Futurama

A few weeks ago, I met up with a student - we’ll call her Mavis - for a tutorial prior to an exam. Nothing unusual in that, pretty standard university lecturer activity. Except Mavis was a third year, who should have qualified last September but was still resitting an exam she had already failed three times in her second year.

For some reason, the chair of our exam board is incredibly generous with resits and it’s not unheard of for students to get fourth and fifth attempts. This would make sense were there any evidence of actual improvement in performance, indicative that perhaps one more go might be the charm. But Mavis’s marks had hovered in the low twenties throughout all three previous attempts. There was very little chance of her suddenly pulling the rabbit out of the hat and being successful.

Now, Mavis could have just decided she was going to jack it all in and not bother putting herself through the stress of the exam for a fourth time. And who could blame her? But when I tentatively broached the subject of her considering the prospect of the possibility of the potentiality of her not passing yet again, she made the not unreasonable point that she had spent just over three years of her life on this course and to fail now would be as if she had wasted all that time.

Why do I mention this? Because Mavis is not alone. There are dozens of students resitting one exam or another, at various stages in their course. Some, like Mavis, are drinking in the last chance saloon. Some are just stepping onto the yellow brick road that might just lead to the fabled city of Exam Success, but possibly doesn’t and won’t and never will. What would be better for some of these students would be if they could step off the course with workable qualifications that fell just short of registration.

Of course, we used to have something similar to this in Ye Olden Dayes. They used to be called Enrolled Nurses. The qualification was dispensed with in the 90s, at around the same time as nurse education moved into universities, in the quest for greater professionalisation and thus better pay and conditions. It has to be said, being an enrolled nurse was a bit of a career dead end and there was an over-representation of women from minority ethnic groups among their number but the longer I work in nurse education, the more I think we may have thrown the baby out with the bath water.

I’m not about to argue for the return of the EN. That would roll back all the hard work done in the name of greater professionalism and equity with other healthcare professionals. What I would argue for is an all-graduate profession. Dispense with the diploma route altogether and drag nursing up to the same standard of education as occupational therapy, physiotherapy and social work. But build in stepping off points for students who decide they don’t want to, or aren’t able to progress through the whole three years. So, you could step off at year one with a certificate in higher education, which would prepare you for an advanced HCA role. You could step off at year two with a diploma in higher education, which would be the minimum qualification for an associate practitioner of some sort.

But why stop there? Why have only one route into advanced HCA or associate practitioner roles? Because, let’s face it, there just aren’t going to be that many registered nurses about in the near future. A significant number of RMNs come up for retirement in four years time; commissions for student nurse places were cut in the latest NHS deficits - there’s a massive shortfall in nurse numbers just around the corner.

I believe this means the nature of a registered nurse’s work will change. They will become directors, managers and supervisors of care. The frontline care-providers will be those associate practitioners and advanced HCAs I mentioned before. So let’s increase their numbers now. NVQs at level 3 and 4 and foundation degrees focussing on specific domains of care are the future. Trusts will grow to love them - they’re cheaper, mostly part-time and the people they train up are proficient in specific interventions or in specific areas and can pretty much hit the ground running, having acquired their qualification through work-based learning.

The EN is dead, and long may it remain so. But prepare for the rise of the HCA. They’re already in your unis, or colleges of further education, beavering away at those NVQs and foundation degrees. They’re coming, soon, to a workplace near you. Embrace them, they just might save your service.