A range of measures to encourage people from a diverse range of backgrounds into nursing and midwifery have been recommended, following the publication of a major workforce and education review that was commissioned by the chief nursing officer for Scotland.
In addition, nursing students in Scotland recognise they are lucky to still get a bursary but many are still struggling with basic living costs, according to the review of current routes into nursing and midwifery across the border.
“They were fortunate to receive the bursary, which provided them with a significant sum of money”
CNO commission report
A report on the findings from the wide-ranging investigation, which was first announced by the CNO in April, has called for a separate review of financial support for nursing and midwifery students including the bursary, extra allowances and access to student loans.
Meanwhile, it warned that the public image of nursing remained “firmly stuck in the past” and more must be done to sell the profession as a rewarding career to a wider range of people including men.
The CNO Commission on Widening Participation in Nursing Midwifery Education and Careers set out a range of measures aimed at boosting the numbers and diversity of people coming into nursing and midwifery as part of wider work to ensure enough nurses and midwives for the future.
In particular, it called for urgent action to develop new, flexible routes into nursing and midwifery, describing current arrangements as complex and unclear.
The commission, led by Professor Paul Martin, depute principal of the University of the West of Scotland, was especially concerned about the lack of flexible access to midwifery training “that may compromise extremely capable people, such as maternity care staff, seeking access to the degree programme”.
It also called for more work to explore how apprenticeships could help budding nurses and midwives achieve registration, including those from under-represented groups.
Review backs campaign to diversify Scottish nurse workforce
The commission recommended the development of a “common articulation framework” for nursing and midwifery education in Scotland, to include nationally agreed progression routes for support workers.
It cited one approach that could be rolled out was a government-funded Open University scheme trialed by NHS Grampian, which has seen support staff do access courses in literacy and numeracy to get qualifications to help them apply for further study or degree courses.
The report also called for changes to the commissioning of pre-registration training places that extend existing routes and encourage and enable a wider range of people to apply.
This should include reviewing financial support for students, including the nursing and midwifery bursary, means-tested discretionary funds and access to student loans. Unlike England, Scotland has kept the bursary for nursing and midwifery students.
The commission found this financial support and other allowances “continue to play a vital role in supporting access to education” and that nursing students in Scotland recognised they were lucky to still have them.
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However, many were still struggling to make ends meet at the same time as studying, noted the report. A survey by the commission highlighted that the “financial burden experienced by students who find the bursary is insufficient to live on, particularly for those with children or other dependants”.
“This financial pressure leads to student nurses experiencing the stress of holding down part-time jobs to support themselves through their programmes, placing additional pressure on them during placement times,” said the report.
But it added: “The students were nevertheless aware that the situation in Scotland is different from the rest of the UK and that they were fortunate to receive the bursary, which provided them with a significant sum of money.”
“It is clear there are pressures that need solutions now and, importantly, plans created and implemented for the future”
It said there was need to examine “possible alternative funding models that will enable students to meet their basic living costs”. This would include looking at arrangements for extra funding to top-up bursaries and the idea of a “minimum income guarantee for nursing and midwifery students”.
“The bursary, while substantial, barely covers most higher education institutions’ accommodation costs, which leaves little for students’ other needs,” warned the report.
“Calls have been made to the commission to support the idea of a minimum income guarantee for nursing and midwifery students,” it said. “This would potentially avoid the situation of students reducing their study time by having to work at additional jobs to enhance their income.”
A wider review of student support in Scotland recently recommended students in higher and further education should receive a guaranteed minimum income of £8,100 a year.
The commission said a future review of financial support should also look at whether student nurses and midwives should be allowed to apply for students loans through the Student Loans Company – something they are disqualified from doing at the moment.
“Students see this as being discriminatory: it does not apply to any other students in Scotland. They recognise that the loans would need to be reimbursed from their salaries over time but many would prefer this option to seeking loans from commercial outlets, which are more expensive,” said the report.
“We want to go further in promoting those careers across health and care settings”
Fiona Mc Queen
Meanwhile, there was a need for a national campaign to promote nursing and midwifery as a career to a range of different audiences including high achieving students and men.
Other target groups should include young people, mature students, people from disadvantaged and ethnic minority backgrounds and those with disabilities, said the commission.
This should “emphasise the professions’ flexibility and extensive opportunities for personal and professional development” and seek to tackle stereotypical images of nurses and midwives.
While midwifery “enjoys a comparatively modern image”, the commission found perceptions of nurses and nursing were “firmly stuck in the past” and often ingrained in people’s minds from school.
“This suggests that updating and enhancing the public image of nursing roles could deliver significant benefits for recruitment,” said the report.
When it came to attracting more men to nursing and midwifery the report said the perceptions that nursing is a “female profession” could put men off.
“If the anticipated workforce deficit is to be tackled, it is imperative that men are not deterred from entering the professions. Specific initiatives focusing on boys should therefore be developed,” it said.
“We welcome the proposal to review the funding package available for student nurses”
The University of Dundee is currently trying to attract more men into nursing and boost the proportion of male nursing students from 8% to at least 25% and ultimately 50:50 men and women.
Efforts to recruit more men have included setting up a pop-up stall in a shopping centre staffed by male nursing students, lecturers and staff from the local hospital and further education. The event was run in conjunction with a social media campaign with the hashtag MenDoCare.
Meanwhile, work is underway to encourage male school-leavers to consider nursing as a career and develop projects for boys at primary schools.
Responding to the commission’s report, Scottish CNO Fiona McQueen said the recommendations could help ensure “we have the right number of people in education, completing their course and enjoying a successful career”.
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“The latest workforce statistics for NHS Scotland show we have a record number of staff including nurses and midwives, who are at the heart of our health service,” she said. “But we want to go further in promoting those careers across health and care settings, and remove any barrier that might stand in the way.”
Professor Martin said he hoped the report would address “recognised pressures” that were getting in the way of recruiting enough nurses and midwives with the right skills.
“There are areas where nurses and midwives are difficult to recruit – not just by region but in clinical and service specialities and particularly in care homes,” he said. “Add to that a change agenda in health and social care, the repositioning of acute care, and the age profile of the workforce and it is clear there are pressures that need solutions now and, importantly, plans created and implemented for the future.”
Ellen Hudson, associate director for the Royal College of Nursing in Scotland, described the report as “a positive step in encouraging and supporting people from a diverse range of backgrounds and experiences to choose nursing”.
“The report recognises the importance of expanding the range and flexibility of routes into nursing education, both further and higher, and of having a consistent framework, so those looking to develop careers in nursing across Scotland can be clear on the options available,” she said.
Bursary ‘protected’ for Scottish student nurses in 2017-18
“However, the commission also acknowledged that the financial burden of being a student is often seen as a barrier, and we welcome the proposal to review the funding package available for student nurses,” she added.
The Royal College of Midwives also welcomed the report and its recommendations, which include the re-introduction of shorter courses to enable registered nurses to become midwives and continued support for return to practice schemes.
“We are pleased to see the recommendations that return to practice courses for previous midwives to return to the profession receive continued support and that the Nursing and Midwifery Bursary should continue: adequate financial support for student midwives that does not leave newly qualified midwives with a burden of debt is a vital element in attracting and retaining students and new midwives in the profession,” said Mary Ross-Davie, RCM director for Scotland.
“The RCM’s hope is that the commission’s recommendations will be acted upon and will result in a growing number of men and women from diverse backgrounds and parts of Scotland choosing to enter the exciting and hugely rewarding career of midwifery,” she said.
Review recommendations include:
- A national recruitment campaign, including a reflection of the diversity of Scotland’s population and workforce, and tackling stereotypical perceptions of nurses and midwives
- Make recommendations for attracting more men to the professions, with realistic targets to achieve this
- Development of a common articulation framework for nursing and midwifery careers, which enables flexible entry and exit points and consistently recognises prior learning
- Further exploration of the apprenticeship model as a way of accessing pre-registration education
- Adoption of a positive approach to commissioning pathways to nursing and midwifery education, to incentivise widening participation