Save us from self-important nurses with degrees who care more about their careers than their patients

Does she need a degree?

Picture this: an elderly patient lies immobile in a hospital bed. She's thirsty but cannot reach the mug of water the nurse left on her bedside table. Her body hurts – bedsores are developing because she has not been able to turn in her bed. And she feels lonely: she's outlived her husband and friends, and her only son lives and works in another city so only sees her on weekends.

Now, who could ease this woman's condition? A nurse with a degree? Or a nurse with a vocation for caring and nurturing? No contest. The elderly lady's misery would be infinitely improved by a smiling "good morning", and Nurse spotting that her water lies beyond reach, and that her frail body needs to be turned on one side, so as to relieve the pressure on the very thin skin.

The two – a degree and a vocation – are not mutually exclusive, of course. But by demanding that all nurses hold a degree (and by 2013 they will have to)  the NHS risks packing its staff with graduates who see their main role as managers, not old-fashioned carers; that lowly job falls to the caring assistant.

More than a quarter of nurses (that's 100,000) already have a degree (which involves a three- or four-year course); the other 300,000 hold a diploma. The gulf between the two has grown, making for a two-tier system within every hospital. The top dogs too often aspire to climb the ladder of NHS management, and see themselves as too important for wiping bottoms, changing bedpans, and engaging the patient in chitchat. This attitude has dire consequences: caring assistants, who don't have the nurses' degrees or self-regard, feel put upon and slighted. Many of them have come into this profession to care for others – but it must be quite a job to hold onto such a mission, when you are made to feel you are a second-class employee. Patients, meanwhile, fear bothering the self-important, clip-board-wielding nurse with her eyes always on the promotion that will lift her from the ward to the conference room.

The introduction of nursing degrees was hailed as one of the biggest shake-ups in the NHS. In fact, it's shaken many people's faith in the NHS.