Time to raise the bar for entry to nurse education?

Will Ball, a member of the Social Science and Nursing core student group, asks whether it’s time to re-think nurse recruitment.

As a current Adult Nursing student, it was a privilege to be involved in the conversations stimulated at the first seminar in Inverness.

Discussion on the day focused on the role that social sciences, specifically geographical approaches, could play in nurse education and the case was put forward that it could serve to instil compassion and critical thinking skills in future professionals. Alongside this was an interesting exploration of the academic validation of nursing as a subject that could come with this approach.

One point of discussion that interests me concerns the demographics of applicants to nursing degree courses. Having recently dropped the diploma entry and converted all UK nursing courses to degree only, the direction of movement in nurse education is already towards academia. However, standards for entry to courses generally remain flexible and are much less demanding in terms of school-leaving grades than other subjects. Could raising the qualification bar for entry to nursing feed into a more academically grounded group of professionals?

My experience of studying in both London and the Highlands of Scotland tells me that nursing courses attract a variety of people, from recent school leavers to more mature students who have experienced the job market and made a conscious decision to join the nursing profession later in life. Both groups make a contribution to the profession and higher grades would affect access for some who would otherwise make excellent nurses. If the standards were to be raised, more room could surely be made for access or ‘pre-nursing’ courses to allow for those dedicated to the profession who may not have applied themselves earlier.

There is also the (somewhat flawed) perception that newly qualified nurses today are ‘too posh to wash’. Making entry to nursing more academically demanding would certainly not play well in the current media narrative. One should only look at our medical colleagues to see that higher standards of entry do not mean less compassionate professionals.

If we value a more analytical and academic cohort of nursing students, who will respond to perceived deficiencies of the profession in their future nursing careers, should we not look toward those high-school or college students who excel already?

Will Ball is Student Nurse at the Highland Campus of the School of Nursing, Midwifery and Health, University of Stirling and member of the core student group of the Social Science and Nursing Seminar Series.



  1. James Shewan says:

    Interesting stuff, Will. Question: how do academically minded nurses thrive in hospital and ward settings where academia is not actively promoted and encouraged? I can’t help but notice on many of my placements how much easier it is for a newly qualified nurse keen to put their theory into practice to relapse into traditional routines and patterns. There is also low morale, poor work contracts and staffing levels to contend with on many wards – dis-empowering an army of nurses.

    I suppose I figure until this is overcome, lecturers need to instill confidence, empowerment and solidarity in their students. Perhaps, the pursuit of academic excellence in nursing, therefore, needs to wait until we establish a strong and confident foundation upon which it can thrive.

  2. Will Ball says:

    That is certainly an issue to overcome. Newly qualified nurses (indeed any professional in any field at the beginning of their career) can be massively influenced by the culture in which they work.

    A very simplified and perhaps optimistic side of me would hope that a different demographic of nursing students would, as a cohort, translate into a group more likely to challenge the negative perceptions you mention.

    I believe that more academically minded students in courses wouldn’t simply result in better essay writers. I have seen reference made to a Florence Nightingale quote which (to paraphrase) urges us to not just be people of thought, but also people of action.

    An academically minded nursing student might be more disposed to challenge conventional wisdom on a ward as well as fulfil the ideals of evidence based nursing which we are taught today.

    I do agree that our lecturers and mentors play a hugely important role in this. I also see that students with more developed critical faculties as a starting point can help to close the gaps between theory and practice.

  3. Raising the bar? Well, yes/but… The first issue for me is a pragmatic one. It is the number of RNs required by the NHS. There would be a point reached where the raised bar would not produce enough applicants to meet education commissioning targets. The higher the bar means better academically prepared students but this cohort would face competing with other career pathways that have much better pay and conditions. You really would be asking for altruism/vocation as a compensatory mechanism. Given the current context of the NHS, prospective students with good grades have ‘better’ options in terms of career. Nursing is not yet culturally acknowledged by the lay public as a ‘proper’ profession despite the the best efforts of Nursing itself. Thus to attract a high number of high achievers, the occupation has to ‘sell’ itself as a profession in which you exercise a degree of autonomy, financial reward, mastery of skills and a very clear purpose beyond nebulous notions of ‘care’. I don’t think that in theory, or in many practices settings, it can deliver on that promise. Until the NHS/Society properly supports nursing, it will be a Cinderella ‘profession’ relying on the goodwill of its practitioners and so not attractive enough to the required number of high grade students. I don’t know how high the bar has to go before we see a drop off in applicants.

    James’ point is therefore pertinent as he acknowledges the culture into which academic nurses have to survive. Make no mistake, this is a socio-political issue which society never has dealt with and now through government, has accepted that is too expensive, see: http://www.bennygoodman.co.uk/care-quality-in-the-nhs-we-can-do-better-than-this/ . Care is also a feminist issue (i could go on….)

    Ana answer is to accept the current bar, but struggle for educational resources to help build confidence, resilience, academic development for our future workforce.

  4. I think Will and Benny raise a number of interesting points.

    I feel the debate regarding entry standards is a rather complex one as there are so many vested interests in nursing. For example the Philosophy Department at a university have to think within their budget, what expertise members of their department hold and how they can share that with students. Nursing has to contend with all that but also keep practice partners sweet, the NMC, NHS Education for Scotland, Scottish Government as well as having new entry numbers set by that government! I think we have been a bit absent minded in terms of looking to the future. How many universities embrace the European Credit Transfer System for example? Universities are striving to be more international and nursing cannot turn its back to this. We need to start thinking ‘undergraduate’ rather than ‘pre-registration.’ At the first seminar Professor Andrews raised an interesting point that the ‘pre-registration’ course as we know it will be gone, as we embrace European and North American ways of taking broad undergraduate courses and specialising as we progress up the academic ladder. Are Nursing departments in universities thinking ahead to ten or fifteen years time when courses are going to be structured in dramatically different ways? How this will affect the number of candidates who goes on to become a nurse, I do not know or if it would meet government/workforce number targets.

    As for entrance requirements. It’s an issue I wrangle with in my head. Personally I feel that a standard is a standard. You either reach it or you do not. I think they are played with far too much in order to appease university bosses in meeting certain popular policy targets. I do not see why it should go up or down to0 much, and I think it was Francis (2013) who recommended a standard entrance criteria across the whole of the UK.

    As for attracting the right kind of person into the profession. This is where nursing stands out from the crowd. There is a reason for a 50:50 theory: practice spilt. To be an excellent nurse you need to have both. We have moved to values based recruitment and retention. There is a reason why the academic standards exist- to ensure a person meets one part of the 50% and a whole recruitment and selection process to ensure the person meets the other 50%.

    James you make a really good point. But why do we prefix so many words with nurse? Shouldn’t all nurses be academic? As we move to an all degree profession, is that not going to be the case? But I do think you articulate that tension and the realities of why that tension exist very well. Matt talks about our medical colleagues. How do they manage these issues? Perhaps there is no one answer but I do think embracing dual posts in one way- nurses who are based in practice a number of days and a number of days attached to the university. How many of our medical colleagues, including recently graduated ones holding part-time academic fellowships alongside their clinical work. Or indeed consultants who hold honorary lectureship posts, where the university department has clear and tangible links with the hospital ward or community clinic.

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