Fast Track: Carry on nursing, please

We need nurses, but it seems nobody wants to be one. Except a new breed of highly articulate graduates.

A recent shortage of nurses in Birmingham hospitals caused one manager to lament, "We are all out recruiting like crazy, and we have taken on 100 from overseas." A dearth of National Health Service nurses is nothing new, of course. But this year's winter crisis has exposed the lack of slack in the system as never before - with an estimated 13,000 vacancies nationwide and horror stories about emergency cover.

Indeed, NHS trusts have launched recruitment drives in countries such as Finland, South Africa, New Zealand and Australia in sheer desperation. And while pounds 21bn is to be spent on improving the NHS, agency nurse cover still costs pounds 192m a year, plus pounds 41m to advertise for recruits.

So why the lack of British nurses? The obvious answer is image. Modern nursing simply isn't a serious career option for those with intelligence, self-motivation and initiative; more a tenure of lifelong, low-level drudgery. Or is it?

Graduates who have stuck out the training period and are about to enter the profession seem to be more positive and driven about their chosen career than nurses have ever been.

In addition, they are highly articulate, a quality perhaps less marked in previous nursing generations. They attest to the fact that it is possible to get job satisfaction and to carve an ambitious career path despite the problems, lack of funding and prejudices.

Their enthusiasm is backed up by the efforts of the Royal College of Nursing (RCN) in promoting an intelligent approach by and to practitioners. Ten years ago, nurse education was moved from the arena of hospitals into that of higher education: 90 per cent of nurses now study for the Project 2000 diploma and 10 per cent take a degree course, currently four years long but soon to be reduced to three. That shift has led to better trained, more capable and empowered nurses - not theoretically minded disasters, says the RCN. Nurses in training now spend half their time learning practical skills, up from 40 per cent.

Craig Kirby, who is sabbatical officer for the RCN's student association and part way through a four-year nursing degree at Oxford, says: "Nursing isn't just routines any more. We've not just learnt to do things the way it's always done. That's in the best interests of the patients, because they know that nurses have the expertise to explain to them and advocate for them."

Julia Skilton, 22, who gained four A-levels and is in the final year of her nursing degree at King's College, London, agrees. "It's now a very autonomous job and you have an awful lot of responsibility. It's been extremely academic. We do communication studies, psychology, sociology; it's a holistic course, and everything's thrown in there."

Even those with a less academic bent are not debarred from entry. The Government recently almost doubled the number of nursing degree places, and there are alternative routes into the profession through NVQs and cadet placements, which are aimed at 16-year-old school-leavers.

"These days, it's much more dynamic and forward," says Mr Kirby. "Nurses lead projects and schemes." He points to the fact that the Government has made a push towards a more autonomous system of community health care.

"Every other health-care professional has a degree base, and I don't think nurses deliver any less dynamic care," he says.

In fact, in the rest of Europe and North America, higher education for nurses has been well established for years. Consequently, the Department of Health has finally admitted that an emphasis on "the intellectual challenge of nursing" and on nurses as "autonomous practitioners with the authority to make decisions" was needed.

The belief that: "It requires nothing but a disappointment in love, the want of an object, or incapacity for other things, to turn a woman into a good nurse", as noted by Florence Nightingale, is now as laughable as the idea that a stock-market analyst can train himself by using a shop till.

Nevertheless, problems in recruiting British nurses are not just about incorrect assumptions. The nursing student drop-out rate sometimes reaches 25 per cent - which, says Mr Kirby, is due to two major factors. One is financial hardship and the accumulation of debt, with no prospect of well paid work. Student nurses at King's College, for example, do a practical two-month unpaid placement after the summer term.

Julia Skilton is uncomplaining, but points out: "The problem comes at the beginning of August because not many people are willing to employ you for a couple of months." Newly qualified D grade nurses start out on pounds 12,855; if they move up a grade, they can expect pounds 14,705.

Students also become discouraged by early exposure to others' low morale during clinical practice.

"Unfortunately, as it stands at the moment, it's not always a very positive experience," says Craig Kirby. "They are being exposed to this very early on, and they're not going to want to stay."

The RCN hopes to help by lobbying to improve practical skills - piloting an intensive skills training period immediately before registration - and, as in other professions, to ensure that new recruits are mentored successfully.

"Trusts and universities need to develop closer working links, and trusts in particular need to take more ownership of the students on placement with them. However, as a result of the shortage of nurses, many trusts are now paying lip-service to the idea of a structured preceptorship, as experienced nurses struggle to cope with their own clinical workload," comments a recent RCN briefing.

Kirby believes that more structured training would also help.

"Having a career pathway is what's going to keep people in nursing - that they do see a step forward and the pay would reflect that," he says.

Long working hours, low pay and lack of ongoing training are off-putting, agree bright graduates. When they can earn big bucks in management consultancy, why should they slave away for little thanks on a hospital ward? As it is, one in four of the nation's nursing workforce tops up basic earnings with agency shifts. This issue is Julia Skilton's "main concern" - and she feels that NHS trusts are burying their heads in the sand.

"The trusts have had these advertising incentives. They've wanted to know our views. They give us gym membership, but what we need is adequate pay. They say `Come and work for us, you'll have a great night-life.' But that's not the point. We need creches, things like that. If you're trying to look after a home, you don't have time for night-life."

But at least she can be confident that job security will never be a problem in the nursing profession.