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Exclusive: Quality and quantity of student placements at risk from staff shortages

Student nurses are struggling to get good practice placements because hospital wards are over-stretched and staff too busy to supervise them, according to an investigation by Nursing Times.

In some areas students have seen the time they spend in practice reduced while others say they are missing out on hands-on training in key areas.

There are fears shortages will get worse after the first ever national workforce plan for the NHS promised a welcome increase in nursing training places in England.

Meanwhile nursing education leaders warn the NHS could find itself in a situation where it was suffering from nursing staff shortages but unable to train enough new nurses.

“Everyone in my year is dreading qualifying because we don’t feel we have had enough time out in practice,” one final year nursing student told Nursing Times. “I have only had one ward placement and I’m frightened about how I’ll manage. You need the right balance between community and hospital and we haven’t had that balance.”

Claire Jeeves, chair of the Royal College of Nursing’s students committee, said Accident and Emergency departments and other settings were refusing to take students on placements “because they are so busy and short-staffed”.

Claire Jeeves

Claire Jeeves

“A lot of the time wards are happy to have students but the quality of the placements is not always brilliant because of the shortages,” she said.

“It’s everywhere within the UK and it is not nursing staff’s fault. At lot of them want to teach and be there to support their students but they just don’t physically have the time to do it.”

Gail Adams, head of nursing at Unison, added: “There have been issues with placements for about 18 months. Some organisations are unable to take students due to supervision issues.”

Other nursing experts have highlighted a worrying lack of community placements, especially given the drive to move care into community settings.

Anne Corrin, MSc Adult Nursing programme lead at Essex University and a member of the RCN’s education forum steering committee, has carried out in-depth research into students’ placement experiences.

“There are pressures on placements, particularly in the community, in terms of quantity,” she said. “This is very problematic, as there is an acknowledgment of the need for more community nurses but it is difficult to access placement areas where students could develop the skills for working in the community.

“As commissions for adult nurses will be increased next year, this is a problem that will not diminish,” she warned.

Anne Corrin

Anne Corrin

As part of a national workforce plan, Health Education England announced it would commission 13,228 university places for trainee nurses from 2014-15, an increase of 1,094 on 2013-14.

Meanwhile a 6.7% increase in nursing and midwifery students was recently announced in Scotland, with organisations such as the Council of Deans of Health warning placements will need to keep up.

“Finding suitable practice placements for all our students can already be difficult,” said Professor Brian Webster, the council’s executive member for Scotland, who said a “clear strategy” was needed to cater for the increase.

Brian Webster

Professor Brian Webster

The quality of practice placements is a critical factor in drop-out rates for nursing courses, with a 2013 study commissioned by NHS London identifying practice placement experience as “the most important factor” in whether a student chose to stay on or leave a course.

“If students are unhappy in placements, they may leave the profession,” said Ms Corrin. “It also means learning opportunities are missed as students may be less motivated.”

She said many nurses fulfilled some of their mentoring role in their own time and needed more support , which could include protected time to do assessments or having dedicated education posts in practice settings.

For example, the Florence Nightingale School of Nursing and Midwifery at King’s College London employs clinical teachers who are primarily based with placement providers.

Universities cannot force providers to take students. However some, such as the University of Brighton, hope a new placement tariff could be an incentive (see box below) with the cash used to improve support for trainee nurses and mentors.

“We work very closely with our partners in the NHS who have the responsibility for providing the placements,” said a University of Brighton spokesman. “We have in the last year, had some difficulties in finding placements due to the rationalisation of services.

“However, we do think the changes in funding for student nurse placements, where funding will follow the students to the organisations providing the placement, will help ease this problem.”

Professor Ieuan Ellis, chair of the Council of Deans, said previous cuts in nursing student numbers combined with cuts in services and staff numbers meant nurses were “under more pressure to deliver patient care and at the same time provide supervision”.

Professor Ieuan Ellis

Professor Ieuan Ellis

“Managers will say ‘I don’t know whether we can cope with increases in student numbers at the moment because I’m not sure where we’re going to put them in terms of placements’,” he said.

“There’s a bit of a Catch-22 situation. There’s a recognition we need to train more students and need more placements but part of the reason we need to train more students is because there’s a shortage of staff out there in the service. Because of that the message coming back is that it is challenging.”

However, he stressed universities, trusts and other healthcare providers and Local Education and Training Boards (LETBs) were working closely together to come up with strategies to improve placement capacity and there was innovative work going on.

“It has to be a partnership approach,” he said. “No one person can ensure there will be enough placements of sufficient high quality in order to deliver the current and future workforce.”

One issue in England is confusion over who is ultimately accountable for ensuring there are enough suitable placements.

Health Education England said LETBs should monitor the supply of placements in their areas and escalate “any significant issues” to it.

“Higher education institutions work with their placement providers to ensure there are sufficient placements for the students they are commissioned for,” said an HEE spokeswoman.

“The LETBs play a key role in ensuring that higher education institutions have robust partnerships with placement providers to ensure placements are of a good quality.”

She said HEE recognised the need to increase placements in community settings and its community workforce group was focusing on that.

 

New pay system ‘increases’ range of experience, says Health Education England

Early reports suggest extra funding for practice placements is helping secure new opportunities for nursing students, Health Education England has claimed.

Under a new system – introduced in April last year – healthcare providers get a tariff payment in return for taking on student nurses, midwives and other non-medical undergraduates.

HEE said initial reports from its Local Education and Training Boards suggested the money was making a difference to the availability of placements.

An HEE spokeswoman said: “We have anecdotal evidence that LETBs believe this is opening up new placement opportunities and incentivising appropriate levels of placements. Some also see it as a lever to drive quality.”

From April this year the tariff will equate to £61 per student per week on placement, an increase on “transitional” payments in the first year of the scheme. The money is first distributed to LETBs.

“They [LETBs] will work with local organisations to determine how it follows the student,” the HEE spokeswoman told Nursing Times. “In some areas it goes via the higher education institutions who manage the placements, while other areas pay directly to the providers.”

The new tariff follows a long-running battle to ensure non-medical students benefited from education and training funding previously only set aside for student doctors.

However, there are concerns within the sector the money could be swallowed up by cash-strapped trusts and not spent on education and training as intended.

Universities, nursing schools and unions who spoke to Nursing Times said they were keen to see the money benefit students, but agreed it was too soon to judge the impact.

HEE confirmed LETBs would monitor the investment by looking at “placement delivery and quality”.

 

 

What do you think?

We’re going to be discussing this investigation and the impact a lack of placements will have on the future workforce in our weekly twitter chat.

To join in, simply log on to twitter at 1pm, search for #NTtwitchat and include this hastag in all your tweets so everyone can see your comments.

 

Readers' comments (13)

  • 'However, there are concerns within the sector the money could be swallowed up by cash-strapped trusts and not spent on education and training as intended.'

    Money should follow the placement student, be used directly for education + support with the mentor. But likely just get sucked up into general coffers to fund lack of resources elsewhere.
    If staff are already stressed with caring for so many patients, it's no wonder students don't gain as much as they should with their experiences.

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  • michael stone

    From what I can gather, nurses tend to learn/upskill by, effctively, 'studying good nurses in action' as a major (perhaps the main) part of their learning process. So if experienced nurses do not have the time to do that, it looks to be very problematic.

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  • tinkerbell

    the hits just keep on coming, how to effectively destroy one of the best things this country had going for it is to be confined to the history books. Can't even be bothered to swear about it anymore or the tory spivs who brought about our downfall. Just too sad for words.

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  • tinkerbell

    Hope some of the students on the new tv series will speak out about their struggle too. Never know do you just a tiny tiny hope, get the message out there. We need the media coverage.

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  • It isn't as if the present state of sastisfactory student placement is unexpected....

    Both ward staff and students have known of and complained of difficulties with student; placement, mentoring and on the job learning since Care in the Community and the concept of P2K was introduced.

    The horrendous reduction in staff numbers have exacerbated an already unsatisfactory system to the virtually irrepairable state we find we are in today.

    Perhaps HR can supply more ready trained staff from the EU or the Far East, it must much cheaper than training them here.

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  • Money raised from tarrif is being spent on projects that have NOTHING to do with students..Its the people that hold the purse strings that decide where the money is spent. My worry is that the student again will miss out as money is moved for OTHER things... it should have funded extra, interested, experienced supernumerary mentors, responsible for organising the student experience on each ward.. Its a shame that some peoples vision doesn't match the reality..

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  • I have had a very bad experience during many of my placements where I was treated as an extra staff member and had no time to work with my mentors.To complete my UWE paperwork I had to stay after my shift and was not allowed to add these hours to my total working hrs as my mentor said"she did not get paid for it". Many of "mentors" should not be allowed to mentor as they are bad example to student nurses.My mentor said"she has students to do her hard work" and "students are treated like s"so only the strongest will survive like in the army" Students are treated very badly without respect and are on placements to do the hard job for their mentors.If you complain you will fail your placements 100%. I only had 2 mentors who I can honestly said mentored me during my placements, very good nurses and lovely people.I wanted to give up and leave the nursing course because of my 2 mentors.They made my life very hard only because they did not like my face.When complained to UWE and ward manager I was told"get on with it", nothing was done.What made me sad was that many of the staff members witnessed my mentors being rude and unfair to me but remained silence.My mentor told me:I do not like students" on my first day of my placement. Very bad staff morale, no respect or team work.
    Many of my friends failed their placements because they were not liked by their mentors.Honestly what is wrong with people???I hope that something will be done.Mentors should get money for their mentoring and be assessed by their students and than assessed again by UWE.

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  • Anonymous | 13-Feb-2014 4:29 pm
    That is really sad and I can quite understand how you feel.

    Sadly this is not just about nurses it is about people and there are some horrible people in the world, unfortunately some are nurses.

    There should be some two way feed back you are right. Maybe something Jane Cummings needs to address. The 6 C's should not be confined to patients !

    Keep your chin up.

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  • I agree - some people should not be allowed to mentor students, let alone patients!!

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  • I think nurses should be paid extra money to mentor student nurses, other professions do!
    Oh and I'll sweep the car park while I'm here!
    They just don't get it!

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  • I must be honest, I am in my final year studying Adult Nursing, I have never had a mentor on any placement who has not had the time to teach me things, whether it be washing someone, learning about assessment skills or medication. With regards to getting the students paperwork signed off, I always find it easier to say to my mentors "we will do some paperwork today" rather than "can we do my paperwork today." It's your placement-so take control of it.

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  • yes it is sad but true. As a staff nurse on a busy admissions unit, time constraints are tight, and i feel we do not do the students justice on their practice placments. I appreciate they have specifics they need to cover but often these are not. I have a belief that student nurses in their first year need to learn essential care and within our time we assign a buddy to assist in this, this helps the student to learn to use their initiative and be more proactive in their role as a student. Remembering the student is only as good as the teaching that they are receiving and we need to make allowances for this. This can be acheived by placing thestudent with all members of the team to get an overview of how each works with one another. One of the most important needs is a willingness to learn.

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  • Im a first year student and have had the pleasure of working with amazing mentors and nurses on my placements. I agree with James, you need to be proactive and make the most out of every single placement. If my mentor/nurse was busy with paper work, i'd ask what it was they were doing and why it was done this way and because I was taking a genuine interest they always found the time to explain things to me. We dont allow time pressure to be an excuse for lower levels of patient care so why should this be the case for students receiving lower levels of support?!

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