The shortage of nurses in the UK has been described as approaching ‘crisis level’, with the NHS carrying record levels of vacancies. Dr Paula Holt, Pro Vice-Chancellor Dean of Health and Social Care at the University of Derby, explores the issue.
Figures published by the regulator NHS Improvement for the April to June 18 period showed the NHS was short of 41,722 nurses – 11.8% of the entire nursing workforce.
The combination of a reduction of applications for nursing to universities (post removal of the fees bursary), a reduction in nurses coming from the EU and an increased number of registered nurses leaving the profession have all been reported in the press as contributing to this shortfall.
In contrast, in November 2018 the Nursing and Midwifery Council (NMC) reported that the number of nurses and midwives registered to work in the UK had increased by almost 4,000 in the past 12 months. At the end of September, 693,618 nurses and midwives were registered to work in the UK – the highest level in recent years. This increase has been fuelled by a rise in UK-trained nurses and midwives, and those trained outside the EU.
Retaining skilled nurses
As important as encouraging more people into the nursing profession is retaining the ones we have, and this is a key focus of a range of stakeholders from the Department of Health and Social Care to NHS employers. Key issues reported are flexibility of working hours and patterns to meet the increasing workforce demands for work/life balance, pay, and support for staff to develop and progress through continuing professional development.
In terms of the pipeline, universities play a significant role in enhancing the number of nursing students and are keen to support growth. We work closely as a Higher Education sector via the Council of Deans of Health with the Nursing and Midwifery Council, the Department of Health and Social Care and other stakeholders to support increasing nursing numbers.
A reduction in the number of nurses coming into the profession came as no surprise following the removal of bursaries in 2017, and it led to a 17.6% decline in the number of applicants to nursing through UCAS (from 66,735 to 54,985 applicants). This resulted in a 0.9% reduction in acceptances on to nursing degree courses, from 28, 890 in 2016 to 28,620, actually making September 2017 the second highest number of students ever accepted onto nursing courses after the high 2016 number – which was the last year of the fees bursary.
Doom and gloom dominated the press around nursing applications for September 2018 as they reached their lowest point, with a further 7.6% fall. Subsequently, there were just 80 fewer acceptances onto nursing programmes this past year (28,540), making it the third highest number of student nurses on record. In years gone by, acceptance rates for those applying to nursing were low due to the vast number of applicants, but acceptance rates are now coming closer to that seen in other subject areas.
Recruitment to nursing is not easy when we are experiencing a demographic trough that has seen the UK’s 18-year-old population fall by 5.7% over the past three years, so competition for young people into all professions is high. It is therefore no surprise that universities, and employers of nurses, are keen to engage more mature learners to consider nursing.
Nursing students accepted onto programmes currently are more likely to be female, and the vast majority are aged 21 and over. Many mature learners are choosing to change their career, and most report their reason for coming into nursing is to make a difference.
The removal of bursaries for nursing and allied health professionals is discussed with our students frequently, and they report concerns with debt accrual for living costs rather than any issues with the student loan for university fees. In particular, many cite the cost of childcare and upfront costs for parking and travel being most problematic for these students who are restricted in time to go to work because they are usually on a 45-week, five-days-a-week programme of university study and placements. If they do paid work in the free time they have, they risk not being able to keep up with their studies, so may see grades fall or may need to take a break in study (or leave) if finances get too tight. The RePAIR project (Reducing Pre-registration Attrition and Improving Retention) highlights the particular issues that students in nursing, midwifery and allied health professions encounter during their pre-registration education, with recommendations to enhance retention.
In order to maintain and increase the number of applicants to nursing, midwifery and allied health professions, we need to recognise that these full-time students, who spend 2,300 hours at university and 2,300 hours in practice placements over the duration of a three-year degree, lack the capacity to engage in paid work. On top of this, they struggle to find the means to travel and park to placements (as reimbursement can take weeks), and many struggle with childcare, reporting that without the support of family they would not be able to continue on their degree. We need to urgently address how we support these students whose vocation to care for others is a key motivator to continue despite the financial challenges.
Apprenticeships as an alternative route to nursing
We are pleased to support the introduction of Higher Apprenticeships for Nursing Associates, and Degree Apprenticeships for Nursing, which enable students to be in paid employment while they train. It is widely recognised, however, that the three-year full-time university route is still the key pipeline to providing the numbers of nurses we need in the future, and so making nursing more attractive to applicants and retaining the students we have on nursing degree programmes remains a key priority.