Are modern 'angels' prepared for the wards?

Nurses are not carrying on

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting is investing Pounds 500,000 in its education review, which could, with government approval, again transform nurse education.

The UKCC stresses that the review should not be seen as a criticism of Project 2000, whose underlying philosophy is still valid, it says. The question is whether the programme has deviated from the original intent of preparation for practice.

But some of the questions before the commission seem to go to the heart of nursing education. For example, what level of qualifications, academic or vocational or both, should apply to the framework? And should a pre-registration framework be competency based? Most fundamentally, the review is asking to what extent university-based pre-registration education prepares nurses for practice.

So far, 70,000 questionnaires have been sent to registered nurses to gauge opinion on the issue, and half have been returned. Last month the UKCC held 24 nationwide consultation seminars on the topic for nurses, students, lecturers and the public.

A recent edition of Nursing Times spoke of a Project 2000 trainee nurse specialising in mental health. It quotes the student as saying: "I'm nearly finished now, but I feel completely unskilled I When I go on to acute admissions wards, I'm scared to death. I feel like a liability." This feeling was underlined by a survey at East Yorkshire Hospitals NHS Trust, which found that staff on half of wards felt newly qualified nurses lacked grounding in essential clinical knowledge.

Paul Chapman, professional officer at the union Unison, agrees that this is a crucial area: "There is a lot of anecdotal evidence that nurses feel underequipped on the clinical side when they finish Project 2000."

A Department of Health spokeswoman acknowledged this problem but argued that today's nurses are better prepared as fellow professionals. "We want nurses able to innovate and to challenge tradition. There is some evidence that Project 2000 nurses are able to do that," she said. The DoH also points out that diploma courses are not totally theory-based, and students spend about half of their time in hospital. One way round the problem was the idea of a house year, similar to that undertaken by medical students. The idea is supported by Tony Butterworth, chairman of the council of deans of nursing schools.

Unison's Mr Chapman, himself a registered nurse, said the review must also consider care assistants. "The real problem is the huge chasm between care assistants with NVQs, who have the clinical skills to make very good nurses, and the demands of Project 2000. Not everyone who could make a good nurse wants to follow such an academic path." He envisages a system that gives such assistants more academic support, while providing better academically qualified nurses more clinical time.

Earlier this year, the government announced financial support to enable more healthcare assistants, who carry out much of the hands-on clinical work once done by nurses, to progress to Project 2000 courses. Those who follow this path and spend three years at university will retain their salaries while training.

However, the DoH acknowledged that there were many people interested in nursing who were put off by the academic qualifications. "We are looking at more flexible entry, but it's too early to speculate," it said.

The UKCC is studying the returned questionnaires. It plans to extend the survey to current student nurses and to take oral evidence.