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Student nurse pass rate linked to funding incentives

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Nursing academics have admitted universities are incentivised to pass as many students as possible but denied it resulted in them passing poor students.

However, one in five “sign-off” mentors responding to Nursing Times’ survey said their decisions on failing students had been overturned by universities.

If you lose a student, potentially you are penalised. So you can see that pressure

Mentors have told Nursing Times they are concerned universities have a “perverse incentive” to keep passing bad students, as higher education institutions did not want to lose their funding.

This concern will be further fuelled by research underway at Birmingham City University’s department of practice learning, which found some universities have not failed or withdrawn any students from courses on the basis of their practical assessments.

Louise Hunt, a senior lecturer at the university, told Nursing Times preliminary findings from her as yet unpublished research showed “only a very small number of student nurses were withdrawn from courses because they failed practical assessments”.

She compared the failure rate between theory and practice courses, finding the rate of failure on theory outstripped practice failures by a ratio of almost five to one.

Jacqueline Fletcher, principal lecturer at the University of Hertfordshire school of nursing, midwifery and social work, admitted that a high level of student failures “did attract [funding] penalties” but said the blame lay with strategic health authorities.

“It’s about the SHA, not the university. They financially penalise us if more than a fixed percentage of students don’t pass. It’s about the way it’s funded.”

“If you lose a student, potentially you are penalised. So you can see that pressure, although the universities also want students who are safe and competent. The university is constantly trying to play off those two things.”

A spokeswoman for the Council of Deans of Health confirmed the funding worked to incentivise a low fail rate, but said the system allowed for a baseline of 13 per cent of students to fail as it was recognised a proportion would not be “fit for purpose”.

Jayne Hardicre, a nursing project manager with five years experience as a nursing lecturer, told Nursing Times it was true students frequently challenged the assessments of their mentors, creating what had now become “quite a litigious process”.

But she said lecturers themselves were often “frustrated about students being passed even through there are concerns raised constantly”.

This was because mentors too often gave students the “benefit of the doubt” or “passed the buck” to the next placement, not realise all others were doing the same, she said.

Royal College of Nursing head of policy development and implementation Howard Catton told Nursing Times: “That’s a really worrying issue. The RCN wouldn’t condone that. Nurses need to think extremely carefully about their own responsibility in relation to the code of conduct.”

He said both universities and mentors had to “take responsibility” for the problem. “Nurses need to identify when there are problems [with students] and then raise them and [universities] need to recognise where there are deficits and provide support [to mentors] as needed,” he said.

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