The skilling fields: de-skilling, re-skilling, up-skilling, on-skilling, out-skilling (or, with apologies to the Who: Giving it all away)

Now. Settle down and let me tell you a story: 

Once upon a time, when dinosaurs roamed the earth, HAI* was just something heard in art-house Japanese films, and a patient getting a pressure sore was an occasion of shame, people on a big rock off the coast of Europe who wanted to look after other people professionally, and do some good on the way, had several options. 

If they didn't possess enough pieces of paper proclaiming their successful progress through the educational system, but could demonstrate literacy and numeracy, they could go to a hospital and train for two years as an 'enrolled nurse'. They would be expected to be found mainly at the bedside; the nonsensical paperwork bits were for others to do (unless it suited the rulers of the castle, a fierce tribe called 'Policy'). 

Then there were those who had more pieces of paper, and they could undergo three years' training as a registered nurse, learning not just how to care for people, but to manage them as well. 

(There was a much smaller group, which could go to a university and become degree nurses... but I'm getting ahead of the story. Sorry.) 

Then, in the magical year of 1986, a window in the castle opened, and down rained stone tablets engraved 'Project 2000' onto the heads of the nurses below, who read, in sore amaze: 

• Thou shalt have no more enrolled nurses, even though they're rather good at their job 
• Registered nurses will henceforth be in subjugation to ones having 'diplomas' (as soon as we've worked out the details) 
• And by the way, hospitals are a rubbish place to learn about nursing, we're giving all that stuff to the universities 

And lo, it did come to pass, in 1995 (five years ahead of schedule). 

And nurses did pass into the universities, spending 18 months before seeing a patient, which caused many to leave; and the wise heads in the castle set about altering all that. Sort of. 

Many years passed, and another stone tablet was lobbed out of the castle window, decreeing 'all nurses henceforth will have degrees'. 

In the country below the castle, where humble nurses toiled on the wards, it was noticed that some (certainly not all) of the new nurses who would be their masters were not quite that skilled. So they looked to the sky, and it wasn't long before a new stone tablet concussed one of them: 

• From this day, thou shalt have support workers, paid almost as much as you, but not quite, who will be given their Theory in our universities, which did such a good job with nurses. 

And lo, they did appear, able to change surgical dressings, give sub-cut injections and do other sundry 'nursing' tasks. 

And a sarcastic nurse asked: 'When are you going to let them give out meds?' 

And the answer came: 'We're working on it...'

*(Hospital Acquired Infection)