SIX months after qualifying as a State Registered Nurse in Oxford in 1972, I joined the district nursing team. I went into people’s homes to assist them with washing and dressing, helping them to walk, to move out of bed, to reach chair and toilet. I dressed wounds, helped the person to eat and drink, gave medications, changed the bed and carried out general nursing care. This changed in the 1980s, one of the consequences of the move of nursing into the academy. From then on these tasks were delivered by ‘carers’ rather than trained nurses. No longer termed ‘nursing care’, this is called ‘social care’ and it is currently in crisis.
In 2021, in response to the pandemic and the crisis in social care, the Lancet and the London School of Economics published a series of papers on the NHS. One, ‘Securing a sustainable and fit-for-purpose UK health and care workforce’, argues that ‘major reform is needed across the entire health and care education system to meet changing health and care needs’. One of the authors of the LSE-Lancet paper is Dame Jill Macleod Clark, an emeritus university nursing professor who ‘influenced the move of nursing education to universities, championing evidence-based practice’ in the 1990s.
This eminent nurse made a surprising admission about the state of UK nursing in a lecture to a Canadian university nursing department in 2015. She is quoted: ‘There is a huge gap between the academy and practice . . . Do we carry on doing more of the same, or do we start reframing the way we think about faculty and evidence-based nursing care?’ In her view, the culture in nursing ‘is largely not evidence-based. If you ask a nurse who has expressed an interest in, for example, urology, who the clinical experts are they will give you a blank look.’ The forensic Francis Report agrees. Much of the care at the Mid-Staffordshire Foundation Trust was below an acceptable standard due to a lack of staff as well as nursing staff not being skilled enough to provide the care required.
But the nursing academy has fought against any changes to supposed academe. In 2014 the Lancet published a paper of which the lead researcher is a professor at a US university nursing department. This study concludes that improved nurse staffing and education is associated with a decreased risk of mortality in patients. But the paper does not admit that there is no standardised nursing education or international qualification. The implications of this flaw, which fatally undermines the validity of this study, are not addressed. Notwithstanding, because it is published by a respected medical journal, the study has been key to promoting and keeping the nursing academy internationally, including in the UK.
Yet health research is coming into serious question. In July 2021 Richard Smith, former editor of the British Medical Journal, argued that there is widespread fraud in health research. He was referring to hard scientific research, the evidence base for the treatment of patients. But this surprising admission is extremely relevant to the nursing academy. The rationale given to government for costly changes in nurse training from the hospital to higher education by the Briggs Report in 1972 was to develop a body of nursing knowledge by becoming a research-based profession. This was followed a decade later by Project 2000 which intended to make nursing students into qualified nurses who would take individual professional accountability for the care of the patient. As a result, the role of the nurse would change. No longer would the nurse give ‘basic nursing care’, instead she (or he) was intended to be a ‘knowledgeable doer’, a manager, a communicator, and a researcher, or at least a research implementer.
But most nursing research does not even attempt empirical hard science. It is mainly soft social science that cannot be measured or verified. Hence it is innately flawed and easily open to fraud. It is not, as Professor Macleod Clark admits, providing an evidence base for nursing. This is because truth for much of nursing research is a state of mind or attitude related to organisational conditions. This is illustrated by the rather extreme but nonetheless influential work of professors at the University of Ulster and Queen Margaret University, both from departments of nursing.
It is surely arguable that nursing academe has failed both patients and nurses. Nursing academics, desperate to keep the academy, financially and for its prestige, have an undeclared conflict of interest when the interests of patients in hospital and in the community would be better served by a reform of nurse training by removing it from the clutches of the academy. This would save the vast cost of the nursing professoriat and university degree apparatus, return nurse training to the NHS wards and command and control of the nursing trainees for use in pandemic surges, and return ‘social care’ to nursing care thus raising standards and helping the aged stay in their own homes.