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Cut clinical hours to attract more student nurses, says renowned academic Linda Aiken


A renowned academic from the world’s top-ranking nursing school has put forward a case for reducing the hours that English student nurses have to spend on clinical placements.

Linda Aiken, professor and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in the US, said a way of attracting more people into nursing education would be to make it more like the traditional university experience.

“We have half of the required clinical hours in our university programmes than you do and we have great nurses”

Linda Aiken

She said: “The best and the brightest in both of our countries are often wanting to go to the university, like everybody else wants to go to the university, but nursing schools are really not university programmes, they are not integrating with the university.”

Addressing a nursing workforce conference in London on Thursday, Dr Aiken said the US had “put a big focus” on making degree-level education for nurses the same as other students.

She highlighted how student nurses in the states were required to complete 868 clinical hours over a four-year course, compared to 2,300 hours over three years in England.

“We have half of the required clinical hours in our university programmes than you do and we have great nurses – nobody’s criticising our nurses for not being good,” she noted.

“You are sort of taking that apprentice idea that through education you have to drill these things into people when things are changing so fast in education by the time they graduate there will be a whole new set of things they have to do,” said Dr Aiken.

“So, think about, do you really need all these clinical hours and could you move to something that looks more like education for other people,” she added.

Dr Aiken was speaking during an event hosted by leading think tank the Health Foundation called Bridging the nursing gap: addressing the workforce challenge in the short term.

She noted that over the past 20 years the US had solved its nursing shortage, adding that it was “much bigger” than the one England was now facing.

Nursing was now the number one career choice in the US, said Dr Aiken. She said this was achieved in part through upskilling nurses.

“There are so many jobs for nurses, there are so many people that want them - that has really been generated by expanding the roles of nurses,” she told delegates.

She suggested England was lagging decades behind the US on this agenda. “England is, I would say, 40 years behind the US in the use of nurses in expanded roles,” she said.

“The message today…. is that having nurse practitioners and really leveraging the role of having nurses being able to move up into a higher level of practice has brought nurses into the workforce and into nursing schools,” Dr Aiken said.

The respected nurse academic also championed the idea of mandatory nurse staffing requirements, highlighting how one year after California adopted nurse-to-patient ratios it had eradicated its nursing vacancies.

The University of Pennsylvania – which has been ranked number one across the globe for nursing education for three years running – is evaluating the introduction of safe staffing legislation in Queensland, Australia.

Dr Aiken said findings showed that as well as addressing staff shortages, the law had resulted in nurses in the state taking care of one less patient on average and mortality rates declining by 12%.

The conference was held following the recent release of the major Closing the gap report by the Health Foundation, King’s Fund and Nuffield Trust.

The think tanks warned that if nothing changed, England’s nurse shortage would hit 70,000 by 2023-24 and could rise to as high as 108,000 in a decade.


Readers' comments (16)

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  • Ridiculous. If anything, student nurses need more clinical hours in order to transition seamlessly from university to health care.

    Personally, having studied nursing, I feel that university hindered my learning as a nurse. I felt I learned more when undertaking an NVQ through a ward I was working on as I could put it into practice as and when I was learning.

    I'm all for nursing apprenticeships. Don't get me wrong, I loved the university aspect of my course which provided me with some brilliant soft skills, however, these didn't transfer well onto the wards.

    Imagine finishing uni and being employed as a qualified, responsible nurse having never witnessed a seizure, cardiac arrest, or patient death! No thanks. It won't benefit anyone.

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  • I find this a really interesting approach, I work in a role to support nursing students in practice. On the one hand students always feedback that they don’t feel they have enough time in clinical practice or simulation to feel confident in their practice. On the other hand they are all struggling financially especially since the removal of the bursary and are having to work part time to make ends meet but the demands of practice placement shift patterns often prevent them working while they are on placement resulting in withdrawals from the course due to financial difficulties. I think reducing hours will encourage students in and help retention from a financial point of view, but will potentially have a detrimental effect on students confidence developing their clinical practice so it would need to be carefully balanced.

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  • No. Bad idea. I am just coming to the end of my degree and my placements are where I have learnt the most. Uni has just taught me how to write essays. If you want to change anything I would say increase the clinical placements and decrease the essays!!

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  • This is ridiculous because England is already producing the least competent nurses on when they leave the school.
    After 3y of nursing you need to have additional training for IV cannulation and phlebotomy, IV medication training day, medical devices training, catheterization... Most of the nursing schools in the world have that as a part of their curriculum.

    Also, people are going into nursing because they want to be clinical and help people and be there for the people - not to sit in school.

    Yes, you might attract more people but do you really want to have those nurses to look after you?

    This must be a joke and the article must be a click bait because I'm sure there's no REAL nurse who would say such a thing. If you wanna increase number of nurses, make it easier for overseas people and not block them with NMC tests that most UK employed nurses wouldn't pass normally.

    Cancel the NMC premium because nurses don't understand why do we pay for someone who's doing a service to the public and not nurses - let the public pay for that boogie man.

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  • Totally agree, students might actually learn something if they completed less hours, rather than being used as extra HCA’s.

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  • “but will potentially have a detrimental effect on students confidence developing their clinical practice so it would need to be carefully balanced.”

    What clinical practice though? We aren’t allowed to preform venepuncture or cannulation. We can’t preform fluid therapy. We can’t preform male catheterisation. We can’t act as second checkers for drugs.

    We CAN take obs and do ecgs and preform bed baths. We are used as FREE band twos and frankly, it’s absolutely b****cks. One of the arguments put forward for us NOT being taught venepuncture as students for example, is that that is all we’d do all day. But that same argument isn’t lobbied at medical students.

    We aren’t even given access to computer systems! We also can’t check blood sugars because we allegedly wouldn’t know what to do with the results. But a HCA who’s been doing the job 2 minutes can.

    I’m in my second year now so I will finish this god forsaken degree. But the real learning of practical skills that make you a useful nurse doesn’t start until AFTER graduation.

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  • Equip nurses to come fully packaged on the wards .IV training should be done.Dressings so that when they come on the ward within a week,getting the confidence they need.Universities need to engage nurses mentors go the university and teach them these skills pay them if you have to.After spending time gaining a degree the students should spend less time and integrate into the job.NMC IELT system is a money making scheme.Reduce the scores and let people be attracted to come on nursing career.One can have all the wealth but without good health you are doomed.Nursing is not a job to compare like selling cars or working in a shop its peoples lives let's invest more into it.Reduce fees in Univesity to start with it's not like any other job.Its looking after people.Thank you.

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  • Facts don’t lie and clearly helped the US bridge the gap. I think there’s a huge difference in views between fresh and old blood. New programmes from September 2019 will include bloods/IVs etc. Some people just want to nurse some want to nurse and have a degree to progress. Essentially students are free labour and we barely get the time to learn on wards - culture needs to change and fresh ideas not the same old harrowing stories of failure but to focus on a brilliant future

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  • Quite frankly weekend shifts on placements caused me a financial instability. The charge nurse was not interested in the fact that I needed to pay my bills. I believe that this may be very discouraging to the students. If we can’t get paid for placement just give us enough flexibility to keep our jobs.

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