In my role at the Nursing and Midwifery Council (NMC) I have frequently shared with colleagues my view that there is an opportunity for improved senior leadership of practice learning for student nurses in partnership with NMC-approved education institutions by nurse leaders across health and social care providers. One of the key goals in NHS England's (2023)Long Term Workforce Plan is to increase the number of nursing students, but this goes against a backdrop of a 7% drop in applications to nursing programmes for 2023/24 reported by UCAS (Council of Deans of Health, 2024a). There is some targeted work to do.
An open letter jointly signed by key education leaders before the election called for the next prime minister to support a whole-government approach to improving the domestic pipeline of nurses by taking responsibility for closer collaboration between universities and healthcare providers to increase student uptake (Council of Deans of Health et al, 2024b).
In February 2023, the Scottish Government (2023) established a nursing and midwifery taskforce, with a broad remit to consider attraction, training, recruitment and retention issues in nursing and midwifery, and to make recommendations for improvements as part of an agreed workplan. As a member of the taskforce, I have received with great interest updates on local intelligence gathering, alongside considerations of global evidence that could inform work in the UK.
The Australian and Victorian governments have been leading on building the evidence base for a National Nursing Workforce Strategy, which has had significant public and professional engagement, and included undertaking global literature reviews. A report summary of the work undertaken provides a valuable set of considerations for us in the UK (WhereTo Research Based Consulting, 2024).
The report shows that nursing workforce sustainability is a global challenge, and that workplace conditions and changing demographics are pressure points for nurses. In terms of hearing the student voice in relation to practice placements, the research shows that:
- 67% of nurses make substantial sacrifices to fulfil professional practice requirements
- 45% of nurses think that, when they started in their first professional role, they had the necessary practical skills
- 51% of nurses think that, pre registration, they had sufficient opportunities to develop their professional practice in a healthcare setting.
Nursing students, say the researchers, face significant financial and logistical challenges in attending and completing their placement, so support during clinical placements needs to be strengthened. The practice hours requirement is lower in Australia than that required by the NMC in the UK, but it is still a mandatory part of nursing education.
Despite the fact that there was a strong voice from students to support the clinical placement model in order provide effective hands-on learning in situ, concerns were raised that not all newly graduated nurses have the required skills, mindset and competencies to start their jobs confidently and effectively. Many of those involved in the research highlighted the following:
- The structure of clinical placements is inflexible and unrealistic, making it difficult (and, in some cases, unsafe) for many students to complete
- The experiences of students during placement can be negative, with some reporting a poor workplace culture and a lack of acceptance from colleagues
- More comprehensive training could better prepare students for the tasks they will need to undertake in their nursing career.
The research also touched on wider population needs and the broader context. For example, it highlighted that future nurse preparation needs to consider the increasing role that digital tools and technologies will have in nursing. It also recognised that nurses in rural and remote areas face added challenges and that nursing workforce planning does need to support the broader health system.
In the UK, the NMC has commissioned independent research from The Nuffield Trust to inform potential improvements to education and training. This aims to ensure that nursing and midwifery education and training are based on the highest quality evidence from the UK and abroad, and are fit-for-purpose in the modern health and care system. This work, taken together with my involvement with the Scottish Government taskforce, shows that this is an exciting time for nurses to get involved and influence the direction of travel for practice learning for the profession.
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