by investing in nursing

Marion Mason R.G.N.

32

Thank you to my m

any colleagues whom

I used as “S

ounding Boards”. E

nabling me to focus on this w

ork, to show

the way forw

ard and resolve our NH

S crisis.

© M

arion Mason 2017. A

ll rights reserved.

In accordance with the C

opyright, Designs and P

atents Act 1988,

the author asserts her moral right to be identified as the author of this w

ork.

54

Marion (centre) in training

Marion, staff nurse, 1973

Marion (m

ore recent) nursing

Saving the NH

S

Our B

ritish National H

ealth Service was originated on the ideal that

health care should be available to all based on need, regardless of m

eans to pay.

The British public hold to this right despite the constant changes in m

edical technology and political interference. In 1948 this country form

ulated a process of health care delivery unheard of.

Britain had at that tim

e the best medical facilities, research and m

edical professionals in the w

orld. Many countries have since evolved their

own health care packages but all have their faults and draw

backs. Our

National H

ealth Service w

as and still is the best in the world.

This is despite various Governm

ents in our country using the NH

S as

a “Political Football”! This has unfortunately had a knock on effect in

its ability to deliver. Political intervention has only tinkered at its edges

preventing any long term positive effects. B

ut one change in nurse training introduced approxim

ately 28 years ago has unfortunately had an effect upon both nurse training and the operation of the N

HS

. This is called P

roject 2000.

To inform you clearly I have to give you a short history lesson of how

nurse training and eventual qualification operated.

In 1948 at the inception of the National H

ealth Service, the country having

inherited post war nurses of varying abilities, there w

ere no formally

76

trained nurses, which is w

hy we therefore proceeded to have tw

o levels of nurse training in this country.

Establishing a formal regulated training

That was tw

o qualifications of nurses which w

as different to most other

countries at that time.

State Registered N

urses (SRN

)W

ho did three years training and were 1

st level nurses.

State Enrolled Nurses (SEN

)W

ho did two years training and w

ere 2nd level nurses.

In the Beginning

My first personal experience of nurse training w

as in 1966 when I joined

as a trainee nurse.

At that tim

e my interest had been triggered w

hen I visited a relative in H

ospital over several months. I had not decided on any specific career

path, so I decided to enquire about nurse training. I applied, was

successful in the entrance exam and com

menced nurse training six

months later.

Here com

es the history lesson as I have to now explain how

nurse training operated etc. To show

what has changed for the w

orse and how

it needs to be rectified and reversed, which w

ill lead to saving the NH

S.

From the inception of our N

ational Health S

ervice and subsequent nurse training, this training took place in each large hospital they could be called a “Training” hospital. E

ach large hospital had its own S

chool of Nursing.

It was quite extensive w

ith tutors, admin staff, practical training room

s, classroom

s etc. Each follow

ed a national curriculum and the training

was run on excellent academ

ic lines with a com

bination of academic

classroom teaching and practical experience.

I elaborate on this to confirm that the training w

as as good as the more

recent university training and it worked!

This resulted in qualified nurses with a w

ide practical experience to be staff nurses on our w

ards and who w

ere often headhunted from other

countries. We therefore had tw

o qualifications of nurses in this country different from

most other countries as I have m

entioned.

After the point of initial registration there is an expectation that all

qualified nurses will continue to update their skills and know

ledge. There are opportunities for m

any nurses to gain additional clinical skills after qualification, this has alw

ays been in operation.

The nursing and midw

ifery council insists on a minim

um of 35 hours of

education every 3 years as part of its post-registration education and practice requirem

ents.

To clarify further we had 3 years training for state registered nurses

(SR

N) and 2 years training for state enrolled nurses (S

EN

). Application

and acceptance to enter the training was based on requested G

CE

98

results or a successful entrance exam. The three year training w

as arranged to ensure a process of academ

ic training and practical experience. A

t comm

encement approxim

ately 6-8 weeks initially spent

in the classroom then allocated to w

ork on a ward in the hospital for a

specific amount of w

eeks.

The first year student nurse was an im

portant part of the team and

allocated accordingly to ensure experience was gained in all specialities.

The team on w

ards, depending on how acute the care delivery, w

as balanced w

ith varying levels of 1st year, 2

nd year and 3rd year students,

trained staff and nursing auxiliaries (care assistants). The students were

part of the working team

not supernumerary!

To ensure students received an element of full experience these w

eeks on specific specialities w

ere pre-arranged well ahead of the placem

ent and covered the full year. E

ach student knew their allocation of tim

e and date in each w

ard. The ward also knew

and could balance the skill staffing accordingly. This w

orked well and w

e had no staffing issues due to lack of staff. P

ractical training was arranged and follow

ed through w

ith practice nurses/tutors visiting and spending time w

ith each student sim

ilar to what is now

referred to as mentors.

Prior to the end of each year of training, the student w

ent back into “block”, the school of nursing for a designated period, approxim

ately 4 w

eeks for additional academic training and an end of year exam

to ensure they w

ere competent to proceed and progress to becom

e a 2nd

year student, then a 3rd year etc.

Each tim

e as this was a recognised accolade/prom

otion in their scale an additional stripe w

as added to their uniform/cap or epaulettes or different

colour belt. This ensured a visible accolade within the nursing profession

of their achievements.

All staff w

ere aware of the level a student had achieved.

The same training process w

as followed for the 2 year nurse training

(SE

N).

As I have m

entioned we had 2 levels of qualified nurses in this country.

The 2 year training was a slightly less academ

ic entrance exam w

ith a shorter training period. These nurses w

ere called State E

nrolled Nurses

(SE

N). In training they w

ere called pupil nurses as against the student nurse title. W

hen qualified SR

N’s w

ere 1st level nurses and S

EN

’s were

2nd level nurses.

When in training they had a fairly sim

ilar training plan as student nurses they initially spent several w

eeks in the school of nursing, approximately

6-8 weeks then w

ere allocated to a ward for a specific period of tim

e follow

ed through with practical training on the w

ards (mentoring). They

were an im

portant mem

ber of the team. N

ot supernumerary! A

gain, as w

ith students, they returned to the School of N

ursing for additional academ

ic training and end of year exams.

The final package was that w

e had very experienced nurses due to having w

orked in hospitals as part of the team and w

ith academic tim

e spent in the class room

. An additional positive outcom

e from this in house training

1110

was the ability to m

onitor the individual student/pupil within the w

orking situation and help establish if they had chosen the right career path.

1. H

aving the opportunity to work in this environm

ent as part of the team

enabled the students to judge if this is what they had presum

ed a nursing career w

as, it was w

hat they expected and it was the right career for them

.

2. M

entors and senior nursing staff also had the ability to monitor the

student’s adaptability to this nursing position. Their empathy and ability

to look after ill, dependant patients and if they had the patience and attitude to perform

as expected in this vocation as a professional nurse.

This ensured very little dropout rates of trainees. Unlike the current

situation post Project 2000, unfortunately due to the sm

all amount of

time spent on the w

ards, most only com

e to the conclusion it is not for them

well into their training. C

urrently there is a dropout rate of 28-30 %.

This can prove very costly and time w

asting.

The Present Training

We now

, since the early 1990’s, have a training system w

hich is called P

roject 2000.

In the past there were various debates about the need for nurses to be

degree trained, most of this cam

e from various academ

ics and to some

degree politicians! What w

as behind their thinking of this need to change

what had proved to be a successful form

of training was never clarified

except for nursing to equate to a degree career. Approxim

ately 28 years ago w

e were inform

ed that there would be a big change in nursing. The

initial information did not define w

hat or how it w

ould change. When

the Project 2000 training w

as announced, it was that nurses should be

trained at a degree academic level and it w

ould continue with only the

3 year training to qualify as a nurse. No longer w

ould there be State

Enrolled N

urses!

Therefore the current stream of S

.E.N

’s would be phased out. This w

ould happen in several w

ays. State enrolled nurses 2 year training w

ould no longer exist. S

.E.N

’s were given a choice to apply to convert w

ith additional training after, w

hich they would be S

tate Registered N

urses. M

ost of the SE

N’s opted to apply for this course as they had additional

status and an increase in salary and of course they wished to rem

ain in the nursing profession. S

ome w

ho did not choose to do so, mostly older

nurses could continue with their current status and as they retired this

would eventually phase out S

EN

’s.

Project 2000 radically altered the face of nurse education.

Also to accom

modate the am

ount of SE

N nurses to change to S

RN

’s eventually took several years.

The change to the training of student nurses i.e. State R

egistered Nurses

began its process also.

To proceed with this change and have degree trained nurses, the training

1312

was passed to U

niversities. A prospective nurse applied as required for entry to the allocated university, acceptance w

hen confirmed w

as for entry in S

eptember as is usual in the academ

ic year. The student spent initially 6-8 w

eeks in the classroom/U

niversity. There after they proceeded w

ith Monday to Friday as per the academ

ic week. B

ut for this nursing course it consisted of 2 days in U

niversity, 2 days in an allocated supernum

erary placement in a hospital. Then one day study. They are

no longer part of the team!! This m

ay in theory sound like a usual way

of taking a degree course but in reality the drawbacks are huge and it

is this Project 2000 process that has contributed to the current abysm

al situation in the nursing sector w

ith lack of experience and less working

on the wards. B

ut let me put it into a reality context. I have m

entioned previously nurse training and that you w

ere part of the team on a w

ard/departm

ent etc. This in theory was a seven day a w

eek working situation

but where the student did only 37.5 hours per w

eek as part of the team,

study time w

as allocated for these students as an expected part of their em

ployment. They w

ere allocated different shifts weekly over seven

days, consideration of course was given to requests for particular days

off this worked w

ell and all staff were rota’d in the sam

e manner.

In the University scenario, the student is no longer in this experience

situation as they are Monday to Friday only.

• Tw

o days in the university setting•

Two days in the allocated w

ork setting•

One day study

But are supernum

erary in this position therefore experience of the

post of a nurse, of the vocation, does not signify unless they are pro-active in putting them

selves into learning situations where they can

gain experience. It does not always happen even w

hen allocated a m

entor, which is usually a senior m

ember of staff on the w

ard/dept. who

themselves are very stretched in their ow

n work situation. The one day

study is really farcical as this rarely is that. I can confirm m

ost use this day to w

ork elsewhere, som

e in care homes as care assistants in order to

supplement their incom

e. Students need to supplem

ent their low incom

e. I w

ill discuss the wage/bursary situation later.

In the previous two and three year training part of the allocations w

as enabling trainees a period of tim

e in all specialities which included w

orking in the com

munity w

ith a district nurse, working in the psychiatric sector

and longer period in gynaecology with som

e midw

ifery experience.

In the past pre-Project 2000 there w

as a very low dropout rate of trainees

prior to graduation. Yet currently the dropout rate of students is now 28-

30%, rather alarm

ing. Som

e reasons given for this is that students want

to work on the w

ards, want to spend m

ore time in the practical setting.

Caring for patients and gaining experience and they w

ant to be valued as part of the team

.

Again I repeat som

e admit that w

hen they qualify they do not feel capable of the sudden responsibility of the position due to lack of practical experience.

1514 Shortage of N

urses

In this current time, w

e are all living longer due to medical im

provements

and technology, we w

ill all benefit from the innovations in m

edical progress.

We therefore have a larger elderly sector living longer w

ith complex

medical conditions, therefore the need for increased hospital care delivery,

increasing pressure on the need for more resources and m

ore staff.

We need m

ore nurses!

This has also added to the necessity for more nursing hom

es to help care for our increasing elderly sector. B

ut we need m

ore nurses to man

these care homes. Therefore m

ore nurses are needed!

Yet we are training few

er! The government has reduced the funding for

training. They are responsible for the current shortage having over the years slashed student nurse places. The dropout rate over the past years has also increased resulting in less nurses qualifying.

Pre P

roject 2000 student training in the hospitals usually had 2 intakes, M

arch and Septem

ber. This resulted in more trainees in place, the

current new degree training is based on one intake annually therefore

training less students. Another knock on effect/cause for the reduction in

nurses qualifying.

Com

munity C

are – Social Care

Nursing shortages are creating a huge hole in com

munity care, less/

no nurses to deliver this care to patients in the comm

unity. This leads to m

ore pressure on hospitals and more adm

issions. Shortages of staff

are comprom

ising quality with district nurses at breaking point. There is

a profound and growing gap betw

een capacity and demand. The district

nurse role is in danger of extinction.

Previous to Project 2000

Com

munity nurses enabled m

edical care to be delivered to anyone in the com

munity w

ith chronic conditions. This care and monitoring in the

comm

unity prevented hospital admissions unless absolutely necessary.

These district nurses were an essential part of the linked up care that did

exist.

Also, post-operative patients could be sent hom

e earlier from hospital

with a package of care, this w

as arranged and passed to district nurses. It w

as usually arranged in liaison with them

prior to discharge. This helped prevent the current situation of bed blocking.

Currently in 2016 nearly 100,000 dead days w

ere lost when patients

ready for leaving hospital could not be discharged. This has increased by 33%

due to cuts in council funding.

1716

The choice is no longer available – fewer trained – few

er nurses to continue the valuable and necessary service. The years of cuts w

ill take m

any years to repair, for too long there has been a lackadaisical approach to nursing w

orkforce planning. All this is a false econom

y.

The cost implication alone due to the increase in hospital adm

issions, bed blocking, dem

and on accident and emergency attendances and the

additional demand on the am

bulance service could all be improved w

ith m

ore nurses.

Why does the governm

ent therefore reduce the funding for nurse training? W

e constantly read how m

uch money is needed to operate the

NH

S. The answ

er to our NH

S crisis is sim

ple. Train more nurses!

Cuts to nurse training places have forced trusts to rely on hiring nurses

from overseas and hire tem

porary agency staff just to provide safe staffing.

Who is to blam

e?

Successive governm

ents have used the NH

S as a political football to

the detriment of the B

ritish people and the ultimate core policy of this

health service which w

as such a forward thinking project and the envy

of the world.

They need to wake up and realise that budget cuts w

ill never improve

patient care.

The NH

S is in critical crisis and needs m

ajor investment in nurse training.

Also, put a stop to dow

n grading of nursing skills and experience.

The impact of years of pay restraints is affecting recruitm

ent and retention of staff. N

urses pay is now 10%

behind inflation.

Unfortunately m

uch evidence has become available of the drop in real

terms of nurses earnings since 2008. The R

oyal College of N

urses (R

CN

) has agreed that restraining pay while dem

and is increasing is a false econom

y, making it harder to retain staff and forcing m

any to work

for agencies to make ends m

eet.

1918 Past G

ood Practice

It is not often when speaking to young people about their career choices

that nursing comes into the conversation.

We need to change this.

One schem

e that hospitals used to operate was to recruit a lim

ited num

ber of school leavers who w

anted to become nurses, (entry to

training was not available until 18) to have a placem

ent at hospitals until they reached the age of application. These cadets, as they w

ere called, w

orked in various departments in the hospital i.e. m

edical records, clerk, non practise position.

The same system

could be introduced back with 16 year olds being

recruited as a form of apprentice training. They w

ould work in the hospital

part time w

ith part time study release. They w

ould study the additional requirem

ents needed for nursing entry such as anatomy, E

nglish etc.

This would ensure a stream

of interested dedicated individuals who

would gain the required passes in college in relevant subjects needed

to enter nurse training, also simultaneously gaining experience in the

hospital setting. They would be paid an agreed w

age (dependant on the apprentice training). They w

ould make a contribution to the operational

working of the hospital. They w

ould have a goal in sight in the example

of the nurses they observe daily.

Solution

We need to pursue an increase in nurse training but to continue this as

partly what training w

as pre Project 2000, the student has to be part of

the working team

in the hospital.

To continue with the operation of nursing as a degree vocation, w

e could com

mence the intake at universities as the current situation, but

arrangements w

ould be in place to accomm

odate the “hands on” experience by allocating students to placem

ents as discussed previously. After the initial 6-8 w

eeks, students would w

ork in their allocated speciality, as part of the team

, not supernumerary. As part of the team

, they would w

ork 37.5 hours w

eekly, rota’d as other staff but they would be treated as their level i.e. first

year, second year or third year for skill mix. To ensure study hours are also

incorporated as part of the working situation, agreed hours w

eekly would

be part of the contract. This would therefore certainly equate to the current

University situation and w

ould ensure good academic outcom

es. Also with

e-learning, which has now

evolved, it would progress w

ell.

Mentors/clinical nurse tutors w

ould work w

ith the students in the work

place setting and would help deliver the best practical training and

experience currently lacking. Students w

ould attend the university at the prescribed tim

es, end of first year, end of second year and end of third year, for additional classroom

training and end of year exams to progress

to next level.

This change only needs a willingness from

government and academ

ia to progress.

2120 R

ecomm

endation

Another w

ay of ensuring we have an increase in nurses w

ould be to introduce 2

nd level nurses back into the training schedule and the w

orkforce (SE

N’s).

The academic requirem

ent for entry and/or the entrance exam w

ould be low

er/less stringent and it would be for a 2 year training program

me.

This would ensure continuation of vocational and com

mitted accountable

nurses, it would open the doorw

ay to those whom

would be excellent

nurses but the initial academic level exam

precludes them. There are a

lot of prospective nurses out there.

Training would com

mence at university in the sam

e way as the R

GN

’s or 1

st level 3 year training with a different suitable curriculum

. They too would

be back into the hospital setting as part of the team, not supernum

erary, financially it w

ould eventually save all the agency costs to have more

training and eventual trained nurses.

Any initial financial outlay to change the curriculum

with university and

organise the administration issues w

ould be negligible compared to the

pending cost implication of increasing agency staffing and recruiting

from overseas.

There are more overseas nurses than ever before, since 2004-2005 they

have made 40%

of the new entrants to the nursing and m

idwifery board.

The new training process could be changed to w

hat was pre P

roject 2000 w

ith salaries paid to the students as agreed with their w

orking situation. The governm

ent could agree a level of funding to the universities so academ

ic sustainability is continued. This would be sim

pler than the situation w

ith bursaries that exists now but about to be changed to the

student loan situation.

The student nurse would not be burdened w

ith this pending student loan situation. The student nurse w

ould be working partly in the hospital

environment gaining experience, w

ith agreed study sessions and returning to university for end of year additional tutoring and subsequent final exam

s, thus progressing to becom

e a very experienced qualified nurse.

We w

ould very soon have a strong home grow

n nursing force.

More nurses to w

ork in the comm

unity, more to w

ork in nursing and residential hom

es. More nurses to m

an the wards therefore bring back

the nursing levels required, reduce agency costs and importing nurses

from other countries.

Wage and B

ursary Situation

The RC

N has expressed serious concerns about governm

ent proposals to change the w

ay nurse training is funded and planned.

In the spending review D

ecember 2015, C

hancellor George O

sbourne

2322

announced that there will be 10,000 additional training places and health

professional training places in England but students w

ill have to pay additional tuition fees and use a loan instead of receiving m

eans tested bursaries from

2017!

The RC

N believes “the risks reducing the num

ber of older students being able to afford to enter nursing” 1.

The RC

N argues “that nursing courses are not com

parable to other undergraduate degrees, w

ith student nurses having a longer academic

year and spending 50% of their tim

e in clinical practise.” 2 This gives them

fewer opportunities to supplem

ent their incomes in the w

ay that other students do. M

any are older than the average student and have families to

provide for. With salaries as they currently stand, it is unlikely new

nurses w

ill be able to repay student debt during the course of their careers.

Many hospitals now

are not delivering the care that we have com

e to expect. S

ome of this is due to staffing shortages, som

e due to poor com

munication that does exist w

here many staff recruited from

other countries have E

nglish as their second language.

More nurses w

ould ensure A&

E is fully staffed, C

omm

unity care is im

proved, nursing homes are better staffed. C

urrently due to nursing shortages, nursing hom

es, not “residential only” homes are currently

having to be managed by non nursing m

anagers. Not an ideal situation.

Governm

ent tinkering on the edges again

Recently there have been plans announced to introduce “nursing

associates”. This is to be a new role for health care assistants to introduce

more training for them

to assist nurses.

But from

this announcement and subsequent discussion letters etc.

sent into the RC

N m

agazine, many have observed that the prospective

nursing associates is almost the equivalent of w

hat used to be the State

Enrolled N

urses!

Those who can relate to that tim

e in the 80’s and early 90’s remem

ber the statem

ents that there is no place for SE

N’s and they had to either

convert or in some cases good nurses left the profession w

ho did not w

ant to convert.

The government has already stated that it w

ould look at what opportunities

there are for staff in the role of “nursing associates” to become registered

nurses through either a degree level apprenticeship or a shortened degree at university. W

hy did they get rid of SE

N’s”!

Nursing A

ssociates are no replacement for accountable and trained

nurses. Who w

ill control/issue guidance on how their duties w

ill evolve. N

ursing Associates are not accountable. The solution is to train m

ore nurses, not attem

pt to introduce a different care level. This nursing associate idea looks as if it w

ill be unregulated so many questions rem

ain unansw

ered.

2524

This government has a vision for 7 day care yet they appear oblivious

to the lack of nurses which leads to inadequate staffing levels and is

therefore the biggest barrier to this vision of care. How

can an inadequately staffed N

HS

, short of tens of thousands of nurses, also Doctors deliver

this vision of a more efficient and better service.

Previous R

CN

chief executive Dr P

eter Carter has stated regularly that

reduction in nurse training has a “knock on effect”. He stated “there are

clear signals that the hard work of staff is papering over the deep cracks

in our NH

S!” 3

The NH

S w

ill spend at least £980 million on agency staff this financial

year 2015-20164 unless urgent changes are m

ade.

The Royal C

ollege of Nursing has revealed results of freedom

of inform

ation requests showing the cost of agency nurses have increased

by 150% since 2012-2013

5.

Cuts to nurse training places, years of pay restraints and attacks on

terms and conditions have m

ade retention and recruitment difficult, the

RC

N has also reported

6.

Governm

ent plans to scrap the bursary and make nursing students in

England pay tuition fees have been condem

ned by a majority of the

17,000 respondents to an RC

N survey

7.

Almost 90%

rejected the plans which w

ould see bursaries replaced with

loans and could mean nurses starting their careers w

ith debts up to £60,000.

The post Project 2000 university training as mentioned previously aw

arded nursing students w

ith a bursary when training w

as passed to Universities.

Not ideal or as good as w

hen students worked in the hospital setting

(and gained better experience) they were paid a salary at that tim

e. This bursary is to be replaced w

ith tuition fees and students loans. Currently

student nurses receive a bursary from the governm

ent to support them

during their nurse training, this is around £8,000 per year with additional

allowances for students w

ith dependent children.

To now attem

pt to bring in tuition fees and student loans will reduce

those caring and compassionate prospective nurses w

ho cannot afford to proceed w

ith this proposed training package. It could be almost as if

students are paying to work in the N

HS

!

Nursing has been undervalued for too long by the governm

ent. They fail to appreciate how

nurses affect the operation of our NH

S, both in

the hospital and in the comm

unity. How

their vast experience as nurse practitioners can at tim

es replace doctors in some areas. C

urrently they often perform

roles similar to those of doctors, w

ith agreed protocols.

Nurse practitioners carry out care at an advanced practice level.

Specialist com

munity public health nurses, know

n as district nurses and health visitors, nurse consultants and m

any more senior experienced

nurses all these are the glue that has held the NH

S together!

Now

with few

er nurses training, more retiring and the governm

ent’s blinkered approach to nurses it is in part responsible for the current

2726

staffing position shortages. This apparent undervalued perception is also obvious w

ith the pay freeze in the nursing profession.

Now

we have bursary’s w

hich help to subsidise student nurses being rem

oved! Who w

ill now w

ant to enter the nursing profession?!

I am advocating that nurse training should be increased and changed.

We can do this if there is w

illingness on the part of the government

and the current academia w

here some still feel there is a need to have

graduate nurses.

I am not totally disagreeing w

ith this “degree” desire. In theory it is understandable, but student nurse training m

ust be arranged differently to other graduate training courses.

We can incorporate part of the university teaching but the students m

ust have the ability to be part of the w

orking team. This w

ill result in better trained and experienced nurses. In this scenario of the “w

orking” student, a salary can be paid, therefore resolving the pending bursary/student loan situation. Incorporated w

ith this, I am advocating the re-introduction

of 2nd level nurses; they can be called a suitable title of choice, opening

an additional nursing stream. This w

ould introduce more trainees w

ho w

ould also be part of the team; they w

ould be professional, accountable nurses unlike the nursing associates the governm

ent are attempting to

foist upon us now. W

e do not need more care assistants, no m

atter their level of experience, w

e need more nurses.

Re-introduce apprenticeships into the nursing plan, they used to be

called cadets. This is all good workforce planning for the future. W

ith all these changes w

e will soon have an excellent increased hom

e grown

nursing work force. S

aving our NH

S.

Information

Some additional inform

ation regarding state enrolled nurses (2nd level)S

tate Enrolled N

urses (SE

N’s) w

ere formally recognised in the 1940’s.

When w

e in Britain had tw

o levels of nurses, this was at this tim

e very innovative as it w

orked well on various levels, in the w

orking team of

hospitals in every ward and departm

ent, the hierarchical status was the

team itself. N

o one was restricted in any w

ay, the level of qualification/training w

as accepted it was norm

al. The SE

N’s w

ere very much

complim

entary to the team, m

ost important patients had confidence in

the nursing team. M

any patients, if you speak to them in today’s hospital

do not know w

ho is who? ie. carer, nurse, cleaner etc? often leading

to poor comm

unication. Som

e hospital departments have resorted to

putting a huge notice board with the uniform

on show, confirm

ing who is

who, partly, a “necessary” good idea.

The state enrolled nurse (2nd level) nursing training consisted of a less

academic entrance exam

and a 2 year training period, but the end result w

as a qualified nurse. This training encouraged more m

ature applicants and individuals w

ho did not perform w

ell at tests but became excellent

nurses. A very varied applicant stream.

2928

I must em

phasise that did not mean they w

ere lesser academically than

the state registered nurse (SR

N) as qualified nurses, the state enrolled

nurse had the opportunity to access additional training post graduate they could all becom

e specialist in a chosen field of nursing.

Also post graduate courses existed in som

e training hospitals which after

5 years as a qualified SE

N, they could apply for entry to. This w

as a full 2 year course w

hich then resulted in the SE

N’s qualifying as an S

RN

. This had a very high success rate, proving the capability of the 2

nd level nurse (S

EN

). This 2nd level qualification also proved to be an advantage

for students in the 3 year SR

N course, w

hich if they failed their exams at

the third attempt, w

ere then allowed to enter the nursing register as S

tate E

nrolled Nurses. Thus keeping som

eone in the nursing sector who had

put in 3 years in training in a field they were accom

plished in.

The 3 year training was to qualify as a S

tate Registered N

urse (SR

N),

this title changed to RG

N several years ago and is currently called

Registered G

eneral Nurse (R

GN

).

Good Practise Elsew

here

Many other countries have sim

ilar 2nd level nursing positions. I w

ill m

ention only some, but m

ost similar is A

ustralia. They, similar to this

country, have enrolled nurses (SE

N) but they have kept them

. Where

as we did not! B

lame P

roject 2000. The Australian enrolled nurse has a

different title in some instances and has increased and changed from

its original concept.

Enrolled nurses or division 2 nurses in A

ustralia usually spend 24 m

onths training consisting of 36 weeks at an approved college, follow

ed by practical experience in hospital w

ards for the remainder of the tim

e. The m

ajority of EN

’s eventually move on to attend university and becom

e registered nurses, although a substantial num

ber remain as E

N’s in

hospitals and nursing homes. The role of enrolled nurses in A

ustralia has increased greatly in recent years in response to the continuing shortage of registered nurses in the A

ustralian public health care system.

In Am

erica they have licensed practical nurses (LPN

), these are similar

to what our S

EN

’s were, they perform

most of the duties of a nurse but

work under the direction of registered nurses.

In Canada, O

ntario. There are two basic types of nurses, R

egistered N

urses (RN

), they must have a B

Sc in nursing, 4 years of university for

entry to practice. While registered practical nurses (R

PN

’s), must have a

two year diplom

a programm

e for entry to practice.

Footnotes1 R

CN

Issue No. 334

2 RC

N Issue N

o. 334

3 RC

N B

ulletin Issue No. 325

4 RC

N Issue N

o. 325

5 RC

N Issue N

o. 325

6 RC

N Issue N

o. 325

7 RC

N Issue N

o. 341

3130 Personal N

ursing Profile of the author

Author: M

arion Ann M

asonN

ow nursing for 50 years, entered training 1966

1966-1968 Q

ualified as State E

nrolled Nurse (S

EN

)

1978-1980 P

ost graduate training qualified as a State R

egistered

Nurse (S

RN

)

1988 E

NB

941 Diplom

a “Care of the elderly”

1990-1991 Training as O

ccupational Health N

urse, qualified (OH

PN

)

Occupational H

ealth practise nurse

1994 P

artner and Matron of private nursing hom

e for the elderly

for 19 years

2005 R

MA R

egistered Managers Aw

ard (a required qualification

for managing a nursing hom

e)

2006-2010 H

elped comm

ission (from land acquisition to build) a new

140 bed nursing home.

2010-2012 M

anaged above nursing home

Personal experience of first level nursing and second level nursing.

Vast experience working in both the N

HS

and the private sector.

About the author

Having been in the nursing profession for m

any years Marion has w

orked in several large hospitals in m

ost specialities.

Also in the com

munity and G

.P. Practice.

As an occupational health nurse she has w

orked in the private sector in several large com

panies.

She proceeded to becom

e matron/m

anager of a nursing home for the

elderly for nineteen years.

Then helped establish a large new nursing hom

e, where she also w

as the registered m

anager for several years.

Marion has alw

ays been actively involved in the local comm

unity. Over

the years she has been a Borough C

ouncillor, comm

ittee mem

ber of a local com

munity centre, school governor, m

ember of the m

anagement

comm

ittee of Age U

K locally, com

mittee m

ember for m

any years of the H

ertfordshire Nursing and R

esidential Association.

Business w

oman, charity w

orker.

Active in politics for m

any years she is currently on the National E

xecutive C

omm

ittee of a political party.

Lastly, but by no means least, a m

other and grandmother.

Marion (front centre) when matron of a nursing home pictured with some of the staff.