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Major review of nurse education and training in England

A major review of pre- and post-registration training for nurses and midwives in England is to be carried out to improve standards of patient care, Nursing Times can reveal.

Health Education England and the Nursing and Midwifery Council will launch the review in May to specifically investigate the standard of education provided to around 60,000 nursing and midwifery students each year.

The Shape of Caring Review, which will be led by Lord Willis of Knaresborough, will also consider the standard of post-registration training for the NHS nurses once they have qualified. The review is due to produce a final report by early next year.

Lord WillisLord Willis

It follows concerns over the standard of nurse training raised by the Francis report into care failings at Mid Staffordshire Foundation Trust.

As part of its work, the review will examine the controversial pre-nursing experience pilots that have seen around 160 students work as healthcare assistants for a year before starting courses, and which were a key plank of the government’s initial response to the Francis report.

“We don’t work hard enough to get the right people on training programmes to start with”

Kath Fenton

In a statement, Health Education England said: “The review will make recommendations for the improvement of pre- and post-registration nursing and HCA education and training.

“This should produce healthcare professionals of high calibre, who are able to meet the changing needs of patients and the broader population.”

Professor Katherine Fenton, chief nurse at University College London Hospitals Foundation Trust, told Nursing Times there were weaknesses in the way nurses were currently being trained, with “too much variation between universities”.

Fenton_kathKath Fenton

She said a review of nurse training was “long overdue”. “We don’t work hard enough to get the right people on the training programmes to start with; I don’t think we make sure they have the strengths and commitment to the profession when they first start and I believe they need to spend longer in clinical practice than they are now,” she said.

Helen Ryan, director of nursing at Yeovil District Hospital Foundation Trust, agreed there was variation around pre-registration training.

She argued there should be a focus on the final few months students spent training as well as the first six to nine months as newly qualified nurses. “We have quite a lot to learn from the foundation programme that doctors go through,” she said.

But Professor Ieuan Ellis, chair of the Council of Deans of Health, said he was concerned the review would duplicate work already underway by “multiple different projects and working groups”.

“This group needs to reflect on the reviews that have already happened, some quite recently – otherwise there will be a lot of duplication going on,” he added.

Jackie Kelly, head of nursing at the University of Hertfordshire, pointed out that the NMC had already imposed new standards for pre-registration courses in 2010, and stressed 50% of nursing students time was spent in a clinical setting away from the classroom.

She said: “We have already gone a long way and I wouldn’t want the review to move in a direction of travel before we have seen the output from the new standards agreed in 2010.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing said: “The vast majority of nurses are highly caring and compassionate, upholding the traditions and values of profession, and putting patients first to provide the best possible care despite often difficult circumstances and overstretched resources.

“Any drive to ensure the culture in all organisations in the NHS is one that puts patient care first is welcome,” he said. “Nurse education and recruitment is just one aspect of this drive, along with strong leadership and the right numbers of staff in the right areas.”


Readers' comments (27)

  • michael stone

    I've got nothing against Lord Willis - I know nothing about him.

    But I hope this review is as good as the one Robert Francis wrote: in particular, I hope the review is presented in the same way that Francis made his recommendations 'coherent as a whole, and thus difficult to 'cherry pick''.

    'Reviews' seems to be a growth sector ?

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  • Potential students may have the academic ability but within the application process we need to be finding out what is their motivation for wanting to be a nurse. Being selective through a robust interviewing process to ensure they have the softer skills which cannot be learned such as compassion.

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  • Interestingly Lord Willis has already reviewed nurse education in 2012 - a very poor and weak review which did not seem to relate to the Francis issues at all.

    So - does the nursing profession want him to review again - when he was paid for a poor job the first time round!

    I say get someone else and lets see a curriculum with a content that is not just about domains and hours linked to competencies. Lets see a core curriculum - core subject areas and focus on the real issues that arose from Francis - learning about working and support older people who are the majority (75% +) of NHS patients.

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  • The demand for nurse education is foremost in our Trusts' future plans, but courses are being cancelled because staff can't be released for training unless it's mandatory. It's not that they dont want to attend, its due to staff shortages across the community. This poses a clinical risk, as surely clinical skills for front line staff should be of paramount importance. Hands on practice for Clinical skills can not be undertaken on e-learning although the theory behind the skill can. This is fine, but many nurses do not have the time or I.T skills to access e-learning. I am currently looking for new ways to disseminate training in the community,through training experienced nurses to undertake 1 hour a week teaching sessions in thier teams using a variety of resources to try and provide hands on training when it is needed

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  • I remember this all happening before - I was part of a group that worked with the NMC to try to standardise the various branches of training around 15 years ago - it went nowhere!! all we seemed to do was sit around tables trying to define what makes a children's / adult / mental health / learning disabilities nurse. No idea what ever happened with that particular project but it clearly made no difference at all. Nurses need to actually look after real patients to learn their skill and craft

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  • Anonymous | 15-Apr-2014 12:20 pm

    did you get free coffee and bickies? surely at least that would have gone some way towards a positive outcome for all of these meetings.

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  • As a recently qualified nurse, personally I would recommend a review of the learning that takes place during clinical placements. It is increasingly difficult for teaching to occur with an increasing patient workload and poor staffing levels. Personal experience highlighted the need to negotiate learning opportunities with the requirements of the clinical placement. Students are often required to replace that of HCA's replacing their status as supernumerary. Providing basic care and developing communication skills are of course vital to the developing as a practitioner and inherent to future delivery of healthcare. However students (especially those in their final year) need the learning opportunities to fulfill the role of a nurse upon qualifying. There are numerous students that highligh newly qualified nurses fail to have the required skill set required for their first post. Students also require supportive mentors that will nurture and support learning, again which literature demonstrates is lacking.

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  • michael stone

    Anonymous | 15-Apr-2014 2:09 pm

    'It is increasingly difficult for teaching to occur with an increasing patient workload and poor staffing levels.'

    I asked recently, in one of those 'Trust in crisis recruits more nurses' stories, 'where is the money coming from ?'.

    The King's Fund has just published a report with one possible answer - it seems many hospitals are currently over-spending (compared to their anticipated future budgets) and in a couple of years, lots of them will be in quite serious financial trouble.

    I'm not happy with this ploy by the current goverment to [effectively] reduce NHS resourcing, so that 'problems can be foreseen', and to also push the decisions AND THE 'BLAME' onto CCGs: especially when politicians, who are no longer so 'hands on' re the NHS, keep saying things like 'we have told them how important it is to sort this problem out' or 'they will cover it by greater efficiency'.

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  • I trained as a nurse in the 1960's and came to the USA in the early 1970's. At that time there was a huge shortage of qualified nurses in this country. The training and experience of British nurses was greatly valued, we spent a lot of time training nurses who came out of universities with 4 year degrees and hardly any clinical experience. At that time 50 years ago, we trained in a hospital, starting at the very bottom giving bedbaths etc and worked our way up over 3 years where we were ready to assume charge nurse responsibilities. It is sad to see nursing become a science instead of an art.
    I was recently in England to attend to my dying father and took quite ill and was admitted to the hospital. I was shocked to say the least. The nursing care was virtually non-existent. I was bedridden, in severe pain with IV's in both arms and was told to go to the shower down the hall to take a bath. That was the best part of the care!

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  • There needs to be more interaction between the universities and the staff on the ground. Clinical tutors from the school of nursing (as it was known then) would work with students during their placements to ensure they were exposed to the clinical skills required to become a nurse and underpinned the theory they were taught. This would also relieve some of the pressures put on mentors. Perhaps it's the university staff are the ones that are too posh to wash.

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  • Regarding assessing potential Nursing students for soft skills, such as compassion:
    I am a potential student, and both universities that invited me for a selection session had interviews centred on assessing this skill set. There were discussions on dignity, on courage, on compassion. The academic part (literacy and numeracy) was of course treated as essential to Nursing, but the focus was on screening the potential students for these inherent qualities; the 6 C's developed as a result of the Francis Report.

    I am pleased to announce that I received an offer from both universities!

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  • I do feel that we lost more than we gained when nurse education became university led. I know it's tempting to feel that your training was the best (in my day etc) but nursing is still a practical hands-on job and training is vocational. Most of us learn by doing and whilst traditional hospital based training may not have produced the most academic of nurses we did at least have a wealth of experience of dealing with patients by the time we qualified. Maybe some of the best people to review nurse training would be patients and nurses themselves?

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  • I agree with Brian. I had the chance to do a degree in nursing back in 1979 (in NZ, not the UK), but chose to come back to England to do 'old fashioned' training. I enjoyed it (well, not so much psychy & obstetrics!), felt I had an excellent all-round preparation for life as a qualified nurse (while knowing that learning never stops in nursing), and loved watching the drama unfold as we went from task allocation to the /nursing process'

    I also know that some of those involved in the degree curriculum planning certainly didn't predict the fall-out we have now, believing this was the right way forward.
    But as Brian states, the reality is that nursing is a practical job, which while requiring skills in evaluation and assessment, decision making etc, does not necessarily require an degree to be done effectively and in a manner in which serves the patient best. Having said that, I've experienced both poor and good care from both degree nurses and 'apprentice' nurses. It's a challenge...

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  • Too much navel gazing here. Anon stated "It is increasingly difficult for teaching to occur with an increasing patient workload and poor staffing levels". Quite. This is not about university education v hospital based training, it is not about whether students are selected for their 'compassion' - it is about the context within which health care is delivered. For many years our populations has been getting older and we have not designed a service to deal with that pressure. Now to add to that we have structural reforms including financial troubles which have been building prior to Mid Staffs. University staff are too thin on the ground to provide much clinical teaching in the clinical setting - in any case that is what the University gives the Trust millions of pounds to do. Faced with intakes of 300+ in september and another 160 in february academic staff have to juggle the competing demands of their corporate university to be 'innovative and enterprising', to conduct research and to adopt new pedagogical approaches in a digital age. Trust staff who are responsible for 50% of the student's education (and 100% of their practice) are often too pushed in many settings to provide care, to then engage in high quality mentorship, teaching and assessment is a step too far. The context is that society, through its representatives, has decided that care is too expensive and education for care is too expensive, and reels away from providing the resources and contexts in which students can really learn. Professional nursing is not just 'practical hands on' -it is/should be highly skilled application of higher cognitive functioning that can only be developed with time and support. Making students go through hoops, and initiatives such as health care assistant training is a waste of time, tells you nothing about the longevity of any compassion they display and misdirects action. The review may be well meaning, but its looking in the wrong direction unless it can say something about the socio-political context of care in the UK: read Roy Lilley on the idea of a 'silver service' and you'll get a flavour of the issues in which nurse education has to struggle.

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  • Context>

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  • Context: "Nearly half of all nurses believe their organisation is at risk of becoming the “next Mid Staffs” or heading that way already, reveals the latest large-scale survey on NHS staffing levels".

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  • I trained as a general nurse in the early 70's then went onto mental health nursing. I have worked as a clinical teacher and nurse tutor in statutory education and completed my days in health education in an NHS Trust. I also have a helath related masters degree. My daughter completed her adult nurse training three years ago. My point in all this? I have to say I was impressed by my daughter's training, I consider she learnt practical skills as well as the ability to analysis the care she delivers, and therefore question decisions and advocate for the patinets. I feel a balance is needed, providing practical skills and critical thinking. It all goes wrong on qualifying and the culture in which we all work threatens to take over. As a current colleague of mine frequently says "this wouldn't happen in non-NHS health care providers".
    Finally - when the review takes place please consider giving mental health and learning disability nurses practical experience in adult nursing once again, and vice versa.

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  • Context: read especially the concept: 'the deaf effect' Staff repeatedly report poor and unsafe practice (across both private and public sector) but senior decision makers are often deaf to these concerns. So, educate students as much as you like about being compassionate but there is a bigger picture going on....what makes us think that compassionate students can make this sort of difference?

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  • Yet another costly report - will it change anything? My father died fairly recently and I have to say as a nurse myself I was appalled by the attitudes of the nurses including the Ward Sister. The lack of care, respect and dignity and what would appear acceptance of poor standards e.g. lack of pillows which meant my father had to be propped up with rolled up blankets!
    Let's stop finding excuses and take action and let's not have yet another report propping an office door open!

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  • Can't say that much has really changed in 40 years, more highly trained nurses are doing more, in terms of numbers treated and higher level skills, but a fundamental hasn't changed ------

    Adequate resource = adequate care.-----

    Post Francis, Trusts are bursting their staffing budgets, would like to know how sustainable this 'improvement' is

    All else is just hot air

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