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”
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”
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.
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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”
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.