Jane Salvage: 'Too posh to wash' is a common charge

"You've Got a degree," said Sister. "You can calculate the insulin dose." As a new student nurse, I was flummoxed – my degree wasn't in maths. But she ignored my objections. Like most of the nurses I worked with in the late 1970s, she had no higher education herself and was probably rather threatened by us bright young things.

"If you wanted to think, you shouldn't have come into nursing," said another sister. She was right in a way, as I wanted some action after reading all that literature at Cambridge. But what she really meant was "don't ask questions and don't rock the boat": junior nurses should be seen and not heard. That went completely against the grain of an education that had trained me to think for myself.

Alas, those attitudes are still found today among the old school – some patients, a few senior nurses, and a great many doctors. But in the past 30 years nursing has inched towards being an all-graduate profession. It is embracing lifelong learning and evidence-based practice, and values rational thinking and emotional intelligence as well as the traditional attributes of a good heart, a strong back and a safe pair of hands.

Training as a nurse in the 1970s was like going back to school, with serried ranks of desks, bored students, blackboards and chalk, and rote learning. What we were taught and what happened on the wards seemed worlds apart. Now, a steadily increasing proportion of newly qualified nurses have degrees in nursing and health sciences. They're also, on average, older, have more life experience when they come into nursing, and expect to be treated like adults.

Yet, far from being welcomed as the intelligent practitioners they are, graduate nurses still encounter a lot of prejudice. "Too posh to wash" is a common accusation, as though well-educated nurses are not willing to deliver the intimate personal care at the heart of good nursing. Research suggests the opposite – that graduate nurses are highly committed to clinical work.

The universities are not free of such prejudices. Most are only too happy to accept the funding that comes with such a large number of students, but only grudgingly accept nursing faculties as full academic partners. Sexism may be partly to blame, as well as lingering snobbery about vocational education. Yet no challenge is more stimulating than preparing students to be " thinking doers", getting the theory/practice balance right and responding to society's changing values and needs.

People who think nurses don't need all that high-falutin book-learning are the first to complain when their care is poor. Yet it is extremely difficult to give good care. Compassion and intelligence may be innate, but empathy, good judgement, up-to-date knowledge and the ability to make independent decisions are attributes most of us have to learn. Poorly educated nurses (and support workers often wrongly described as nurses) are often the weakest link in scandals such as the Maidstone deaths from hospital-associated infection, where there is usually a chain of management failure.

If my tutors, family and friends thought I was wasting my university education by going into nursing (and not, for example, medicine), they never said so. I have never regretted it. Working in nursing has opened amazing doors: I've taught nursing leaders in Bosnia, received a Nightingale medal in Uzbekistan, and edited Nursing Times.

As importantly, nursing gave me the skills to help care for my dying mother. A well-educated nurse is a jewel to be treasured, and I hope I have one caring for me when it's my turn to go.

The writer is visiting professor, Florence Nightingale School of Nursing and Midwifery, King's College London

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