Analysis

Worries remain over future of specialist nurse degrees

Some fear training could fall short if undergraduate specialists are weakened by changes proposed in the Shape of Caring Review.

Some fear training could fall short if undergraduate specialists are weakened by changes proposed in the Shape of Caring Review

Training nurses on children's ward
Nurse in training on a children's ward. Picture: John Houlihan

It's a year and a half since the Shape of Caring review was published with 34 recommendations to shake up nursing education over the next 15 years.

Health Education England (HEE), the government's education and training body, is moving forward with a programme to turn the recommendations into reality.

It published a response to the review in May, and is focusing on five priority areas over the next 2 years in a bid to improve the quality of training and education of healthcare assistants and registered nurses.

The Nursing and Midwifery Council (NMC), which commissioned the review along with HEE, is now reviewing the standards of pre-registration education. It told Nursing Standard it expects to have public consultations on any revised standards in early 2017.

Biggest question

Perhaps the biggest question that remains among the profession is what will become of specialist degrees.

One of the review's recommendations was to do away with the current system of separate undergraduate courses in adult, children's, learning disability and mental health nursing, and instead have all nursing students undergo two years of general training followed by a year of specialising in a specific area and a one-year preceptorship.

Concerns were raised at the time that the move would see a watering down of the specialist children’s, learning disability and mental health nursing. Such concerns have been raised again by a new alliance of children's nurse academics.

Debbie Fallon, chair of the group of over 160 academics across the UK set up to respond to the review, says: ‘We now realise that we have a strong unified voice among children’s nursing academics to respond to whatever comes our way.

Time to gain skills

‘If we are being asked if the 4 fields of nursing model is fit for the future you need to have groups of people standing up for nursing,’ says Dr Fallon, a senior lecturer at the University of Manchester, whose group is called Children and Young People Nurse Academics UK (CYPNA).

‘We are concerned because we don’t want children’s nursing as a specific specialism to disappear. Our worry with the model of 2 years generic training with one year of specialising is that students won’t be able to gain all the knowledge and skills required.

‘HEE talks about a flexible model for nurse education, but they don’t say what that really means. There is still a great deal to be ironed out but hopefully we can now continue to consult in a more meaningful way.’

June Andrews, professor of dementia studies at the University of Stirling, shares some of the anxieties of CYPNA: ‘It is really important that general nurses understand mental health along with physical health needs and there has to be a limit as to how long people spend in education, but with children’s nursing it is completely different.

Asking too much

‘To shove children’s nursing graduates out with one year of specialist training could be asking too much, and there would be white heat from the public if things go wrong.

‘There would be a huge amount of public disquiet if something went wrong in the case of a child patient who was being treated by an inexperienced nurse. We want to create an alpha nurse when students graduate, not a beta minus nurse.’

South London and Maudsley NHS Foundation Trust provides a wide range of mental health services and is finding it challenging to recruit band 5 nurses, particularly for inpatient care.

Director of nursing Neil Brimblecombe says: ‘Lord Willis (who led the review) was keen to establish the parity of mental and physical needs, but the way to do it is not to dumb down mental health nursing. A year of training will not equip people with the specific mental health competencies to go into practice.

Not ready to nurse

‘Either people coming into practice would not be ready to be staff nurses or we would be lowering our expectations, and it's hard to see how trusts could take on someone who is not ready.

‘HEE have reduced continuing professional development training for us by 37%, so the idea that a graduate may receive intensive post-registration training is also very problematic.’

The Unite trade union has its own mental health nurses association, and professional lead officer Dave Munday says questions need to be asked about whether the recommendations are ‘actually the right prescription or will they cause more problems than they can solve’.

‘If you asked a member of the public with mental health issues if they would want someone with generic training or a specialist to treat them I think we know how they would probably answer’ says Mr Munday.

Finding best model

HEE director of nursing Lisa Bayliss-Pratt says HEE is establishing an expert reference group to develop a curriculum to ensure ‘joined-up, ongoing learning and development in the context of a robust, overarching career framework, linking roles to competencies’.

‘It is clear to us all that our partners and stakeholders share our passion to find the best model of education to support quality care, which has at its heart the support of children, young people and their families within their own communities, and HEE will continue to work in partnership with our key CYP stakeholders to support and help us drive this forward.’

An NMC spokesperson told Nursing Standard: 'Work on developing revised competencies and competencies for nurses entering the profession is being led by Dame Jill Macleod Clark, and we will be working closely with a range of stakeholders to ensure future standards are fit for purpose.'

HEE’s 5 priority areas from the Shape of Caring

1. Excellence in nursing practice

2. Valuing and developing the care assistant workforce

3. Ensuring meaningful patient and public involvement

4. Flexibility in pre-registration education

5. Standards for post-registration education

Petra Kendall-Raynor is a freelance health journalist

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