References

Aiken LH, Sloane DM, Bruyneel L Nurse staffing and education and hospital mortality in nine European countries: a retrospective observation study. Lancet. 2014; 383:184-1830

Nursing vacancies in Wales. 2017. https://tinyurl.com/y3lep9vu (accessed 28 August 2019)

Griffiths P, Maurotti A, Saucedo AR Nurse staffing, nursing assistants and hospital mortality: a retrospective longitudinal cohort study. BMJ. Quality and Safety. 2019; 28:609-617

Education and training of nurses: where are we going?

10 October 2019
Volume 28 · Issue 18

A number of recent nurse education initiatives have recently come to the fore in England and Wales. By their nature these initiatives are connected with the implementation of the new nurse associate (NA) role; the updating of the curriculum for undergraduate pre-registration training (which some might consider radical due to the inclusion of certain skills, for example, phlebotomy, previously only undertaken post-registration); a cadet scheme in Wales; and finally a use of the apprenticeship levy allowing healthcare support workers (HCSWs) to undertake a 4-year undergraduate nurse training programme, so they can ‘earn while they learn’. The programme length of 4 years allows part-time study along with their employers' required working-hours, as part of the apprentice employment contract.

These initiatives are to be welcomed for their contribution to the delivery of patient care and widening of access opportunities. The NA role has been designed to bridge the gap between unregulated HCSWs and registered nurses (RNs). The first NAs were admitted to the NMC register in January 2019 after a 2-year foundation degree programme. They are professionally accountable under the NMC Code and are eligible to apply for a shortened (18 months–2 years) pre-registration nurse training programme. Competences are undertaken semi-autonomously.

The cadet scheme in Wales allows 18 young people (16–25 years) to have a guided, experiential learning experience with observational clinical placements with local healthcare providers. Following completion of a foundation programme and dependent on the individual's level of education, the cadets will be eligible for further study including entry to an undergraduate pre-registration nurse training programme, or a guaranteed interview for an HCSW position.

HCSWs who would like to become RNs and who have the Certificate in Fundamental Care (CFC), a good employment record and level 2 skills in English and Maths, can ask their employers to use the apprenticeship levy to support a 4-year undergraduate pre-registration nursing programme. This requires stamina and commitment by HCSWs because, to ‘earn while they learn’, they have to combine studies with continuing employment. To avoid staff–student burnout and compromising the intended learning outcomes, an effective working partnership has to be established between the university and the employer—no mean feat for both parties' negotiating skills. One benefit of apprenticeships is that they allow employers to ‘grow’ their own staff into RNs.

The role of the graduate RN will change from that of a fundamental, and generic hands-on care practitioner to that of a knowledgeable care strategist exercising leadership and management competences in overseeing the identification of patients' priorities, and in deploying staff to meet these needs in an individualised and holistic way. This change in role emphasis is necessary due to declining numbers of RNs. The RCN has predicted a 40 000 shortfall of RNs in England, and shortages of RNs and HCSWs in Wales have been reported (Donnelly, 2017). To successfully realise a strategic leadership role, the RN will need to employ the varying skills and competences of the whole team, all of whom will be required to participate in continuing professional development. The ultimate aim is to keep patients safe.

So what are the blots on the horizon? If nurse staffing is compromised, there is no guarantee of patients' safety. Aiken et al (2014) and Griffiths et al (2019) show a correlation between increasing patient mortality with fewer on-duty RNs and a lack of nursing degrees. Additionally, these initiatives should not be used by policy drivers to show an ‘on paper’ increase in staffing levels. Nurse leaders must face the current shortage of RNs and plan accordingly to ensure safe staffing.