Why the NHS needs more graduate nurses

The Keogh report pointed to inadequate levels of nursing staff in hospitals. Photograph: Monty Rakusen/ Alamy

Care in the NHS has come under considerable scrutiny over the past year – the Francis report into Mid-Staffs, the Morecambe Bay investigations, and the review of the Liverpool care pathway have all pointed to issues of inadequate practice, leadership and staffing levels. In addition, the Keogh review of 14 NHS Trusts with higher than expected death rates has led to a focus on health care and nursing that hasn't been seen for decades. This has provided an unprecedented opportunity to recognise and address the failures while showcasing the excellence and good practice that everyone can learn from, and through which we can reassure the public that nurses are still there caring for them. We have seen some of the former but the latter has not been much in evidence.

The Keogh report published on 16 July points to inadequate levels of nursing staff. We note Sir Bruce's wording – not care staff, but nursing staff. This is a credible assertion from the medical director of the NHS stating that there is a relationship between the number of nurses and the quality of care. Why have there been no loud nursing voices reminding the government and providers of healthcare that the sick and health-vulnerable need expert nurses? It is not best value to have fewer qualified nurses supervising a less skilled workforce.

All organisations are well versed in the concept of value for money. Some of what we see now are the effects of interpreting staffing value for money as being about more people for the lowest possible wage bill, with no serious (evidence-based) attempt to define patient or indeed organisational need. It is time for leaders of nursing to grasp this opportunity and insist upon the improvements in care and the added value to organisations that a registered nurse workforce can bring. Reviews of skill mix should be well underway as a result of the Francis and Keogh reports. We hope that trust chief nurses will be tasked with bringing to their boards a strategy to increase the numbers of qualified nurses giving direct care and that their value to the organisation is demonstrated at every opportunity.

Simple nurse/patient ratios or minimum staffing levels are likely to be the initial response, but a significantly increased ratio of graduate registered nurses to support staff offers many more opportunities for enhanced care and cultural impact. The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.

One of the most important changes for the future is that all nurse leaders – both clinical and academic – resist the political knee-jerk responses to the recent investigations. They must champion and celebrate the place of nursing in our universities as a positive influence on care and challenge any questioning or undermining of its place as an evidence-based, research literate profession. Clinical and academic leaders need to collaborate to drive a reinvigorated research agenda in nursing, patient experience and quality of care – an agenda that aims to develop a strong evidence base for the value and impact of nursing on the widest range of care.

All too often in nursing, the word "academic" is used as a pejorative term rather than as a signifier of the knowledgeable do-er that is so in demand. Graduate nurses can bring their knowledge and expertise to enhance patient experience and outcome and to contribute to innovation in care. In our view, a crucial component of the required cultural change is healthcare professionals who can offer much more than technical skill. This is the added value of the graduate nurse.

June Girvin is pro vice-chancellor and dean of the faculty of health and life sciences at Oxford Brookes University, Mark Hayter is professor in the faculty of health and social care University of Hull

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