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Nursing apprenticeships ‘must not repeat mistakes of past’, says RCN


The new apprenticeship system for nurses risks repeating the mistakes of the past, potentially putting both patients and apprentices at risk, the Royal College of Nursing has warned MPs.

Janet Davies, RCN chief executive and general secretary, told the Commons education select committee on Tuesday that there was clear evidence to support the traditional system of degree-based training.

“We need a whole picture of where we need investment in nursing education”

Janet Davies

It was safer, more consistent and more inclusive than the old style apprenticeships through which all nurses were once trained, she claimed.

Under this old system, both registered nurses and state enrolled nurses were paid by their employer and put on the duty rota as part of the team, rather than being supernumerary.

Apprentices had to learn from an inadequate number of fully qualified registered nurses, which reduced both patients’ quality of care, and the quality of the training, said Ms Davies.

This approach to training was phased out following seminal pieces of work on nurse education reform called the Judge Report and Project 2000, which were both carried out in the mid-1980s.

Both concluded that hospital-based apprentice training was unsafe and inefficient, and did not equip nurses with the necessary skills for the future, noted Ms Davies.

“Many of the directors of nursing that we talk to feel the cost of training has just been transferred from the government to employers”

Janet Davies

She highlighted that, with more than 40,000 nurse vacancies in England alone, there were fears history could repeat itself with the government’s new apprenticeship scheme.

She said apprenticeships risked putting undue pressure on overstretched NHS services, as they placed the responsibility for training staff on cash-strapped employers, instead of universities.

Giving evidence to the committee, which is carrying out an inquiry into nursing apprenticeships, Ms Davies said: “The big challenge we have is ensuring we’ve got a proper environment where students can be students and where patients can be kept safe.

“Many of the directors of nursing that we talk to feel the cost of training has just been transferred from the government to employers, who are already overstretched,” she said.

“We are currently working in an environment where we have 40,000 registered nursing vacancies,” she said. “These are the people who have to be the mentors and supervisors and their focus has to be providing safe care to their patients.

Janet davies

Janet davies

Janet Davies

“It is not chance that we have the level of vacancies that we have. This was because of poor policy, and saving money in the past. Apprenticeships themselves will not fix this. We need a whole picture of where we need investment in nursing education,” Ms Davies told MPs.

She also highlighted to the committee that prior to the scrapping of the bursary that 41% of people on nursing degree programmes were over 25 and that representation of people from local communities and ethnic minority backgrounds was better than the rest of the student population.

“We need to have incentives for people to be able to have a university education as well as people having the opportunity via an apprenticeship,” she said. “Both models need investment not just one over another.”

The RCN leader also warned that the current apprenticeship levy does not cover the full cost of training, leaving struggling health service trusts to pick up the bill.

Ms Davies referred to previous evidence on the issue of the levy that had been given to the influential Commons health select committee.

Health select committee

CPD cuts ‘will lead to fewer advanced nurses’, MPs warned

Danny Mortimer and Janet Davies giving evidence to the Commons health committee in 2017

She noted that Danny Mortimer, chief executive of NHS Employers, had told the committee that the cost of training was “probably something in the region of £125,000 to £155,000 over the four years of a nursing apprenticeship, and the levy will not capture all that cost”.

The government announced degree apprenticeships in 2016 as a new route into nursing, with an ambition to train up to 1,000 a year. But progress has been slow.

The first wave of nurse apprenticeships began at around four universities in England in September 2017, with a further nine universities also funded to offer courses from September 2018.

However, the first wave was hindered by delays with getting courses approved by the Nursing and Midwifery Council as well as a number of other factors.

Confusion over the new levy funding system for apprenticeships, the need to support training for new roles like nursing associates, and pressure on clinical placements also contributed to delays.

Members of the Commons’ education select committee highlighted recent media reports that only around 30 apprentices had started training in 2017.

The RCN has set out four key factors it believes must be in place for apprenticeships to work as intended:

  • Ensure access to a variety of clinical placements across community, general practice, social care and acute settings to ensure nursing students have the necessary exposure and experience of working in different environments
  • Ensure access to safe, effective and appropriate learning environments where nursing apprentices have protected time for learning and access to mentors and assessors. Currently, providers will struggle to meet this requirement due to the unprecedented pressure they are facing
  • Protect the supernumerary status of nursing students. Any compromise to supernumerary status of nursing students would compromise patient safety as well undermine nursing students’ learning ability
  • Ensure a robust quality assurance process is in place to make sure that patient and learner safety is guaranteed and that there is consistency is the skill, knowledge and abilities of all nursing graduates, whatever route they take into becoming a registered nurse



Readers' comments (6)

  • Trained properly the apprentice nurse has a lot to offer. The biggest mistake and waste of money in nursing at the moment is the associate nurse.

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  • My apprentice style training prepared me for anything and everything. But I was lucky enough to train in a really well run establishment where the trained staff received support to develop their skills and there were link nurses working between the wards and the school. The tutors were a visible presence as well.
    I learned care and compassion from wonderful role models. I learned about quality care and reflective practice.
    The difficulty in accessing CPD and the sheer pressures on nursing staff would suggest that apprenticeship will be difficult to maintain as the environment had changed so much now.

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  • I have been told by trainee nurse associates that after doing the 2 year foundation degree they will only have do do another year to become a qualified nurse.

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  • I trained in 1972 to 75. My training hospital offered a high level of academic teaching and wide variety of practical experience. I was fortunate to work in a number of specialities. The negative was perhaps we were given to much responsibility ie taking charge of wards at night in second year with night sister covering a number of wards! The positive side of this was you made sure you did your reading/research so you were prepared for your shift and the cross examination you might have by consultant or night sister! At the end of my training I felt confident to take on my role as a registered nurse and life long learning. After taking early retirement at the age of 54, partly because of frustration of working in NHS, staff shortages, targets and paperwork seeming to take priority to actual patient care, I was happy to start working in a hospice. I had been out of nursing 4 years and took a health care assistant post. My learning continues and I find it wonderful to be able to be at the bedside caring for patients in an environment that supports the best level care putting patients and family first. I loved my career as a qualified nurse but equally find myself enjoying the opportunities my new role has given me. Perhaps if we took the best of the variety of type of training over past 70 years we might have something that ensures we have nurses well prepared for patient care and retain them in the NHS. Nursing always has and always will evolve and there are no easy answers as to how we meet the challenges ahead but I hope we will have a majority of nurses who can say they have enjoyed their careers as much as I have.

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  • Load of rubbish ,nurses trained years ago much better trained to deal with anything ,You ask any patient Who they preferred ,much better nurses

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  • As someone who trained "the old way" in 1982 when I qualified I felt quite confident working as a newly qualified nurse as I had experience of working on wards starting at the basics and working up to ward management skills. I felt supported and learned more than could be taught in books from my peers and from my patients who I cared for. I will never forget the satisfaction of taking out sutures for the first time and being thanked by the patient for not causing them any pain, just one of may small milestones. We learnt a lot by taking increasing responsibilities as we progressed through our training and yes taking charge on nights was scary but the satisfaction of getting through the night and solving the problems as they came up was well worth it. We relied on other Nurses form neighbouring wards as well as the Night Sister for support which we got. We reflected on our practice nearly daily among ourselves and when we were in school for a week we always had lively debates on what had happened on placements. It was not all rosy and even with the best rose tinted specs there was things that could have been much better and some staff more supportive, it was not easy being a male nurse back then especially with some senior staffs attitudes, but I have always felt I was well prepared for my future and while my role has changed and developed well beyond I ever imagined it would the lessons I learned then still influence my practice today. This is just my personal views on my own experiences and my apology if I offend anyone which was not my intention.

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