Some controversies in the education of nurses in New Zealand, Great Britain and the United States, with reference to the impact of economic and social factors

It is shown how debates on the appropriate education of nurses are strongly affected by economic, social and interest group considerations in addition to the overt educational arguments.

Abstract

ABSTRACT This paper aims to show how debates on the appropriate education of nurses are strongly affected by economic, social and interest group considerations in addition to the overt educational arguments. Concentrating on the New Zealand situation, but making some comparisons with the U.S. and U.K., it discusses the following two issues: 1. (i)hospital-based training against training based in an educational institution; 2. (ii)the case for and against two levels of qualified nurses. 1. (i)A phased transfer of responsibility for training of registered nurses from hospital boards to technical institutes is well under way in New Zealand and a detailed evaluation has been published. Reservations about this transfer included (a) the practical and financial problems of staffing hospitals with reduced student labour, (b) the possibility of educational provision above the needs of regular nursing care and raised expectations of a role beyond that which would be encountered, together with unwillingness to perform standard tasks; (c) the possibility of insufficient practical training, while aims in addition to educational concerns included (a) the intention of attracting able students in larger numbers and from a wider variety of backgrounds, (b) the hope of reduced disillusionment with the stress of the dual student/employee role and consequent lower wastage. These reservations and aims are discussed together with evidence to date of their justification. 2. (ii)New Zealand, like the U.S. and the U.K., has a second level of qualified nurses with the training period shorter than registration. Among arguments for abolition of this second level are the perceived need for professionalisation of nursing and the contention that nursing services are expected on the cheap and/or beyond the training provided, while advantages of the second level of nurses include financial savings if substitution is for registered rather than unqualified staff, and opportunities for training for those who would not choose the registration option. On both points it is argued that historical, economic and social factors and the personal and professional interests of participants affect their stance in a predictable manner. Further, educational issues are closely related to the development of nursing as the female-dominated, comparatively low-paid, caring profession in parallel with the male-dominated, higher-paid medical profession. Hence the paper concludes by discussing the impact of educational, economic and social change on supply, demand and wastage in the nursing market and on nurses' expectations and argues that pressure for greater nurse autonomy and responsibility within the health team are irresistible.