A Nurse’s View: Changes To Nurse Training And Policy 1967 - 2021

"I felt the closure of the State Enrolled Nurse role was a great loss for patients and staff alike"

Retired nurse, Lynn, looks at the changes to nurse training over the last 50 years & evaluates whether the move toward theory and qualifications has diminished the concept of nursing as a vocation.

Topics Covered In This Article

NHS Reforms 1967 - 1974

Nursing In The UK - 1976

Becoming A State Registered Nurse (SRN) - 1976

State Registered Nurse & State Enrolled Nurse (SEN) - Explanation

Working And Studying As A Practice Nurse - 1991

Project 2000 Training Versus My 1970s Training

Comparing Nurse Training Over The Years

Caring Hands & Kind Hearts Versus Clinical Practitioners?

It’s Not Which Nurse Training Method Is Best But Lifting The Best Aspects Of All Of Them

Conclusion - Nursing Is Still A Vocation And Not Just A Job

NHS Reforms 1967 - 1974

When I started my nurse training in 1976 I had no inkling of the great changes that had occurred within the NHS and the nursing profession during the previous decade and how this had shaped the future of nursing as a profession for us in 1976.

Nursing As A Profession - 1967

The Salmon Report in 1967 brought an end to the matriarchal role of the long established and revered matron. It aimed to give more power to nurses by inspiring them to become managers, thereby, increasing their standing within hospital management.

Pay Increase - 1974

It was described as “A time of great struggle and consequently great change for NHS nurses” (Adrian Dowd, 2008. Nursing Times). The nurses in 1974 had campaigned for an independent inquiry into their pay and their cry was answered. A very substantial pay rise of on average 30% was granted, such was the strength of feeling.

NHS Reorganisation - 1974

A very significant challenge to the role of nursing also occurred in this year. In 1974 there was an NHS reorganisation. This was twenty-six years after the establishment of the NHS in 1948.

This was the first time that external management consultants were appointed to work with health policy makers on such a massive overhaul of the NHS.

Before this overhaul, local authorities ran community health services.

It was hoped that the now linked- up services with the hospitals within defined geographical areas would result in a much more effective and efficient delivery of services.

However, whilst bureaucracy was increased, the impact for those of us who later worked under this new system was there was not a specific person to whom medical and nursing staff could go to who would take ultimate responsibility for difficult decisions or for the successful running of the service.

Nursing In The UK - 1976

I had no idea about all of this when I started my career in 1976.

It is only with hindsight and forty-five years later that I can reflect and to some extent acknowledge, how this time of discontent and challenges to the traditional view and ethos of nursing influenced the type of training I received and my future nursing career.

For instance, I recall during our introductory block a visual description of the organisation of the NHS displayed on acetates on an overhead projector which unfortunately held very little meaning for me at that time.

Only as my years in nursing continued and the role of me the nurse came under scrutiny and re-evaluation was the order of the day, did I then fully comprehend the angst of my predecessors.

The argument supporting the changes was that nursing had to change to accommodate the changing needs of the modern world.

But I had the clear impression that many of the nursing officers and senior nursing officers I came across during my training wished to continue to evoke the culture and tradition of the now defunct matron role.

It is these same individuals who inspired me as a young nurse, and instilled in me the values that I continued to hold throughout my nursing career.

Becoming A State Registered Nurse (SRN) - 1976

On a very hot day in mid July 1976 I arrived at Morriston Hospital School of Nursing in Swansea.

Morriston Hospital was described as “in a state of dilapidation causing a danger to the health of patients and staff”.

But I relished my time there. We would work a 12-week stint on each ward and then, at the end, we’d consolidate what we had learned ‘In Block’ (as it was called).

We all looked forward to being back together after each module, sharing all our news and comparing notes on what we learnt, what we had achieved and the people we had met.

I had experienced the real world of work and life as a nurse.

For me, that is caring and supporting patients and their families at their most vulnerable.

Yes, this was a lot to consider for an 18 year-old straight from school but as a trained SRN I grew up overnight.

I was experiencing first-hand the extremes of the best and worst that life has to offer.

State Registered Nurse & State Enrolled Nurse (SEN) - Explanation

The training my colleagues and I received at Morriston Hospital School of Nursing 45 years ago was based upon the Platt Report from 1964.

We were training to become SRNs (State Registered Nurses) following our three-year training.

At the same time, there was a two-year training course available to become an SEN (State Enrolled Nurse).

It was explained that the SRN training would be attractive to students who may have attained qualifications and may otherwise go to university or college.

The course would then furnish students with the ability to accept and be competent in leadership skills as a qualified SRN.

The SEN course was considered to be for the more practical nurse.

I learned so much from the qualified SENs during and after my training. Their practical abilities were second to none and I was so sad to see their role ended. I felt the closure of the State Enrolled Nurse role was a great loss for patients and staff alike.

Working And Studying As A Practice Nurse - 1991

In 1991, I was a new recruit to practice nursing. I had been working as a part-time Midwife for 6 years.

I had two young sons, the youngest being severely autistic and I obtained my dream job as a Practice Nurse at a GP surgery.

Following further intense training I was delivering nurse-run respiratory clinics, diabetic clinics and family planning clinics with one of the GPs.

These post registration diplomas I had to undertake were arduous, necessitating a lot of study with exams but they were so interesting and the knowledge I gained was illuminating and empowering.

I loved the autonomy running my own respiratory clinics.

A strong affinity and close professional relationships developed with my patients in 3 practices over 27 years, where I provided holistic, respiratory care working in partnership with a specified GP at each practice and of course the most important people the patients.

Project 2000 Training Versus My 1970s Training

It was in this role that I became acquainted with the nurses who were to become known as the Project 2000 nurses.

The Project 2000 courses commenced slowly from September 1989.

A Royal College of Nursing Commission on Nursing Education in 1985 stated that it was now to be considered necessary for the nursing course to be based in higher education establishments and to be of diploma and degree level.

However, Macleod Clark et al (1996) suggested that the curriculum prioritised the theory to the detriment of practical skills; with the underpinning nature and aims of nurse education being one of health promotion rather than disease management.

Ironically, it was chronic disease management that I aimed to deliver in the 1990s and where I welcomed some of the first third year student nurses.

I was working in partnership with my patients to develop holistic tailor-made interventions and supported self-management plans to control their disease and enhance their well-being.

The student nurses from Project 2000 who attended my clinics were attentive and enthusiastic.

I noticed something interesting about these students.

I had gained years of extra training and knowledge over many years since my own registration - it’s what enabled me to run these clinics.

These student nurses, only in their third of training were already well acquainted with much of the theory.

However, in my experience, they, through no fault of their own, these Project 2000 student nurses lacked in their holistic approach and their interpersonal skills at that time.

My training in the 1970s gave us permission to spend time and talk to our patients, we weren’t made to feel guilty for getting to know them as individuals and did not have the constraints that today’s nurses may feel.

I had been doing these clinics for many years and I was so aware of the significance of developing an affinity with my patients.

For me, that achieved the best outcome for patients. It could be argued, of course, that my relationship with my patients was achieved as a result of my years of experience and not my training, and that these student nurses would also eventually achieve this level of awareness, care and compassion as their careers emerge.

Equally, it could be because my training ingrained this in me by allowing us the time to talk and get to know patients.

Comparing Nurse Training Over The Years

I am of the belief that the foundation and values that were instilled in me during my SRN training allowed me to fulfill this role.

The Royal College of Nursing (2003), stated that “Delivering professional nursing requires not just caring hands or a kind heart but also a sharp inquisitive mind; one that enables the practitioner to utilise clinical judgement and provision of care”.

I agree wholeheartedly with this statement but this is not a new phenomenon. It has applied to myself and my colleagues and I am sure to many generations of nurses that came before us and since.

In the 1990s the disquiet expressed was that during the degree and diploma courses nurses would be learning too much theory at the expense of practical skills.However, higher education for nurses in fact, was certainly not a new concept and what is little known about Florence Nightingale was that she is now considered to be an early forerunner of research nursing: “In a book which contains many of Florence Nightingale’s records from the Crimean war, it can be seen how she relentlessly pursued knowledge and used evidence -based frameworks to try and influence change” (McDonald, 2010).

The dying breed of the Matrons in the early 1970s were against every reform in nurse education.

They felt they were unnecessary changes for the worse which would also impact upon their manpower resource.

The graduate nurses were considered to be “too posh to wash” or “too clever to care”. I’m not sure about that. But I’m equally unsure that the first cohort of student nurses who came out of St Bartholomew’s in 1977 with a BSc in Nursing had received better training than me.

Furthermore, I’m unsure that all their extra theoretical nursing knowledge equipped them better for the baptism of fire that is being a Newly Qualified Nurse.

Caring Hands & Kind Hearts Versus Clinical Practitioners?

It has been suggested by nurse academics, that nurses like myself and my colleagues had been poorly trained and what we were trained for was very narrow and limited compared to the training of nurses today.

As if the caring hands and kind heart of the 1970s nurse did not allow her to be an effective clinical practitioner in her own right, as if each attribute was at the expense of the other and as if they are unable to coexist.

It could be argued that the clinical and often theoretical skills we achieved back then were obtained despite the lack of technology, as we had to rely on our observational skills to a much larger extent.

I don’t agree that what we were trained for was very narrow and limited compared to nursing degree courses and training today because I really don’t think they should be compared at all and certainly not negatively.

They should be considered as being of their time and era, not judged unfairly but being a stepping stone to the nurse we see today.

After all, without the training and practice of nurses of my generation, progress or changes for the better could not be achieved.

Our training equipped us to have inquiring minds and to learn something about the patients in our care even during the execution of the most menial tasks.

It was not about just undertaking a routine task it was about being open to how and why we were carrying it out too!

We were trained to believe that every moment we spent with our patients was an opportunity to extend our knowledge of the particular individual, be it their general condition or their emotional well-being.

It was truly an holistic approach and the permission we were given to talk to our patients allowed us to hone our observational skills to a greater degree. We were hands on but with our eyes and heads on too and learned that no encounter with our patients was time wasted.

It’s Not Which Nurse Training Method Is Best But Lifting The Best Aspects Of All Of Them

My own senior tutor during my nurse training later continued his career at Swansea University when they discontinued the schools of nursing.

In 1976 we were his first ever group of student nurses and to say that was a privilege, would be an understatement.

He headed a group of clinical nurse tutors and together we all began our journey. I thought this teaching team were inspirational from the very first day.

Above all, they taught me that care is not something that should be done or delivered under the pressure of an audit culture.

That route can result in nursing being measured against the wrong values.

The compassionate nurses of today understand the right values.

And they ought to feel free to consider close patient contact as a learning opportunity just as we did in the 1970s.

In terms of comparing the 1970s nurse with today’s nurse, it is not about evaluating which is better, but recognising the attributes of both and the virtues of both types of training.

Conclusion - Nursing Is Still A Vocation And Not Just A Job

In the late 1960s The General Nursing Council criticised the Platt Report for what it did for nurse training - moving the focus to more academically minded students.

It felt it marked a deviation from nursing as a vocation by focussing more on academic qualifications, leadership and career progression.

I would argue that nursing was still very much a vocation when I started in 1976.

And I would also say that nursing is still vocational today as I reflect over the last year on all the nurses who have put their patients before their own health and safety.

That can’t be taught.

I believe it is vital that in this busy world we ensure that our patients know we are interested in them as people and not just their condition.

That they know that we care about them, and that our tact and sensitivity to them is given priority so that they can become partners in their own care.

Nursing is still a vocation and not just a job.