Modelo de Trabajo experimental

The implementation of Project 2000, was the new direction for nurse education; the aim being for nurses to be ‘knowledgeable doers’, United Kingdom Central Council (UKCC, 1986). Prior to Project 2000, most UK nurses were trained at schools of nursing working on the job training within district general hospitals by clinical nurse tutors who were considered experts within clinical practice. Nurses who were trained during this time believe this was the ‘golden era’

(Gillett, 2014, p. 2498) of nursing with student competence and confidence being assessed by clinical nurse tutors working within clinical nursing practice. Nevertheless, student nurses, in the main accepted clinical routines and archaic rituals which had no theoretical underpinning, happy and compliant to continue the habituated practices of their fellow colleagues and senior nurses.

Significantly, O’Connor (2007, p.210) maintains the view that nursing is ‘a calling’ which historically provided the profession with a strong sense of community and ‘role identity’

Susan Harness 36 workforce as lecturers in nursing within higher education. Interestingly, Freshwater (2000, p.484) questioned if nurses have been socialised ‘into having no voice by the teachers who may themselves feel oppressed’. She proposed that the current system of nurse education (which nurses argued should be nurse-led) was in ‘danger of reinforcing the submissive position of nurses’ (Freshwater 2000, p.484).

Since the arrival of Project 2000, the nursing curriculum has been focused on enabling and empowering nurses to develop skills in critical engagement of the theories and underpinning literature that students are able to apply to their clinical practice. In addition, clinical skills are taught in university where students are encouraged to apply critical thinking processes to why these skills are necessary. This new style of education reflected the political and societal drivers to reduce the length of stay for patients in hospital, care to be delivered closer to home, together with the increased complexity of health and social care needs of patients and families, that mirrors the global multi-faceted climate within the 21st _{century (Department of}

Health, The NHS Plan, 2000). Nonetheless, nursing became thwarted by the pressures of managing disease and the acquisition of developing skills and competencies in the ‘discipline of disease’ (Morrall, 2009a). In addition, there are arguments that draw attention to some of the realities of nurse education where there are relatively low entry criteria together with a ‘bums on seats’ philosophy that some higher education institutions (HEI) have regarding nursing. Nursing is often seen as a steady cash flow from large numbers of students. Within this consumerist society where students are seen as ‘customers’ and a feeder for the NHS , means that nursing is at risk of losing their freedom to control its own destiny and

pessimistically, Morrall (2009) regarded universities as ‘training warehouses’ (p.9) for nurses. Goodman (2011) claims that ‘nursing has no philosophy of its own’ (p. 726) with Shields et al.,

(2011) asserting that developing critical thinking skills is encumbered by intellectualism being

‘devalued within nursing (p. 616) and the dumbing down of nursing.

Nevertheless, Cleary et al., (2009, p. 634) identified the challenges to ensure that the nursing workforce is large enough and has the necessary competence to manage the changing demography and demand for the 21st century. The debate continues with the Willis Review (2012) of how nurses need to be educated to degree level at universities. However, there are

Susan Harness 37 conflicts to this concept with a qualitative study by Ross et al., (2013, p.1345) who used open–ended telephone interviews with Deans of Health. Responses were treated anonymously that exposed tensions within universities of offering nursing as a degree. Comments from participants included that nursing was perceived as ‘diluting academic esteem, metrics and performance’. In addition, some universities have a prejudice about nursing and do not consider nursing as being a legitimate part of an academic university. Comments such as:

“Academic standards at university XXX are about grant income, completion rates of PhDs, number of doctoral fellowships funded externally and number of quality publications.” “The university does not see nursing as being a legitimate part of an academic university. Universities are still male dominated institutions with deep-seated prejudice about nursing in universities.”

These anonymised quotations from some HEI’s, reflect the undercurrent of feeling towards nursing, that despite the attraction of money generated from large student numbers, their main priority is maintaining and improving the University’s Research Excellence Framework (REF) score and thereby attracting the ‘best’ students in relation to academic ability. Recent changes within government (Department of Health (DH), 2016) have confirmed that student nurses will now need to pay for their degree and lose their existing bursary. The intention of this policy was to lift the cap on nurse numbers but early evidence suggests it is discouraging applications resulting in a reduction in student numbers. In a House of Commons briefing paper (Hubble et al., 2017) confirmed that there were 10,000 fewer applicants from student nurses in England, a fall of 23%. In addition, The Kings Fund (2017) have recognised that additional pressures may arise from the Brexit negotiations by reducing the number of workers from European countries, specifically into the nursing profession.

Against the cultural backdrop over the last 30 years and the transition from hospital-based training to university education, the implications being that becoming a nurse and nursing has faced multiple challenges that continue to shape and impact on identity. The next section will

Susan Harness 38 provide some understanding of how having a professional identity may influence nurses’ perception of themselves.