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”
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”
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.