Prospective student nurses should be warned about the challenges and demands of the job before choosing to pursue the career, according to a new report by Health Education England.
The national workforce body is leading a piece of work to gain understanding of the reasons why healthcare students fail to complete their course or quit the profession within two years of registration.
“The data suggests students who leave early do so… because they are insufficiently informed about the profession”
The RePAIR (Reducing Attrition and Improving Retention) project covers the four fields of nursing along with midwifery and therapeutic radiography.
In the academic years 2013-14 and 2014-15, the overall percentage of students studying these subjects who did not complete their course on time was 33.4%, the report notes.
Broken down, the attrition rate was worst in learning disabilities nursing programmes, sitting at 39.11%, followed by mental health nursing (34.98%) and adult nursing (33.35).
The top reasons for students considering leaving their course listed in the report include finances, academic concerns, placement experiences, personal reasons, workload, doubting their ability or choice of career, lack of support and mental health challenges or depression.
Among the recommendations listed in the report are for clinical staff to be actively involved in the recruitment of students so they can convey the true demands of the course and subsequent career.
It said: “The data from RePAIR suggests that students who leave early in the course do so because of a wrong career choice or because they are insufficiently informed about the profession, particularly in adult nursing and therapeutic radiography.”
“It is important that the students are given opportunities to take responsibility”
The report also recommended that hardship funds be made available to encourage more people, particularly those who are older, to embark on a career in nursing, midwifery or therapeutic radiography.
It said: “The evidence from RePAIR is that students worry a lot about financial pressures. This may suggest that there needs to be targeted financial support to encourage applications from those considering a career in these fields of healthcare.”
Alternative routes into the professions including as a nursing associate and apprenticeships may be a “more appropriate option” for some students worried about money and should be encouraged, the report noted.
Universities should work closely with their healthcare provider partners to map out detailed clinical placement plans for all students throughout the duration of their course, the document added.
It said a significant number of students reported experiencing enough difficulties around their clinical placements to warrant quitting.
The document said: “A noteworthy frustration for students is the disorganisation of courses. Principally, the lack of forward planning about placement allocations.
“Mature students, particularly those with family commitments or other caring responsibilities, commented on the anxiety of not knowing where they are going to be placed in the following weeks.”
“Others reported that they felt scared at the prospect and wanted to refresh some of their skills”
The report found students on year two of their programmes did not get as much support as their peers in year one and three.
The importance of offering students support during the transition from education to the world of clinical work – referred to as the “flaky bridge” – was also highlighted. Out of 25 newly qualified staff interviewed for the project, just three described the transition as straightforward.
The report said: “Some students are ready for the challenge of being a newly qualified practitioner and want to know when the posts are going to be advertised and how soon they can apply. Others reported that they felt scared at the prospect and wanted to refresh some of their skills.
“It is important that the students are given opportunities to take responsibility, under supervision, towards the end of their course to help them develop confidence in their abilities,” it added.
Evidence collected for the RePAIR project shows there is a “direct correlation” between the quality of preceptorship at an organisation and newly qualified practitioner attrition.
The report also found that students hoped to be offered a job where they had been trained. It recommended that neighbouring healthcare providers work with their local universities to establish a shared model of recruitment.
“Attrition is everyone’s business”
Alongside the report, a toolkit has been created to help universities, healthcare provider organisations and policy makers reduce attrition with a range of learning materials, videos and examples of best practice.
Professor John Clark, regional chief nurse who led the RePAIR project at HEE, said: “Attrition is everyone’s business.
“Every individual or organisation providing pre-registration healthcare education or contributing to clinical placement education must ask how they can work together with HEE to respond to the recommendations made in this report,” he said.