Inserting naso-gastric tubes into your fellow students may not be the first thing you want to do when you get to college, but for those studying nursing at Brighton University, it is an essential part of the course. These tubes go up the nose, down the throat and into the stomach, to feed a patient, and although there is no risk of harm from the procedure, it can be uncomfortable.
Tutors at Brighton think it is an important part of a nurse's training to be on the receiving end of the care they will be giving, so in the tubes go. "We call it experiential learning," says Shirley Bach, head of the university's Institute for Nursing and Midwifery. "This way, they get a better idea of how it feels."
The curriculum and standards for the two nursing qualifications, the degree and the diploma, are set by the Nursing and Midwifery Council (NMC). But universities can, to a point, choose their own ways to meet the NMC's requirements. At Brighton, people who have been patients come in to teach nursing students about their own experiences, and one module is taught entirely by an ex-patient.
"The module is called 'Better than the Book'," explains Bach. "It deals with mental health nursing – often nurses have to assess a person's mental state quite quickly, and this can create difficult feelings for the patient." The department started using this approach in mental health training, but now use it in all areas of the course as well as on their Masters degree programme.
At the University of Wolverhampton, there is a scheme for nursing students to learn Punjabi to help them communicate with hospital patients in the local area. There is a high proportion of Punjabi-speaking patients in Black Country hospitals, and not all speak English. Students are taught elements of the language specific to nursing – for example, asking about dietary requirements and comfort levels – to help their work placements run more smoothly.
Wolverhampton has also introduced life-size dummies that simulate breathing and have pulses, allowing students to gain hands-on experience of treating patients. "They present student nurses with realistic scenarios, to test their critical thinking and their clinical decision-making skills," explains lecturer Marina Kendrick.
For many, one reason to train as a nurse is the chance to work abroad and to provide a vital service in parts of the world where healthcare systems are less well resourced than in Britain. As a result, some universities now offer work placements much further afield than the local hospital. Claire Denison, studying for her nursing diploma at Staffordshire University, spent five weeks working at a village hospital in Karnataka, southern India.
While there, she worked on a labour ward and helped to deliver twins, watched operations, worked in casualty and helped in the special care baby unit. She also visited specialist wards for burns victims and people with leprosy in Bangalore. As the village hospital in which she was based is very remote, she also saw a high number of snakebite victims.
"People may expect hospitals and healthcare to be basic in India," says Denison, "but the places I visited were really well run."
With work placements currently making up about half the time spent on nursing courses, students gain experience in many different nursing environments. Victor Banda spent one placement in the healthcare centre of a prison. His tasks included monitoring the blood sugar levels of those who are diabetic, giving out medication and dealing with injuries inflicted either by other inmates or by the patient themselves.
"If the prisoner is being moved from one cell to another, a nurse has to go and see how that inmate is being handled, to check that he is not being manhandled. Or, if he already has injuries, to check that he is not harmed," says Banda. "You also have to assess whether a person's condition means he needs to go out to the hospital or stay in the prison health centre."
Nursing became a graduate profession in the 1990s, when universities already offering the nursing diploma began to run degree courses alongside the diploma. But the public funding for aspiring nurses (tuition fees are paid, and there is a £6,000 a year grant towards living costs) has so far in England only applied to diploma courses, as the diploma is the minimum requirement for registration as a qualified nurse. In Scotland, Wales and Northern Ireland, however, the full degree is funded.
This, of course, affects the options of prospective students, but some universities do not let the need for funding deter able candidates from getting a degree. At Staffordshire, for example, students who are doing particularly well in the final year of their diploma can switch to the degree course.
However, options like this could soon be a thing of the past. Nursing education is undergoing a significant review by the Nursing and Midwifery Council (NMC), and top of the agenda is whether the full degree should be made the minimum qualification for a nurse. This would bring the UK into line with other developed countries such as New Zealand, Canada and the Republic of Ireland.
Other decisions to be made include the ratio of work-based learning to theoretical learning, and whether more time should be given to specialist branches of nursing.
"All bets are off," says Padraig O'Luanaigh, faculty director for nursing recruitment at Staffordshire University. "But we're watching the NMC very closely for the results of the consultation early in the new year. It takes three years to prepare a nurse, though, so any changes will be gradual."
For some student nurses who have found their vocation, though, which path they take may not matter. As Victor Banda says, "It's not just a job you do to pay the mortgage; it's something that is a part of you. Nursing can be a frustrating job sometimes, but if you know why you're there in the first place, then that will be your pillar."