Applications for nursing programmes in the UK are reported to have risen by 32% this year, with more than 60 000 people expressing an interest in joining our profession (Ford, 2021). Mark Radford, the Chief Nurse of Health Education England (HEE) said:
‘The tireless and outstanding commitment of all our nurses over the past year … is the best advert for the nursing profession.’
This interest is very encouraging, and it will be key that the increase in applicants translates into students and then, ultimately, an increase in registrants. The question is how we might ensure that this increase in demand for nurse training can be supported, particularly in the area of practice placements.
The pandemic has disrupted education, but this has also opened our eyes to different ways of working. Student nurses' clinical placements have been particularly affected. However, we must not forget that prior to COVID-19, improving clinical placements was an area that we were all focused on, in terms of the opportunities for both quality and capacity for increased placements.
Recognising the options for new ways of working during this time, the Nursing and Midwifery Council (NMC) has announced that up to 300 of the 2300 clinical practice hours required to be completed during a pre-registration programme can now be completed in simulated environments. NMC changes aim to increase flexibility to ensure the next generation of nurses have sufficient practical experience to qualify with the skills and knowledge they need.
To support this announcement, the Department of Health and Social Care (DHSC) (2021) has announced a £25 million boost for nurse training, which will see nurses and other healthcare students benefit from expanded virtual training, with up to £15 million for English universities to rapidly expand simulated learning. This can involve the use of virtual reality technology, manikins, role play, and smart phones, tablets or computers, allowing nursing students to practise their clinical skills in a safe environment. They will be able to train themselves on clinical procedures and simulate a realistic clinical setting with support from experienced colleagues.
Dr Katerina Kolyva, Executive Director of the Council of Deans of Health, said:
‘The COVID crisis has put unprecedented pressure on practice placement capacity for students. Many universities have responded by increasing student exposure to simulated experiences … This new investment will go some way to helping universities provide the equipment and facilities necessary to take advantage of this flexibility.’
She hoped that sustained investment would allow more nurses and other health professionals to be educated in this way.
There is no doubt that this investment is hugely welcomed. Fowler-Durham and Alden (2008) discussed the use of simulation in nursing education, reflecting that this allows the absence of risk to a live patient, along with the ability to provide standardisation of cases, the promotion of critical thinking, clinical decision making, and psychomotor skills. Simulation also enables the provision of immediate feedback, and the integration of knowledge and behaviour. They also suggested that simulation offers the opportunity for essential elements of patient safety to be emphasised, such as prevention of medication errors, promotion of effective communication, and the importance of teamwork. The challenge, they concluded, is for the faculty to embrace patient simulation as an instructional strategy and to seek its effective implementation in nursing education.
Mixing the opportunities of simulation and the power of in situ clinical placements with practising mentors and assessors is vital—as reflected by Alexandra Parker, a third-year student nurse in 2020, who stated:
‘Each placement has its own strengths and weaknesses but each one allows us to develop ourselves further and further every day.’
I am, however, disappointed that the opportunity to bid for investment into simulation as an educational strategy as a critical element alongside clinical practice placements has not been offered to both providers and higher education institutions to co-design, given provider responsibilities for clinical placement quality and assessment. I see this as a huge missed opportunity.