Nursing's education revolution is exerting intolerable pressure on staff as they try to juggle studying in their spare-time with a full-time job, argues Jenny Hewison

ANGS-1More and more nurses are studying for diplomas and degrees at university. So many, in fact, that nursing may yet become a graduate profession. But such a massive educational revolution is not without its problems. Our recent research has pinpointed the strain placed on nurses' personal lives by the new demands on their time.

For the revolution has not only affected new recruits into nursing, studying for academic qualifications in universities. It has also involved more senior nurses, who do not have degrees because they trained before the reforms, usually in hospital-based schools of nursing.

These older nurses are under pressure to get more qualifications to keep up in the promotion stakes. In the past, nurses did further training on a day-release basis. Today they are often expected to attend courses in their own time, in order to save on NHS costs. We found that such training makes heavy demands on out-of-work time, and that many people experience family problems and personal stress as a result, especially if they have children. They also suffer financially, losing overtime, which is not offset by an increase in salary at the end of their training.

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We interviewed 89 people on a range of courses. When asked why they were doing their course, 80 per cent mentioned some kind of negative factor - they felt they had to do it to advance in their careers. More than two-thirds said that family and home care activities had suffered as a result of their being on the course. "Oh my God. Yes, my house has gone to rack. I just don't have time. I don't have time to cook, you know, really good full meals every single night like I used to. It's just not a top priority anymore," was a typical response.

Most of those we interviewed who were studying for part-time degrees were given no time off to do the course. One programme demanded that students attend four hours of tutorials and lectures a week, in the evening, with students recommended to spend a further eight hours a week on course work. Many of these students were shift workers - often they even worked the night shift after attending college.

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Only 42 per cent of the staff we talked to thought their course was fitting in reasonably well with home and family life; 48 per cent thought it was a strain, and 10 per cent thought it was having a serious detrimental effect. Many said that lack of time to spend on family activities was leading to strain and tension in relationships. Some people felt guilty that they were not performing well as a parent, or worried about asking friends or relatives to help with child care.

As part of the research we also interviewed NHS managers. All of them were clear that although training was important, the first priority of the health service was the needs of patients. Often this meant that nurses had to use their days off as study days if staff on a particular ward were unable to cover for each other.

Training will always carry costs. Financial savings may be illusory if they result in human costs that are just too high. In our study, the nursing environment and the promotion decisions of managers pressurised staff to gain qualifications in order to maintain their relative position within the health service; but practical support from employers in the form of paid study time was limited.

People with children are faced with particularly difficult choices: to enrol on a course and carry the financial, social and psychological costs, or to turn down the "opportunity" of further training, and accept that their career will suffer as a result. Faced with such choices, who could blame them if the idea of "lifelong learning" became a threat rather than a promise?

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Changing Patterns of Training Provision: Implications for Access and Equityby Jenny Hewison, Therese Dowswell and Bobbie Millar was supported by the Economic and Social Research Council. The researchers are inthe school of psychologyand the school of healthcare studies at the University of Leeds.

TRAINING

THE NURSE'S VIEW

"I think perhaps the biggest change is that I feel as though I have less chance to spend time with the children, especially the youngest one, at weekends. Because I tend to be racing round trying to do everything I Fitting housework and things in that I would have done on myday off."

"Although he (her husband) is really understanding, sometimes he can't understand when I've just got to get this particular work done, and he has just got to take the kids out of the way, and I think he feels a bit resentful sometimes that it has taken quite so much time up.""I think there are conflicts at home,... I'm sort of out three nights now, I'm not getting home till 10 o'clock on a Thursday, so I'm out for three nights. He's working Saturdays. We both get Sunday off but Sunday is the day when I could get up and do four or five hours work, and it is the day that we want to go out together, so I think that is quite a big conflict at the moment."

"When I was doing my nurse training I I knew the way nursing was going I I knew that courses would be springing up and I wanted to complete my training and get a degree I It creates the pressure that people have to do it when they resent having to do it. But the way that nursing's going at the moment, if you don't keep up to date and get some study, you get left behind."

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THE MANAGER'S VIEW

"I'm interviewing this afternoon for a G grade post I and in talking to people who are more experienced than me in interviewing at that level, they consider that a very senior post and automatically look for evidence of continuing degree level. You know it seems to be the most obvious thing. Now you will get some people who will say, well, look this person has this experience, this and this and this, and hasn't got a degree...

"Even when we are short of staff we try very hard not to cancel study leave because we feel it leads to even worse morale...Because I know some hospitals like (a neighbouring trust) stopped all leave because of financial problems but we have tried very hard not to do that."

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