Apprenticeships should not be seen as a solution to the nursing workforce crisis and traditional university training must be the “absolute priority and focus”, warns a leading figure in nurse education.
Professor Dame Jessica Corner, chair of the Council of Deans of Health, which represents UK university nursing and midwifery faculties, said that while new routes into nursing might attract some extra people into the profession, they were by no means an “easy, quick fix”.
“They are not a fast-track method of creating nurses”
She warned that forthcoming apprenticeships – being developed to train both nursing associates and degree-level nurses – may in fact be longer routes to becoming a qualified nurse.
In addition, apprenticeships were “diverting” attention away from “the most important agenda, which is making sure we have an adequate supply of very well-prepared, highly capable, effective graduate nurses,” she told Nursing Times in an interview.
Dame Jessica, who is due to step down from her role as Council of Deans chair in June after almost three years in post, laid out the obstacles that have been overcome in nurse education in recent years and the challenges ahead.
The last eight years had been a “really challenging time”, noted Dame Jessica, who is also pro-vice-chancellor for research and knowledge exchange at Nottingham University and a nurse by background.
She said it had been a struggle, but a “great step forward” to secure the requirement for all nurses to a graduate-only entry to the profession from 2013 onwards.
“We are not talking about a lot of money and we think it should be found”
But that, since then, government cuts to funding for nurse training places, pressure on the NHS to make financial savings, and the Francis inquiry into the former Mid Staffordshire Foundation Trust had left the profession “clawing back”, struggling in an environment with too few nurses that was becoming increasingly pressurised.
It was in light of that growing staffing crisis that the Council of Deans had backed the controversial move from bursaries to loans for student nurses in England from autumn 2017, so the number of annual training places was no longer constrained by funding budgets, she said.
“We supported this mainly because it was probably the only way some of the problems we were observing were ever going to get solved,” she told Nursing Times.
However, Dame Jessica acknowledged that the subsequent 23% drop in applications to nursing courses in England this year was more than the Council of Deans had expected.
It had predicted a 15% reduction in applications, based on the drop in number of applications that universities had seen in other subjects when tuition fees were raised from £3,000 to £9,000 a year in 2012.
“If nurses are confused about other routes into training, for example, that is not going to help”
But she stressed it was still “early days” and the fact that nursing courses received such large numbers of applications meant the same number of training places as last year may be filled.
“We need to be cautious about it. I’m not yet saying the risks that could have been there have been definitively averted,” she said.
The council did have some concerns about fewer mature students becoming nurses though, following the change, and the government should take action in this area, such as through a national campaign to attract people into nursing, she said.
“Although there has been a dip in applications, I don’t think it’s being seen [by the government] to be so problematic that it would stimulate that kind of action at this stage,” she said.
Unfortunately, attempts by the Council of Deans to get the government to look at NHS employers paying back tuition fees if nurses work for them for a set amount of time had not been a success, she noted. Similarly, NHS trusts were not yet seriously exploring this option, she added.
Echoing previous concerns raised by universities, Dame Jessica did say that an increase in training places to the level predicted by the government – 10,000 extra nursing, midwifery and allied health professionals in education by 2020 – would be difficult if ministers failed to boost funding for increasing clinical placements.
“By our calculation, it only needs about £3m additional placement funding every year to cover the extra 10,000 students by end of parliament. We are not talking about a lot of money and we think it should be found…It needs to be available straight away, in the next year,” she said.
“Having ample supply of very well trained graduate nurses should be the absolute priority and focus”
In the past 18 months, alongside the government announcement to remove bursaries, there has also been the introduction of plans for nursing associates and apprentice nurses.
Dame Jessica criticised the lack of a co-ordinated approach to these new routes into nursing, noting the focus on apprenticeships also diverted attention away from securing an adequate supply of nurses.
“It is a little bit unhelpful that we are trying to do these major reforms with nursing education and then we have these other things – associates and apprenticeships – that come along simultaneously without co-ordinating messaging and thinking and planning around how to introduce them,” she said.
“That doesn’t help when we are trying to make sure we still attract the number of applicants into nursing. If nurses are confused about other routes into training, for example, that is not going to help,” she added.
“The most important thing for the NHS and the healthcare system is that we have ample supply of very well trained graduate nurses. That should be the absolute priority and focus,” she said.
“These other initiatives may be helpful in the mix but they kind of divert attention from the most important agenda…some of these other things feel as though they are a bit politically driven,” said Dame Jessica.
“We feel the role needs to be scrutinised very carefully”
She stressed that the ability for a nursing associate – expected to train on a two-year programme as an apprentice – to later become a nurse may not be that easy or quick to do.
Similarly, another new apprenticeship – at degree-level – to become a nurse was also expected to take 12 months longer to complete than the usual three-year university route, she noted.
Apprenticeships would also be likely to cost employers more than the money they invested in traditional university training for nurses, she said, which could limit the number available.
“They are not a fast-track method of creating nurses. It takes longer, employers need to fund their salary and backfill them when they are studying and they can’t only work in one setting – they have to work in a wide range of environments to meet Nursing and Midwifery Council requirements,” she said.
In addition, it was a “big risk” that employers might expect apprentice nurses to work when they should be studying, she said.
“When you think about what we got years and years ago when we transferred all of nursing into universities… they had the freedom to study and be supernumerary. That is such an important and precious thing that we shouldn’t let go lightly,” she said.
Meanwhile, Dame Jessica said nursing associates – designed to bridge the gap between healthcare assistant and nurses – had “probably” been rushed through and expressed concerns that nurses could be substituted with them in the future.
Jessica Corner: No ‘easy fix’ for nurse training challenges
“We feel the role needs to be scrutinised very carefully, so that it is not used to replace registered nurses and so we protect the role of the graduate registered nurse,” she said, outlining the council’s view.
“Anything that looked like it was undermining safe staffing – which we know is safest when there is a greater proportion of graduate nurses – we would be very worried about it,” she said. “We would absolutely not want that to be seen to be a way of sorting out the workforce crisis, but to the detriment of patient safety.”
As well as new training routes into nursing, Dame Jessica said she recognised that curricula for nurse training were also expected to be raised to a higher level due to the NMC’s current revision of pre-registration education standards.
She said deans were supportive of a number of the changes being proposed, especially the plan to clearly define a set of competencies that all graduate nurses should be able to do.
Introducing prescribing and also mentoring skills into curricula could also be advantageous for the profession, she said – though she warned that universities would probably need an increase in funding to deliver such extra teaching.
She added that the NMC’s proposal to potentially reduce placement hours was something ”universities have been asking for, for a long time”.
Compared with other healthcare courses – such as for training physiotherapists – that had fewer placement hours, the requirement for student nurses to spend at least 2,300 hours in practice during their degrees has “always looked quite burdensome,” said Dame Jessica.
She noted that if placement hours were reduced there could be more time available for teaching new elements of the curriculum.
CV: Jessic Corner
- December 2014 – June 2017: Chair of Council of Deans of Health
- January 2016 – present: Pro-vice-chancellor for research and knowledge exchange, University of Nottingham
- 2005-16 Director of improving cancer services and then chief clinician, Macmillan Cancer Support
- 2002-15 Professor of cancer and palliative care, and then dean of the faculty of health sciences, University of Southampton
- 1995-2002 Professor of cancer nursing and director of the Centre for Cancer and Palliative Care Studies, Royal Marsden Hospital and Institute of Cancer Research, London
- 1990s: gains PhD from Kings College London in Nursing, lecturer at Institute of Cancer Research and Royal Marsden Hospital
- 1980s – staff nurse at St George’s Hospital and Royal Marsden Hospital
- 1983 graduates with BSc Hons Nursing Studies, Chelsea College, London University