Christine Ingleton and Jane Seymour
Changes in population demographics, health needs and reforms in healthcare delivery and work practices have had a major impact on the nursing profession in many developed countries. Moreover, the transfer of nurse education into higher education in the UK over the last decade and in North America over the past 20 years has heralded substantial changes in the way nurses are educated and prepared for practice. Nurse education in Australia has also experienced significant changes since the 1980s, including transfer of undergraduate preparation from hospital-based programmes to more formal learning in the tertiary sector and, more recently, growth in postgraduate degrees and clinical specialization (Lee et al. 2002).
In the UK, before the radical revision of the education strategy called Project 2000 (UKCC 1987), nurses were taught in training schools attached to hospitals. Two levels of qualification existed, enrolled and registered, and separate courses educated trainees for four areas of nursing: general (adult), sick children, mental health and mental handicap. Over 60 per cent of trainees' time was spent in providing rostered service, during which time they were responsible to a service manager. Thus nurse training has moved from an apprenticeship model of preparation where trainees worked as 'pairs of hands' to an educationally driven model of preparation where students attend university-based courses.
The need for reform in nursing in the UK emerged from challenges in four main areas: education, service, recruitment and retention, and changes both in health needs and in the NHS. The reforms impacted both upon education and service provision. Educationally, diploma level education was introduced, replacing the previous two-tier system of enrolled and registered nurses. The four specialist routes to qualification were replaced by a Common Foundation Programme (12–18 months) followed by a branch programme in a chosen specialism. Students are now provided with a bursary rather than a salary and are responsible to educationalists rather than service managers.