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Review identifies vital need to find out why student nurses drop out


An “urgent” assessment of the reasons student nurses leave their undergraduate degrees is required to stop NHS education funding from being wasted, according to the chair of a major review of nurse training.

Local and national attrition rates at universities should be tracked on an annual basis and a standardised tool for exit interviews must be developed, said the Shape of Caring Review in its key recommendations.

“We are losing just over 20% during the student journey. The cost of that is phenomenal”

Phil Willis

This “Achilles heel of the nursing world” must be addressed immediately to ensure NHS money is not being needlessly used to train increasing numbers of students, said Lord Willis of Knaresborough, who chaired the review.

He said the average drop out rate for student nurses at universities in England was more than 20%, but warned some places in fact had up to 50% attrition.

“We are losing just over 20% during the student journey. The cost of that is phenomenal  just on the caring side, never mind the monetary side,” he told Nursing Times. “We talk about having to recruit 20,000 more nurses, well we can do that if we can retain more people.”

“So we’ve asked Health Education England to record on an annual basis during the student journey about the student experience to find out where universities are not doing well, where individual placements are not doing well, or where there are problems with mentoring which you can then do something about,” he added.

Lord Willis said it cost over £70,000 to train a student nurse and that the money saved from funding increasing numbers of students at this cost – to plug the gap created by those who do not complete degrees – could be better used on the existing and trainee workforce.

“I want [that money] to go toward preceptorship, supporting placements, for improved mentoring – all of which produces a better workforce that feels valued,” he said.

Lord Willis also said there were problems around the lack of data on how many newly-qualified nurses choose not to register to practice and how long nurses stay in the profession for.

In addition, he called on the Nursing and Midwifery Council to record data from employers about how long nurses remain in the profession and their reasons for leaving.

“If in fact, let’s say a quarter of people who leave in the first five years do so because of maternity – the big question I would ask is how do we get them back? We’ve invested £78,000 in them,” he said.

It is also important to find out if nurses are leaving because employers are asking them to perform tasks outside of their competency without training, he said.

The Shape of Caring Review report, published today, makes 34 recommendations in total to improve future pre-registration and post-registration nurse education and training in England.

It was commissioned by Health Education England, after concerns were raised about standards in the wake of the Francis report into Mid Staffordshire Foundation Trust.

What did the Shape of Caring Review Recommend?

  • HEE, working with higher education institutions (HEIs), should support the development of a standardised student minimum data set, which would enable the calculation of attrition rates at HEIs, local and national levels.
  • HEE should work with HEIs to develop a standardised exit tool to explore in greater depth the causes for leaving the pre-registration programme. Such data should be reviewed and analysed urgently by HEE to inform future student nurse commissioning intentions and processes.

Readers' comments (10)

  • Marc Evans

    Its because people still view this as an easy university option but its not. Training to be a Nurse is a difficult process both mentally and physically. Nursing isn't for everyone you need to have the right attitude and desire to want to do it.

    The media are partly to blame, the way they portray Nursing on television is completely different to Nursing in reality.

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  • Maybe students go into training in the hope they can help people and do something positive and morally rewarding with their lives and have a sense of achievement - but when the reality of what it is REALLY like in the NHS they then change their minds ?

    After all we all read about the extremely negative parts of the NHS that are enough to put anyone off, especially where the Trusts boards of management fail to do anything about the serious problems staff encounter.

    They are only following the lead of our government, the Health Secretary and ministers who also fail to ensure NHS staff are able to safely report failings, abuse and neglect without suffering themselves !

    It all stems down from the ongoing failings of our government to ensure staff and patients are supported and protected when they need to whistleblow.

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  • I left a student nursing purely because of the hours I was expected to work on placement with little funding. They cut down the loan you can claim, the bursary is dependent on many things and I couldn't afford to live when expected to run a car to get to placement and university. I worked part time as a hca but I was exhausted and I loved my job as a healthcare assistant. I chose to take a year out to decide what to do and I am now employed as a band 3 hca, if only there was a way to complete my degree in my current job so that I could still have a salary but there are no options!!

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  • Could it be anything to do with low pay, poor status, inadequate staffing levels, lack of career progression, impossible hours,blame culture, constantly having to cover your back in case of a claim against you? Just a thought!!!

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  • they drop out as nurses are treated like c00p

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  • It's because they are too posh to wash! ( sits back and waits for the sh*t to hit the fan)

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  • There are multiple reasons, Some realise it isn't for them, some don't like univ life or being away from home, some fail assignments, some fail practice (we do afterall want people who can do the job well), some because its too stressful, some because of fitness to practice and some because they become pregnant etc etc. No need to look into why - universities already do that.

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  • Willis only seems to have asked luddites for ideas. More general nursing in 1st 2 yrs, come on we've been pushing physical/mental health being treated equally for ages. Project 2000 started like that and failed. Nurse educ is already too adult focused, the other fields need their specialism enhanced otherwise those service users get an inferior care that is adult focused - not what is needed in child, learning disability or mental health. If he wanted ideas here one, lets have 4 seperate 3 year training with SRN, RLDN, RSCN & RMN. He wants to go back toSEns lets go the whole hog

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  • I think its the hours and the funding you do not get very much. I would rather pay for my degree and have time to pay it off like a normal degree then have to spend three years stressing about my finances. I do not understand how they can cap your funding/loans when you are expected to work 40 hours a week on placement. I was told that student nurses get less than people who are on apprenticeships. Also being told you can not work over a certain number of hours a week when you are a student nurse but on other courses where you can work as many hours as you like they get funded a lot more. It is all worth it in the end and I am sure I will learn a lot about budgeting so not all bad.

    With regards to specialisms my university offer adult , mental health, child and learning disability nursing as separate courses, but a lot of people have said they are doing adult because it is quickest and easiest way to get onto midwifery courses.

    I agree nursing is very demanding physically, mentally and emotionally and maybe some people do not realize this before entering onto the course but that is why I think that new scheme of doing a year as a HCA first is a good idea because you get to see some of the situations that nurses experience.

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  • It's financially unsustainable, too posh to wash has nothing to with it and such comments are extremely offensive. We're working 70-80 hour weeks as the bursary is ridiculously low and student finance options are limited... either open up student finance or increase the bursary!

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