Columnist for The Week is sure they do not
Matthew Walther’s opinion piece argues lightheartedly that despite the malign claims of the “educational-industrial complex,” nurses do not actually need university degrees. After all, like cutting hair, it’s not a matter of “life or death.” Except it is—research shows that nurses save lives, and more educated nurses save more lives, not least by using their science educations to prevent deadly errors.
February 26, 2019 – Today the news magazine The Week published a column by Matthew Walther headlined, “Why must you go to school to be a barber—or a nurse?” Walther claims that the “educational-industrial complex,” aided and abetted by “American credentialism,” is deceiving those seeking “practical” careers into thinking they need expensive educations and licenses. Walther concedes that pursuits that really are matters of “life or death,” like truck-driving and dentistry, require serious training. However, Walther assures us, nurses hardly need to spend four years in what is “essentially a pre-medical school curriculum” that includes “memorizing the types of plankton in biology courses.” After all, during the 1940s, we trained nurses “virtually overnight”! In fact, though, nursing is very much about life and death, as decades of research—by nurses with doctorates—has shown. Better nurse staffing means fewer patient deaths. And better-educated nurses mean even fewer patient deaths. Indeed, a key reason nurses need university health science educations is to rescue patients in decline and prevent deadly errors. Of course a lot of Walther’s piece is tongue-in-cheek. And we understand the political agenda behind even humorous efforts to undermine modern regulatory structures and academic elites. But while such glib know-nothingism might be no big deal in some contexts, this column reinforces damaging angel and handmaiden stereotypes of the nursing profession. And those continue to impede nurses’ efforts to get the resources they need for education, research, and clinical practice. Walther’s reliance on an opinion piece from 10 years ago for the claim that there is now a “consensus” among U.K. nurses that they don’t need degrees is ridiculous. But it does call to mind a few other pieces from that era, by similarly situated opinion columnists, who argued that educated nurses had become “too posh to wash” and needed to be reminded they were just there to clean up, hold hands, and smile. Please join us in educating Matthew Walther.
Banging out nonsense with typewriters
Walther bemoans the “educational-industrial complex,” which has apparently been forcing even those who wish to pursue practical careers such as barbering to attend school, rack up big debts, and get a license. Walther finds this “insane” and says that “it’s hard not to argue that American credentialism is out of hand and getting worse.” He concedes that licenses for commercial truck drivers are needed, and “we rightly impose [restrictions] upon the ability of any lunatic to declare himself a dentist and start drilling away with the Craftsman in his garage. But hair? Come on. This isn’t exactly life or death.”
Unable to resist the nursing angle any longer, Walther then offers a mix of kind personal impressions and condescending stereotypes:
When I was a writing tutor at one of our directional state universities years ago, I often assisted nursing students. These were invariably among the cleverest and most conscientious undergraduates I ever worked with. They were also the nicest. Most of them were if not happy at least willing to spend four years of their lives memorizing the types of plankton in biology courses. They were less enthusiastic about the cost. But they put up with it for the very simple reason that they all wanted one thing: to help people.
We should not put a financial barrier between would-be nurses and their worthy ambition. This is true, among other reasons, because it is not at all clear that the ability to earn high grades in what is essentially a pre-medical school curriculum is the most important quality in a prospective nurse. But the answer to the student debt crisis here is not to throw trillions of dollars of free tuition money at the pizza dispensers and bureaucrats and dorm-upgrading contractors in the universities but to make it possible for people to work as nurses without earning four-year degrees. In the 1940s the United States and Britain managed to train hundreds of thousands of nurses virtually overnight with nothing but practical, on-the-job training. Already there is a widespread consensus among practicing nurses in the United Kingdom that degree programs are unnecessary. We should follow their lead. A two-year training course at a community college, combined with practical experience in hospitals, should be enough.
To his credit, sort of, Walther proceeds to say something similar about his own profession of journalism, claiming to want to return to “happier times” when it was “a blue-collar job for drunks in hats who banged out nonsense with typewriters they positioned in corners of their favorite saloons.” But today, with “the rise of journalism as a pseudo-academic discipline,” the profession has gone down the drain. Walther doesn’t quite claim academics has caused journalism’s decline, but he doesn’t cite anything else either. Wrapping up, Walther jokingly assures readers that he is all for “guild socialism” and he dreams of a “neo-medievalist future” with entities like the “Sovereign Nurses Guild” forcing people to undergo years of “elaborate and highly ritualized training.” But in the real world, he says, requiring those who wish to do things like “help me lose weight” get “a special piece of paper” is completely unnecessary.
It’s hard to know where to start. First, although Walther may or may not be aware of it, it is the case today that you can become a licensed registered nurse in the U.S. after getting an associate’s degree from a community college, although with the many prerequisites, this commonly takes at least three years rather than two. However, more than a million U.S. nurses do now have at least a bachelor of science degree in nursing; hundreds of thousands have master’s or doctoral degrees. Why would that be? Credentialist corruption? No. Nursing is a distinct, autonomous health care science, led by nursing scholars (with doctorates!) who teach at major universities and engage in ground-breaking health research. Practicing nurses hold lives in their hands every day, in settings that range from high-tech ICUs to public schools (yes, public schools, where nurses increasingly manage serious chronic conditions as well as life-threatening acute events). Advanced practice nurses work in primary care and other areas traditionally associated with physicians; extensive research shows their care is at least as effective as that of physicians.
It may be more fun to assume nursing is just the traditional stereotype of mindless pillow-fluffing, or even helping people lose weight—which we admit is not a stereotype and hardly the least skillful or important thing you could use as a shorthand for nursing. But what nurses do is in fact a matter of “life or death”—just like truck-driving and dentistry. Decades of research has shown that skilled nurses save lives and that more educated nurses save more lives. We appreciate that Walther has found nursing students to be clever, conscientious, and nice, but that is not going to get them the resources they or their patients need.
And no, nursing school is not a “pre-medical school curriculum.” Nursing and medicine are overlapping but distinct disciplines. Nurses do have to know a lot about life sciences, for the same reason physicians do. (It is very unlikely that Walther would argue physicians are over-educated.) In fact, one of the most important ways nurses save lives is by detecting and correcting physician errors. Nurses need advanced skills to recognize those errors and a certain level of formal education to advocate effectively. On the other hand, as a result of the unique elements of their education, nurses know plenty that most physicians do not. Examples include expertise in key areas like wound care, psychosocial care, and patient education, including how to coach patients to resume daily activities while coping with their disease or injury. Nurses have a holistic health focus that few physicians do. Nurses actually are good at helping you lose weight.
The link Walther offers to support the supposed U.K. “consensus” that nurses do not need university education is to a Nursing Times piece from 2009. It’s true that around that time, there was a small boom in opinion pieces in the U.K. and Canada making similar arguments against nursing education. The basic idea seemed to be that university education was making nurses too uppity to provide the kind of unskilled angel care the writers assumed nursing was all about. We explained then that such pieces were the result of uninformed stereotyping, at best. It may be that nursing is an attractive vehicle for opinion makers with this type of agenda because of the enduring power of unskilled angel and handmaiden stereotypes. For those who don’t know much more about nursing than that, it just seems beyond the pale that we would need to devote significant educational resources to nurses. Come on. This isn’t exactly life or death.
Today, though, it’s not clear that even a bachelor of nursing science degree is adequate preparation for many increasingly complex clinical settings. That’s why some forward-looking nursing schools like those at Johns Hopkins and the University of Pennsylvania have moved to master’s-of-science-in-nursing entry programs. And whatever might have been done in the 1940s, no competent nurse, then or now, can be trained “virtually overnight.” We wonder if Walther would be happy getting an operation from a surgeon whose training and experience was all in the 1940s.
None of this is to say that every dollar spent on higher education is well spent, or that excessive credentialism doesn’t exist. But the last thing nurses or their patients need is less education. After all, just a little knowledge can be a very dangerous thing.
See Matthew Walther’s op-ed “Why must you go to school to be a barber—or a nurse?”, published on February 26, 2019 in The Week.