An article published today on bmj.com argues that forcing nurses to undergo work experience before their studies will not improve nursing standards.
Following a suggestion from the Francis report that nurses should undergo paid work as healthcare assistants prior to study, Elaine Maxwell says that there is no reason to think it makes them better practitioners.
She argues that it plays to the popular conception that nursing is purely about caring: without recognising the cognitive skills required.
Although there is no evidence to support the idea that work experience will improve the understanding of diagnostic skills, there is strong evidence to suggest the positive association between the educational attainments of nurses and clinical outcomes.
Maxwell gives an example from Jarman and colleagues who found that higher hospital death ratios in the UK were associated with a greater proportion of healthcare assistants in the nursing workforce. Plus, a further study found that for every 10% increase in the number of degree educated nurses in the US there was a 4% drop in patient mortality.
She also points out that as nursing forms the largest part of the healthcare workforce this has a significant overlap with medicine and any deficit in skills will have a significant knock-on effect on medical staff.
Maxwell also worries that as the workforce demographic changes, the bright enthusiastic school-leavers that the nursing world is trying to attract will find it a less attractive option if they have to delay their start to university.
There is also a danger of this changing the shape of the existing workforce and Maxwell asks if the thousands of healthcare assistants will have to give up their jobs for potential nursing students.
Maxwell concludes that the route to improved nursing standards is not to “return to a theory-lite apprenticeship model” but to improve practice environment and supporting the existing workforce to practice high standards.
Personal View: “Francis inquiry: compulsory work as healthcare assistants won’t make better nurses”,
BMJ 2013;346:f2480 doi: 10.1136/bmj.f2480