing nursing degrees should not become involved in supporting them.