GESTIÓN dE RIESGOS FINANCIEROS

The early pioneers who established nursing as a profession and therefore required a recognised and approved process of preparation for nursing work acknowledged the importance of being ‘credentialised’. In an attempt to become accepted within society and distanced fiom the concept of the handmaiden and servant role, foimal ti'aining programmes were founded. Following the end of the Second World War, the SEN was introduced as a support to the SRN, providing a practical-based professional qualification in nursing. As society, technology and debates on professionalisation evolved, the need to review the way nurses were prepared for

employment became an important focus for the UKCC. Since the Briggs Report of 1970, discussed in chapter two, there have been a number of structural changes to the governing body of nuising, and the education models of pre-registration programmes, including the return to a single qualification. This can be viewed as the biggest single change to nurse preparation since the original training programmes, recognising the educational requirements required by nurses in order to practice within an academic discipline. While it is acknowledged that nursing is primarily a vocational profession, the advances in knowledge, technology and treatments, meant the academic preparation for nursing could not be ignored. The recommendations under consideration by the NMC for the preparation of nurses to degree level also include proposals for generic preparation of nurses, with specialist practitioner education available post-registration (NMC 2008) which echoes recommendations of Lord Briggs over thirty years ago.

The recommendations for degree level preparation have been agreed and will be implemented in full by September 2013 (NMC 2009). However the report Nursing: Towards 2015 recognised that “hitroducing graduate level programmes may present difficulties for some of the tiaditional applicants such as HCAs who may no longer be able to access nurse education” (NMC 2007:51). This may also affect the cadet route into nursing, and discussions are currently underway with Valley College and their local HEI to determine if access via a Foundation Degree in Health and Social Care might be an alternative route.

In order to ensure nurses were knowledgeable doers, combining both theoretical knowledge and practical sldlls, changes to the curriculum resulted in the education and training being removed fi'om schools of nursing into HEIs. I have argued that the

demise of the SEN has led directly to a number of potential nurses being excluded from pursuing a career as a qualified nurse because they did not meet the entry criteria set by the HEIs. While the suggestion to reintroduce the SEN is perhaps not wholly realistic, consideration has been given to employing a model of nurse preparation more closely akin to the Briggs model. The reinstatement of the SEN would enable those who wish to enter the profession and become a more practical qualified nurse may do so. Conversely, the role of the SEN has been filled by HCAs through the NVQ training, and while they play a valuable and essential role in the clinical areas, they are, by their very title, assistants and not qualified nurses.

The development of the Associate or Assistant Practitioner may help to provide an alternative career pathway for those who are unable to fulfil the requirements of pre­ registration programmes. However, tlieir role will remain as an assistant as they will not be eligible for entry onto the professional register. This links deeply to the debate, now over 150 years old, on the essential components of a professional muse. The argument for professional expertise and professional knowledge is evident within the literature, but there is also the concept of the semi-professional, perhaps represented today by the HCA, but first debated in 1943 by Mrs Bedford-Fenwick (Bedford-Fenwick 1943).

The transition of nurse preparation into HE was not smooth, and the introduction of Project 2000 led to a number of nurses being inadequately prepared for their intended role within the profession. A review of pre-registration programmes highlighted the issue of access to nurse education and the introduction of stepping-on and stepping-off points within the programmes. The proposal for the new model of nurse education was to facilitate a natural point to step-off after two years which

would also meet the government recommendation of both stepping-on and off points during the nursing programmes. In order to meet the proposals of stepping-on, cadet schemes were reintroduced. Valley College developed a partnership which provided a choice for young people, through a vocational qualification and cadet scheme, to step-on to nurse education programmes.

However, if an option was available where the clinical components of cadet programmes and pre-registration nursing programmes could be wholly managed and delivered firom within training departments in NHS Trusts, hospital staff may have a clearer understanding of the roles and responsibilities of both the cadet and the student nurse, and the accompanying skills and competencies required for entry into the nursing profession. This in turn may help to resolve the misunderstandings which currently occur at clinical level, and enable the HEIs to recognise the cadets as a valuable asset to the nursing programmes and encourage stepping-on, but only if the cadets feel they could cope.

The issue of widening the entry gate to nursing would not have occurred if the academic requirements had not been so radically altered when nurse education moved into HE; if the SEN qualification had been retained it would, as it had done very successfiilly in the past, and provided an alternative route to qualified nurse status. Many believe the practical enrolled nurse should not have been replaced by NVQ qualified HCAs suggesting that the acquisition of skills by HCAs is of less value than the academic knowledge required by qualified nurses today. But we have already seen that nursing is a multi-faceted role with the skills component being equally valuable, and the student nurse curriculum reflects this balance.