A Department of Health and Social Care Media Team blog (2023) summarised the NHS England Long Term Workforce Plan ambition to almost double the number of adult nurse training places by 2031, with around 24000 more nurse and midwife training places a year by 2031. This policy, however, presumes the existence of a sufficient pool of people interested in taking up these opportunities. Although there will be a range of ages of people applying for nurse training, have we really maximised the opportunities in schools to attract people into our professions?
According to Jabbal (2022), despite the NHS being one of the biggest employers in England, only 6 per cent of the workforce is under the age of 25 years, with the average age of staff being around the mid-40s. Granted, the NHS has a larger proportion of jobs that require professional qualifications than some other sectors but, despite major campaigns and initiatives, it does not appear to have delivered.
Adolescent expectations
Using data from the Organisation for Economic Co-operation and Development's (OECD) large-scale Programme for International Student Assessment (PISA) (OECD, 2018), Guo and Hau (2023) showed the distribution of adolescents' medical (doctor) and nursing career expectations in 61 economies. It was found that approximately 11% of adolescents expected to be doctors in each economy, while only 2% expected to be nurses. Guo and Hau (2023) reflected that the technological context of society is seeing that high-ability students are equally competitive for emerging careers, other than doctors and nurses, and that, in developing countries, a high salary package and societal respect are enough to attract adolescents to nursing careers. In contrast, for developed countries, it is seen that there are additional considerations such as a safe work environment.
The OECD, an international organisation, aims to shape policies that foster prosperity, equality, opportunity and wellbeing for all. It works with governments to establish evidence-based international standards and find solutions to a range of social, economic and environmental challenges.
Stereotypical views
The OECD published a country comparative report in May 2024 looking at young people's level of interest in nursing as a career, across 38 high-income countries, at two points in time – 2018 and 2022 (OECD, 2024). It used the PISA database, and revealed that the UK looks relatively poor, below the OECD average, and had been dropping between 2018 and 2022.
The key findings were as follows:
- The interest of 15-year-old students in pursuing careers as nurses has decreased in at least half of OECD countries between 2018 and 2022. This reduction is particularly marked in the US and Canada, some Nordic countries (Norway and Denmark), Ireland, the UK and Switzerland
- One of the main reasons for the relatively low interest in the nursing profession is that it mainly attracts females. Results showed that more than 90% of 15-year-old students expecting to work as nurses are females, presenting the continuing challenge in all countries to address the persistent stereotype that views nursing as a profession suited primarily for women
- More generally, improving the working conditions and pay of nurses is key to attracting more young boys and girls to the profession and to retaining them, reflecting that, if this is not attended to, there will continue to be an over-reliance on international recruitment.
Tackling attrition
In a previous column this year I wrote about the International Council of Nurses' (ICN) call to action for global governments to consider the economic case to invest in our profession (Foster, 2024; ICN, 2024).
In their work for the Nuffield Trust, Palmer et al (2023) reported that for every five nurse training places, only three full-time nurses go on to join the NHS. Furthermore, the rate of attrition in the pipeline from student to early career is worryingly high, with evidence of individuals leaving before or soon after joining the NHS. Palmer et al (2023) go on to put forward a 10-point plan to improve retention, including a policy proposal to gradually write off the student debt accumulated during nurse training – they state that bold policymaking is needed.