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Care experience 'does not produce better nursing students'

  • 29 Comments

Academics have warned the government it must gather more evidence before expanding further its pilot scheme to make aspiring nurses work as healthcare assistants before training, after new research found previous caring experience does not lead to better university results.

In the government’s initial response to the Francis report into care failings at Mid Staffordshire Foundation Trust, it recommended that every aspiring nursing student should serve up to a year as an HCA to “promote frontline caring experience and values, as well as academic strength”.

Subsequently, in September 2013, Health Education England launched a trial scheme that saw around 160 potential student nurses gain experience in care settings across six areas in England, with the scheme being expanded in 2014. Further pilots will take place from February 2015.

But initial findings from a study of 579 nursing and midwifery students in Scotland found that students who joined the course with prior experience – in either a care home, the NHS or among family and friends – achieved on average lower grades than those who did not.

It also found that around 60% of the 48 students who left their nursing degree within the first year were those who had previous care experience.

“There is a very big political push to do this [introduce mandatory HCA training]… we need to get the evidence out there”

Rosie Stenhouse

The research – being led by the University of Edinburgh in collaboration with the University of the West of Scotland and Edinburgh Napier University – looked at students on adult and mental health nursing and midwifery courses and compared average grades across academic and clinical modules for the first year of their undergraduate degree.

Lead researcher Rosie Stenhouse, lecturer in Nursing Studies at the University of Edinburgh, has warned there is currently insufficient evidence to support the government’s proposal that previous care experience creates more competent nurses.

“There is a very big political push to do this and since the majority of nurse educators and people involved in the profession would want to be doing things on basis of evidence  – rather than the basis of assumed association between one activity and a consequence of that activity – then we need to get the evidence out there,” she said.

Ms Stenhouse urged the government not to make HCA training mandatory until the evidence had been gathered as to whether it had an impact on producing more caring nurses. “Otherwise there is a lot of money going into something that may not fulfil the outcome that is desired,” she warned.

“Many of those in the first cohort of pilots are going into nursing degree programmes – around 75% are now at university or have places”

HEE

She said the initial findings from the study – funded by NHS Education for Scotland to assess criteria for selecting nursing students – were surprising, as she had expected both sets of students to achieve similar grades.

“My sense is that while people might not have the caring experience, they often have had very relevant experience in terms of development of their interpersonal and communication skills through work with other people or voluntary groups. That’s why I didn’t necessarily expect there to be a huge mismatch,” she said.

Ms Stenhouse said more investigation was required to look into the complex factors leading to the findings published this month.

She warned that the final results of the study could change by the time it is completed at the end of the three-year course in 2016.

In response, a spokeswoman from Health Education England highlighted some of the benefits emerging from the pilots.

The schemes provided an opportunity to get the “best people into nursing”, she said, especially for those who could not financially afford to risk jumping straight into a nursing degree.

“We already know that many of those in the first cohort of pilots are going into nursing degree programmes – around 75% are now at university, or have conditional or unconditional places starting in September 2014 or spring 2015,” she said. “Twenty-two participants in the first cohort have left the pilot so far (around 12%).”

She confirmed HEE would publish an evaluation of the pilots in February 2015 and would also consider wider reasearch findings at this time.

  • 29 Comments

Readers' comments (29)

  • Someone appears to be confusing care with academic skill. I thought that was the whole point of getting that pre-course experience, to find out if caring is what you want to do and what you have a talent for. As for the Universities being bothered about academic excellence, I am aware of one that would accept a mark of 45% in numeracy - personally I would prefer to have my dose calculated by somone with a better than 50% chance of getting it right.

    Could this piece of research (led by Universities) possibly be a reaction to potential nursing students taking an extra year to arrive in the Universities - therefore causing a temporary gap in income generation - sorry I mean a gap in recruitment onto courses?

    Statistics have the potential to say whatever you want them to - and I work with them every day!

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  • nice one to the coment 30-dec-2014 5:17 pm you are 100% but uni cant afford a year in important basics it is strat in with in two weeks sitting on butts thay pick most of this basic any way of the auxcillarys but we can put a stop to that?

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  • I am currently in my first year as a Nursing Student after almost a year working as a health care assistant. Personally, I believe that previous experience has helped me immensely.

    University does not and cannot teach you how to talk to the relatives of someone who just died, or give someone a bed bath with dignity, amongst numerous other things.

    But for me, the reason I began work as a HCA was because I was interested in nursing, but thought I couldn't really know what nurses truly did until I had worked alongside them, done the night shifts, dealt with the difficult patients etc. Thankfully, I found I loved my job, and admired my colleagues, and wanted to further my career so here I am now.

    However, we are only one semester in, and already, before even beginning placement, 15 people have left the course.

    15 student nurses, who fought for a place on the course when there were 10 applicants for every one place, have left because they didn't realise what nursing really was about. And I can't help thinking that if they had had experience working as a healthcare assistant, learning caring skills, but also learning whether it was for them, those places could have been given to people that would have continued on to qualification.

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  • congratulations charlotte brown you are the start of good nurse be possative and don't let others influence you to the darkside do want you feel is right for the patents.
    all the best for 2015 a star will follow you.

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  • Well done Charlotte Brown, what an erudite and well thought out post. Hopefully Ms Stenhouse will take your experiences into consideration when her team make more investigations into the facts.

    By the way, does anyone else find it a little odd that someone charged with running a lengthy research project starts publicising bits of it in the middle of the study but adds the caveat that those "facts" may not be facts at the end of the study? Is such a disclosure at this point of a study politically motivated, or was it just a slow news day?

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  • I don't know much about the political motives behind revealing some of this information but it is not at all uncommon for researchers to release information about a study before the study is finished. They might have a number of different reasons for this, one of them perhaps to get people to talk about it? The study runs until 2016 but perhaps some things are already becoming very obvious and perhaps based on the facts they have so far, it is not likely that there will be a significant shift in those results? In such cases they might talk about a preliminary picture that is emerging. But since the research is not finished, they would have to put in the caveat of saying the end results might be different.

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  • "It also found that around 60% of the 48 students who left their nursing degree within the first year were those who had previous care experience."

    Seriously? This is the drop-out rate, right? Could it by any remote chance be because, having tried the hands-on experience, these students had realised that, after all, nursing was not for them? A bit like what used to happen in the olden days, in fact? I think it something of an irrelevancy that the drop-outs occurred after, rather than during, the practical experience. Unless, of course, the students realised how divorced the academic side can be from the actual practice of nursing.

    I question the 'experience' gained in care homes or with family and friends. Some care homes are excellent, some are decidedly not, and I really don't think having cared for family and friends can be compared with the requirements of working for a paying employer after a period of formal training.

    Charlotte Brown is spot-on. What a lot of time and money would be saved and what a lot of disappointment avoided if people knew what they were letting themselves in for. Nurses are not saints, it isn't a vocation, it is a job we do to the best of our ability and there is no shame in admitting it's not the profession for us. But at least if we've tried it first, we are making an informed decision.

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  • I also must congratulate Charlotte and wish her all success in her career; she has made a wonderful start. I agree completely with 'Anonymous 30-Dec-2014-5.17' that their is confusion between 'caring' and academic skills, and am struggling to understand how working as a health care assistant could possibly affect one's ability to write good essays! However I firmly believe that some kind of caring experience is beneficial to nursing students, even for a short period. As for the drop out rates,I wonder if those who have worked as HCA's are more likely to drop out for financial reasons than those who have not. There have always been drop outs from nursing courses, and maybe the reasons are not all that different. Suitability for the work, difficulties with the course and financial problems still face students today as always, so tackling them is surely the way to ensure we have a constant stream of fresh, caring, well qualified nursing staff to replace all those who cant wait to retire!

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  • I was very pleased to read Charlotte's comment about her wish to try nursing delivery before embarking on a course, and am sure she did the right thing for her. However, what is right for her may not be right for others and the message of the research so far seems to be that it doesn't follow that the practice experience will deliver that guarantee for all, nor that it will be an indicator of willingness to see the course through. I would be as happy to see people who come in without the experience but who have the human qualities to make a go of it without taking a year to "prove" themselves as I am to see people like Charlotte become nurses - individual examples are an inadequate basis for policy making and we need to watch the research. As HL Menken wrote: there is always a well-known solution to every human problem — neat, plausible, and wrong. Soundbite driven policy is an example of this...

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  • 'Academics' need to be a bit more careful before making their pronouncements. If the point of nursing training was an academic degree, they might have a point: it isn't, and they don't. The point of nursing training is to prepare would-be nurses for their professional life - and an academic degree is relevant to the extent that it contributes to that end. If the profession, and the health service, think there are other, and better, ways, it'll be the academics who are left behind.

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