Sunday, 21 September 2014

Staying the Course: 549 days done, 549 days to do

I was sent a tweet last week from one of our students. She reminded me that 549 days ago I had welcomed her to the School at the start of her journey to becoming a nurse. She said she has 549 more days to go before that ambition is achieved. I am sure, like many others, she will get there and join a profession that continues to develop its knowledge and skills base. More than ever, greater numbers of students complete their studies.

It is inevitable, and probably desirable that there is some attrition, but there are good reasons to see retention of good students as a high priority. According to the Nursing Standard, in 2006 the national attrition rate was around 26%. Back then, this was estimated to cost the NHS some £29 million a year. By 2011, the Nursing Times was reporting some improvement however, with a national attrition rate calculated to be 18%. Calculating the actual rate of attrition is complex, partly due to the fact that students can take up to 5 years to complete a 3 year programme. And some will take this long – for example, stepping off because of pregnancy or perhaps because they have failed to progress academically.

What is easier to calculate is the number of students who never start their second year. In 2011 this was 1.6% (compared to 4.5% in 2009). I think there are many reasons for this reduction. It reflects the level of qualifications we now expect applicants to have achieved before they start and the enhanced recruitment processes we use. Like other Schools, we have adopted a values based approach and we involve colleagues from practice, and service users and carers in the recruitment of our students. With over 6000 applications for 700 places, it is true to say that we have been in the businesses of selecting our students rather than simply recruiting.

Since 2011 we have sought to deliver our new all graduate curricula in creative and challenging ways. We have introduced the 'flipped classroom', and perhaps most importantly have focused on the degree of support students receive from colleagues in the University and in practice. This has included offering enhanced pastoral care, and financial and health support to students. The majority of our students are not your average 18 year old undergraduate, but mature students, often with families and having to juggle studies with a range of other responsibilities.

Robert Francis investigated the concerns of the quality of care available to patients in many hospitals and at Mid-Staffordshire Hospital, in particular. He drew attention to the fact that there were not enough nurses in the NHS, and not enough nurses who were committed to providing compassionate care. Leaving aside that health care is usually provided by a range of different health professions the response from the UK Government was to look at how best to increase the numbers of nurses in the workforce and how to make all nurses more compassionate.

 The Secretary of State for Health, Jeremy Hunt response to the ‘apparent’ shortage of nurses was not to provide additional commissioned student numbers, but to blame Universities for not keeping enough of the student’s on their programmes. At the same time, the Chief Nurse for EnglandJane Cummings set out her 6 C's stall. She advocated that all nurses underpin and inform their practice with: care, courage, competence, communication commitment, and compassion, and that these 6 values should be embedded in University curricular.

Additionally, there was the highly contested ‘spend a year in practice’ idea. This approach suggested that all would be student nurses should spend up to year working as a health care assistant or an equivalent in a care setting. According to the Nursing Times, the pilot of 165 such potential students was costing around £11,000 per applicant. If this cost was rolled out to the nearly 20,000 students who start their nurse education and training every year it would cost the NHS some £225 million. Likewise, in May this year the Minster of State for Care and Support, Norman Lamb suggested that new recruits in to social care settings would need to achieve the so called ‘Care Certificate’

Whilst of course it might be a good thing to enable potential nurses and care workers of the future to gain some hands on experience before they start their training, neither of these approaches has an evidence base that might suggest they will either increase an individual’s sense of compassion or indeed, result in higher rates of student retention. I think that being and caring for others is what brings people into nursing as a profession. It’s a range of other factors that are more likely to contribute to students making the difficult decision to leave their programme. Tomorrow I will welcome another 1000 students to the School as they embark on their own personal journeys. Hopefully like the student who tweeted me last week, for many of them there will be at least 549 reasons for staying the course.