A major review of nursing education and training looks set to recommend that future student nurses undertake care experience before starting their degrees, but that a whole year is too long.
The requirement, expected to form part of the Shape of Caring Review’s final recommendations next year, would probably be more flexible than a controversial government pilot scheme where future students spend up to a year working as healthcare assistants.
The review was set up in May by Health Education England and the Nursing and Midwifery Council to examine standards of pre- and post-registration nurse education and training. It is due to report its findings in February.
“The bottom line is no one should begin a nursing degree who does not have a relevant amount of prior experience”
In an exclusive interview, the review’s chair Lord Phil Willis told Nursing Times that his final report would include a recommendation about “prior experience” for student nurses, but he suggested he was yet to finalise what it would be.
“There will be a recommendation about prior experience, and I have moved over and back on this,” he said. “I think a year is too much, because I don’t think it is financially sustainable to deliver. But what the public demand – and which as a minimum patients should demand – is that nobody works with a patient without appropriate training and experience.
“We are looking at a flexible system, [the] bottom line [is that] no one should begin a nursing degree who does not have a relevant amount of prior experience, but there can be flexibility about how you exhibit that,” he added.
Health Education England is currently running a series of pre-nursing experience pilot schemes, in which prospective students “up to a year on the frontline” prior to starting their degree. The pilot was sparked by the government’s initial response to the Francis inquiry in 2013.
Lord Willis also reiterated themes discussed at the chief nursing officer for England’s summit in November, where it was suggested student education should initially be more generalist in order to break down “silos” between specialisms.
Currently, nurses pick one of four specialisms to study at university – adult, paediatrics, mental health or learning, and disability.
Lord Willis told Nursing Times he was exploring “whether there should be a greater element of generalism, with preceptorship being the start of the specialist process”.
“They [students] might do two years of really detailed rigorous general nursing and then begin their specialism in the final year and run that on into preceptorship,” he said.
Meanwhile, the Liberal Democrat peer criticised the current lack of a structured career path for nurses, describing it as like “snakes and ladders” with no clear paths or milestones.
Nurses must instead rely on “luck and judgment” to progress in their careers, he said.
He also repeated concerns over nurse mentoring, adding that his fears had been “reinforced” by evidence given to the review. He hinted that he might suggest a more formal role for nurse mentors, rather than the current situation where it is a duty expected of the majority.
“I remain convinced that mentoring needs to be streamlined and further professionalised; a key role in any organisation with recognised status. I don’t buy that everyone can be a mentor,” he said.
“In 10 or 15 years, unless we change, it will not be fit for purpose”
The review would also examine whether the independent sector could play a greater role in the education of nurses and the need for universities to improve their training to achieve consistent quality.
Speaking generally about the state of nurse education at present, he said: “Nurse training is pretty good and there isn’t much you would criticise apart from the fact there has been a greater call for standardisation.”
“It is certainly fit for purpose in 2014 but in 10 or 15 years, unless we change, it will not be,” he warned. “Raising the bar is really important.”
He added: “I have been genuinely staggered by the amount of innovation that is going on right across the country which, if replicated, would make a profound difference to the quality of care that we give and the quality of experience for staff giving that care.”