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Exclusive: Nurse education failing to keep up with new care models


Senior nurses have warned that nursing education is currently failing to ensure practitioners are fit for future models of care, which will require an increasing ability to move between care settings and harness a wider range of skills.

A combination of increasing financial strain on health services, changes in patient behaviour and expectation, and advances in technology will provide opportunities for nurse roles to evolve further, nursing directors told Nursing Times.

“We don’t think broadly enough about giving people the range of new skills they need to meet the challenges of the healthcare environment of tomorrow”

Helen Young

But they also warned more must be done at undergraduate level to ensure all students were ready to grasp those opportunities. To tackle the challenge, the directors of nursing that we spoke to urged universities and local trusts providing student placements to work more closely together.

Helen Young, director of nursing and midwifery at Birmingham Women’s NHS Foundation Trust, said: “We are not capturing the direction in which healthcare is moving fast enough.”

“We do workforce assessments – so how many nurses and midwives, learning disability, mental health nurses and so on do we need – but we don’t think broadly enough about giving those people the range of new skills they need to meet the challenges of the healthcare environment of tomorrow,” she said.

Ms Young said students needed training that enabled them to cross boundaries between primary, secondary and social care, as more healthcare moved into community settings.

In addition, she said they should also be taught more management skills, have improved understanding of technology and its use for patient self-care and also skills in basic physiotherapy and occupational therapy for community care.

Ms Young said most senior nurses recognised training needed an overhaul. “We’ve kept on saying this for the past 10 years and the problem is – the time is now for the new type of practitioner and we’re still not producing them,” she said.

She highlighted that her own trust was working closely with its local university to design course content and would in future have half the responsibility for accrediting the student’s learning.

Lancashire Teaching Hospitals NHS Foundation Trust’s nursing director Sue Reed also called for more innovation from placement providers, noting that her organisation was looking at using both mentors and patients as coaches for nurses.

“Generally the training is much more biased to acute as opposed to community or primary care”

Greg Dix

She said the continued emergence of new nursing roles meant there was no blueprint for training, which was a “challenge”.

Therefore, she said it was essential universities and placement providers created “thinking, reflective, knowledgeable practitioners” who could adapt to a range of settings.

“Going forward, there is no blueprint,” she said. “Nurses are evolving – and have done over the past 10 to 20 years from leadership roles to midwife consultants to advanced nurse practitioners – and will continue to change.”

Greg Dix, director of nursing at Plymouth Hospitals NHS Trust, said his organisation was also improving its training by offering a balance across community and acute settings. However, he said the model was not being replicated across the UK.

“There are pockets across the UK where there are nurses coming out of training that could be equipped [to work across a range of settings], but generally the training is much more biased to acute as opposed to community or primary care,” he said.

He suggested the recent Shape of Caring Review into nurse education – which suggested students should spend more time on general training before specialising – offered an opportunity to tackle the problem.

“The Shape of Caring review gives us a chance to review the competencies required and to shape the training a bit differently to fully equip student nurses with the skills required to work in any setting. Now is a real opportunity to influence that agenda,” he said.

The Council of Deans of Health – which represents faculties of nursing and midwifery across the UK – claimed that student training was very responsive to changes in the profession, but agreed there was still room for improvement.

Council chair Dame Jessica Corner noted that all students were required to spend at least one placement in the community, but said it was an ongoing “challenge” for universities to ensure a better balance of experience.

“Universities respond constantly to what leaders in practice are saying about the needs of student training, and it is always evolving”

Jessica Corner

She said a range of skills, including management, promoting self-care and use of technology, were already being taught, which enabled students to adapt to different settings.

Professor Corner said she recognised a need to bring more advanced skills – such as those in assessment and prescribing – forward into the pre-registration curriculum. But she warned that practice mentorship needed to be strengthened to support some areas of learning, such as technology, where students were ahead of those working in practice.

“Universities respond constantly to what leaders in practice are saying about the needs of student training, and it is always evolving. We wouldn’t want to be complacent about that though because there are challenges,” she said.


Readers' comments (15)

  • michael stone

    I think there probably is something going on now, which didn't happen in the past, and which affects clinical training: more rapid changes within society. The 'changes in patient behaviour and expectation' mentioned in the piece above.

    Not only are patients much less 'deferential' than they used to be, but the internet age makes many patients better-informed, and social media allows for 'opinion' to spread rapidly.

    I suspect that 'the healthcare system' has yet to come to terms with these changes - I've just posted an open letter to NHS England

    and in the piece I commented that much current EoL guidance seems to [inappropriately] assume 'a compliant patient'. These days models involving 'very compliant patients' are probably both operationally a miss-match, and neither do they fit our law at all well: which makes it all 'much more complex and mess' from the HCP/Organisational side of patient-clinician interactions.

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  • Business that takes a conservative approach has to play 'catch-up' with a group that, whilst it is playing 'catch-up', continues to change. This is intrinsic to the NHS and Social Services because they stem from the hierarchy of the past (class-system, duty, paternalism) rather than from innovation, science and creativity. Without these qualities, claims that care and empathy are the lost qualities of nursing may be less about that and more about clinging to the past. I have had a relative 'cared for', but the failure to put basic information together would have left her with little more than end-of-life care. She was declining due to a change in medication, and whilst nurses were lovely, they were thick, and she would have died. A little innovation and forward-planning makes the care actually that - care.

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  • Tell me about it! I 'failed' an essay this year and had to re-do it as I didn't follow the modules teachings which are like 5 years out of date... I used data and care models published this year and apparently it's 'not what you've been taught'.

    And don't get me started on the tech support... was promised the results on Tuesday or an e-mail explaining why I haven't got them... still waiting. Least the lecturer was kind enough to say 'Enjoy your holidays' Like I can enjoy them when I'm sat here waiting for the results for the only module I didn't get 70%+ in so I can carry on with my studies...

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  • Like many other universities, Plymouth University are in the process of review and re-approval of our per-registration nursing programme and working closely with our placement providers to inform both the curriculum and to explore new placement opportunities within new integrated service provisions, traditional care settings where students can follow patient journey through the range of health and social care services. These things don't happen overnight but we are optimistic we are working together to get there.

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  • It's good to see this being discussed. Universities and practice areas work hard together to make sure that student nurses and allied health professionals are well-prepared for the roles they will have, but it is a rapidly changing environment. It's a relief to hear senior nurses talking about the transferable skills that nurses need to ensure that they can move between working environments and adapt to different client groups easily. This is a major change from the arguments we have had in the past that nurses just need more and more instrumental, skills-based training. The best nurse education is already helping students to be flexible and adaptable, questioning and analytical, able to recognise and develop leadership and to tailor their learning to patient need alongside the clinical skills that change so rapidly. Clinical areas have a responsibility for 50% of a nurse's education - it's good to hear that many areas are taking that responsibility very seriously. These Trusts should be role models in education for others, demonstrating the benefits of active and constructive partnership between university and service.

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  • This is a great article highlighting a real problem in nurse education both undergraduate and post graduate. The profession needs to have more awareness of how nursing fits in the over all scheme of health care provision now and in the futrure. A key part of mentor update.

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  • HCSW

    Few weeks ago I was working with the student nurse (3rd year) unable to roll the patient on the bed. How about going back to basics?

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  • An overhaul is needed within nursing education. Many of the biggest challenges now reside in more advanced assessments and interventions across all sectors. This means more autonomy and accountability.

    There is 20 years worth of research that tells us nurses are not getting enough bio science education to both equip them for this role and enable them to articulate the biological basis of the diseases they are providing care for.

    This is is just one aspect of nursing education.

    With a retiring workforce new graduates need to be equipped with skills and knowledge to make accurate judgement both enhancing their care, documentation and prioritization.

    Unfortunately a lot of nursing councils will not support educational research that does not have an immediate and apparent benefit to patient safety and quality of care because the fruits of education take time to ripen and become apparent. This feeds into a socio-political agenda of public expectation and governmental reforms as opposed to what is needed for the profession to evolve in its own right.

    Much of nursing education research support comes from the medical field grants/bursaries and studentships.

    Clinical placement coordinators (Band 6/7s) should be on site in hospitals for students acting as an educational link for staff mentors, students and universities, they are available in hospitals throughout Europe and the UK would benefit from the same.

    Until nurses take on diverse roles in these areas and implement discipline specific changes education and research will not keep pace with the clinical environment

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  • Asking as a non-nurse, what is the perception of CPD as provided by the NHS? Every vacancy advertised on NHS Jobs promises extensive amounts of it, but I hear many nurses telling how, in reality, it is virtually non-existent.

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  • Nurses in nhs are often very inflexible thinkers. They have learned one way and that is it! As if they fear change and acceptance of new ideas and give the impression they believe nothing else is any good and show a great deal of scepticism for nurses from elsewhere, often far more highly qualified than their British counterparts. Hopefully university training and ebm will change that to enable nhs nursing to progress

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