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”.
“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.
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.
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”.
“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.