Chris Cottingham: There must be a better way to train our nurses

COMMENT

John Webster, president and chief executive of Unitec, proposes tertiary education as the answer to our technical skill needs. The idea that a tertiary monopoly of adult education as a panacea is common, but it needs less assertion and more discussion.

Nursing education provides an interesting reference point. The past 30 years have seen nursing education transferred from hospital board schools to tertiary institutions.

This transfer was undertaken for a variety of reasons, mainly a belief that tertiary (polytechnic and university) study equated to and would lead to professionalism.

Also, because the advancement of nursing was strongly associated with the advancement of women, there was a strong feminist as well as a professional impetus towards tertiary education for nursing students. This adds a poignancy to what has happened.

Now that nursing students are required to study in tertiary institutions, have these emancipatory aims been achieved? The answer is far from simple.

A major concern is nurses' economic well-being. Whereas the earn-as-you-learn system of nursing education was economically good for students, today's system unarguably is not.

Like many of my colleagues, I graduated from our hospital-based programmes as a landowner. Now, registered nurses owe an average of $20,000 to the student debt scheme.

It is axiomatic that owing money is bad. Owing money, especially at the levels of debt carried by new nurses, has consequences that hurt life choices as well as professional performance.

Nurses are reporting hardships in personal and family circumstances and eschewing postgraduate education because of the costs incurred during their undergraduate education.

Tertiary education was imposed on nursing students to free them from an apprenticeship system. The great irony is that it seems to have obliged them to accept dependence on families or benefits.

It has led to indebtedness. It obliges students to work in often underpaid and demeaning jobs to survive financially their student years.

This results in instances of ill-health, chronic fatigue, academic underachievement, and, in an unacknowledged phenomena, prostitution among nursing students.

Not only has the move to the tertiary sector financially disadvantaged nurses, it has not resolved other issues. The high dropout rate of students from hospital-based programmes was cited as a failure of that system. Unfortunately, the nursing student dropout rate from polytechnics and universities is worse.

The dropout rate in the late 1960s was about 33 per cent. Between 1995 and 1997, according to Ministry of Health figures, the rate was 39 per cent to 43 per cent. Nursing students are no more prepared to see out their time in universities than they were in the hospitals.

Another troubling statistic is the number of nurses graduating from programmes. The numbers of registering nurses have declined progressively from 1444 in 1998 to 1154 in 2002.

This decline is consistent through the years. There are now as many nurses graduating from tertiary institutions as there was in the late 1960s.

In other words, while the population has increased by 30 per cent, nursing graduates have remained at similar levels with a declining trend.

There might be a variety of factors affecting both the dropout and graduating statistics. However, the cost of education must figure in any discussion of the causes.

The usual response to these arguments is that while tertiary institutional education may be expensive, the quality of the education has improved. This assertion is nowhere supported by research. There are no reliable historical studies, or sociological investigations, or any inquiries of adequate rigour into comparisons of what was then and what is now.

Certainly there is no serious, valid or reliable evidence to demonstrate an improvement in educational outcomes. Most discussion of nursing education's history, such as it is, is based on anecdote, opinion and ideology more than rigorous investigation.

Herein is another great irony. The placement of nursing education in the tertiary sector was supposed to bring an academic discipline to nursing knowledge. The lack of adequate investigation into the education itself represents a failure of responsibility.

The tendency to avoid self-criticism might indicate that far from achieving autonomy, nurse educators find themselves constricted by their employers. Freed from the need to please hospital administrators, nurse educators find themselves in thrall to, and owing allegiance to, managers of tertiary organisations.

We now have untrained healthcare workers increasingly being used in the workplace, while senior nursing students with knowledge have a need to develop clinical skills and a desperate need for financial support.

With nursing graduate numbers falling in the face of a global nursing shortage, and with nursing students continuing to leave their programmes, it seems time to at least consider alternatives.

Before the transfer to the tertiary sector, a nursing student needed ambition and ability. Now they also need funds.

Tertiary education has imposed on them a financial requirement for no better educational return. It is time to find a better way.

* Chris Cottingham, a nurse with 17 years' experience in hospital based, polytechnic and university education, is working in Community Mental Health.