The degrees that today's nursing students can expect to receive depend, to a large extent, on which college they attend, rather than their ability, writes John Downes.
AN ANALYSIS of awards to nursing graduates, published for the first time today, has revealed huge variations in the number of "firsts" and other grades handed out by different institutions, both in the university and Institute of Technology sectors.
This appears to have little relationship with the CAO points which the students obtained in their Leaving Certificate, or the particular specialism they study, in turn prompting concern about the overall standard of nurses which the State produces.
Martin O'Grady, a lecturer in psychology at the Institute of Technology, Tralee, undertook a case study of the first cohort of graduates of Bsc in nursing courses which were launched in 2002 and are overseen by An Bord Altranais.
O'Grady who, along with several colleagues, is part of a wider campaign to highlight the issue of grade inflation at third level, sought figures from each of 12 institutions - five universities and seven Institutes of Technology - which provide Bsc in nursing courses.
His study, which relates to entrants to the courses in 2002, is based upon full returns provided by eight of these institutions:University College Cork (UCC), University of Limerick (UL), Dublin City University (DCU), Waterford IT, Athlone IT, Tralee IT, Letterkenny IT and Galway Mayo IT (GMIT).
"Despite repeated e-mail requests and a letter to the registrar in each case, Dundalk Institute of Technology, NUI Galway, University College Dublin and Trinity College Dublin failed to respond," he notes.
According to O'Grady, he chose to analyse the Bsc in nursing because the courses offered within it were introduced across the State in 2002, and were "developed and delivered within a tight regulatory framework designed to ensure common standards".
Furthermore, there were "sound reasons to believe that a commonality of standards would, or at least should, be maintained across the various institutions involved," he says.
Among these reasons, he cites the "strong vocational focus of nursing courses", with graduates within each speciality being qualified for "exactly the same jobs", and the fact that all courses are approved by a single regulatory agency, An Bord Altranais.
Yet, according to the figures, graduates of Waterford IT and Tralee IT were far more likely to obtain a "first" in their degree studies than their counterparts in other institutions.
For example, the rate of first class awards range from 2 per cent at DCU and GMIT to 35 per cent at Tralee IT.
Elsewhere, 28 per cent of students at Waterford IT obtained a "first", compared with 5 per cent at UL, 6 per cent at Athlone IT, 7 per cent at Letterkenny IT, and 14 per cent at UCC.
When first class awards are combined with rates of upper second class awards (or a 2:1), the figures are even more striking.
Whereas about one in five students at Letterkenny Institute of Technology achieved one of these awards, almost every nursing graduate at Waterford Institute of Technology - 98 per cent - obtained one of these two awards.
Similarly, just one in four nursing graduates of DCU obtained a first or a 2:1, compared with 58 per cent of students at IT Tralee, 56 per cent at UCC and 47 per cent at GMIT.
Elsewhere, 44 per cent of graduates of Athlone IT and 38 per cent of graduates of UL obtained one of these awards.
O'Grady also notes "significant variations" in grading across the individual nursing specialisms such as general nursing, psychiatric nursing, and intellectual disability nursing.
For example, psychiatric nursing graduates were in general two-thirds more likely to obtain a "first" than intellectual disability graduates.
However, O'Grady says the differences in grades awarded to students of nursing, whatever their specialism, is not attributable to the fact that certain institutions may offer particular specialisms which happen to award a high number of "firsts" - thereby skewing their results - whereas others may not.
In fact, he finds that significant variations between individual institutions and specialisms remain, regardless of whether they offer general, psychiatric or intellectual disability nursing specialisms within their overall Bsc courses.
He notes that one potential explanation for all this may be that some of the institutions might attract more academically talented students.
But this is not borne out by his examination of the CAO points for entry to these courses, when compared with the rate of firsts and 2:1 degrees handed out.
For example, given the large number of first class and 2.1 awards at Waterford and Tralee, when compared with the other schools of nursing, the prediction would be that they would both show strikingly high median - or mid point - CAO points for entry to individual specialisms, he says.
"On the contrary, neither of them ranks highest . . . In general nursing, UCC students had higher median [ CAO] points than Waterford with UCC and UL both ranking higher than Tralee," he says.
"In psychiatric nursing, UCC, GMIT and UL outrank both Waterford and Tralee on [ CAO] median points and in intellectual disability nursing, UCC, UL and DCU all outrank Waterford."
According to O'Grady, on a broader level the overall rate of firsts handed out for nursing degrees largely mirror the rate of firsts handed out in other degree courses around the State.
In fact, previous research conducted by O'Grady and his colleagues has shown that this figure is itself high and has risen significantly in recent years.
The group has set up a site, www.stopgradeinflation.ie, to highlight its concerns. In the past, it has also expressed concern that academics are being placed under increasing pressure to award students higher marks, with institutions prioritising student numbers and growth at the expense of educational standards.
There is another significant aspect to all this. According to O'Grady's figures, two institutions - UL and Waterford IT - handed out no pass degrees to their nursing students.
By comparison, Letterkenny IT, which has a relatively low rate of first and upper second class graduates, awarded pass degrees to 32 per cent of graduates, while DCU awarded such a degree to 17 per cent of its graduates.
Elsewhere, 12 per cent of graduates at UCC obtained a pass degree, while 11 per cent of students at Athlone IT also obtained this award.
This could reflect the fact that it is generally harder to get either a "top class" award or even just a "pass" degree in some institutions.
Others also argue that being a good nurse does not necessarily depend on getting a "first" or other high mark in academic examinations. They stress that interpersonal skills and other considerations such as an individual's general clinical abilities are also a crucial part of this caring profession.
But O'Grady also raises the prospect that the significant variation in high grades seen among individual institutions may also extend downwards towards the threshold for pass degrees.
This could mean that some institutions are more likely than others to offer a borderline nursing student a "pass degree" rather than to fail them. If true, this could have worrying implications for the quality of nursing care that Irish patients receive.
While raising the possibility, O'Grady also acknowledges that this aspect requires further investigation.
What does appear clear however, is that, when broken down by individual institutions, the level of award which today's nursing students can expect to receive depends, to a large extent, on which college they attend, rather than the ability of students as they enter these courses.
This is despite the claims of commonality of standards made for such courses.
As a result, O'Grady argues that effective external regulation is crucial.
"The alternative is to allow the current laissez faire market in qualifications to continue and leave it to consumers - employers and society at large - to discriminate between identically packaged credentials that in reality denote widely varying levels of ability and achievement," he says.
"This is a course where common standards should apply," he adds. " If they can't do it in relation to nursing studies, the question arises is it being achieved anywhere?"