The times, they are a-changing.
From memory, English nurses used to go initially to a training hospital, and thence to on-the-job training, starting off doing the scut-work that ward-maids do nowadays. They were closely supervised by more experienced ladies (all nurses were female in those days) as they worked their way up the ladder, being promoted entirely on merit and by their superiors. Their academic classes were taken by very senior nurses.
Like Lizzie, I can't see much wrong with this system. It did weed out the unsuitable personalities, at the very least, and they were promoted by people who saw them at work!
I seem to remember a big training hospital in Nottingham. Lots of lovely girls about, there, then.
Joe Offer, a few years ago in NZ/Australia/Britain, foreign-trained doctors, including American, had to be passed to English standards before they are allowed to practice, because that was regarded as the highest! I know one American-trained surgeon who found it VERY hard to requalify.
Don't know how it works now.