My view on the nursing shortage – Dr Paula Holt

The shortage of nurses in the UK has been described as approaching ‘crisis level’, with the NHS carrying record levels of vacancies, writes Dr Paula Holt, Pro Vice-Chancellor Dean of the College of Health and Social Care at the University of Derby.

Figures published by the regulator, NHS Improvement, for the April to June 2018 period showed the NHS was short of 41,722 nurses – 11.8% of the entire nursing workforce.

Regional impact

Across Derbyshire, we are carrying around 400 nursing vacancies and, although nursing is the main focus of the media, we have shortages across midwifery and allied health professions too, not to mention the difficulty of recruiting people into social care.

The removal of fees bursaries for nursing and allied health profession students, and the demographic trough that has seen the UK 18-year-old population fall by 5.7% over the past three years, have contributed to a reduction in applications to study these professions at university.

Paradoxically, the Nursing and Midwifery Council reported in November 2018 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. So even though we are increasing numbers, we are clearly still not meeting demand.

Our civic responsibility

As a university, Derby takes its civic responsibilities seriously. In health and social care, we work strategically at national and regional level to support the growth of our workforce to meet the health and care needs of our communities.

Nationally, we influence policy, regulation and professional practice through the Council of Deans and strategic engagement with bodies such as the Nursing Midwifery Council, Health and Care Professions Council, the Department of Health and Social Care and the Institute of Apprenticeships.

Locally, we liaise closely with our NHS trusts, and private, voluntary and independent care services at all levels, to ensure that we are developing the workforce they require in terms of number, and the skills and competencies required to meet the requirements of a population with ever-growing, increasingly complex care needs.

Increasing student numbers

Though the removal of fees bursaries for health professional programmes was not universally popular, it did allow universities to significantly increase student numbers. At Derby, for example, we saw a doubling of student numbers into mental health nursing and significant increases in adult nursing at both the Derby campus and in Chesterfield.

This was not experienced at all universities, so we published an article to discuss how we were able to do this, primarily through close, effective partnership working with our NHS Trusts and other providers to increase placement capacity (1).

The Nursing Associate programme

The University is committed to alternative career pathways into nursing, and to social mobility, and has been at the forefront of developing the Nursing Associate programme. This has proved effective in supporting the growth in the workforce that we need but, more importantly it has provided a much-needed career pathway to mobilise a group of existing, committed staff – healthcare support workers.

We started this as a pilot project with Health Education England in 2017, and we now deliver this as a Higher Apprenticeship Foundation degree, funded through the apprenticeship levy. We currently have over 200 students training to be Nursing Associates. Our first qualified Nursing Associates registered with the Nursing and Midwifery Council in January 2019, as soon as the register opened, and will graduate this summer.

The Nursing Associate programme provides an entry route into nursing for many who are working as healthcare support workers, who do not have the academic qualifications to apply to study for a Nursing degree, but do have the passion and commitment to contribute to the nursing workforce.

Our Nursing Associate students usually have many years of practice but never thought they would be able to progress their careers. We learned quickly that it was not lack of competence, but lack of confidence that held many back from believing they could engage in education, and once they did commence this workbased programme they flourished.

We are proud to see some now progressing to ‘top up’ by joining the degree students to become a registered nurse, and all are making positive contributions to patient care in our region. Our newly qualified Nursing Associates cannot speak highly enough of the support they have had from the academic team and from the clinical practice educators in their workplace, a team that worked closely to ensure their progress and success.

It is this supportive, collaborative and personal approach to student learning that the University of Derby is known for, and which in turn results in graduates who are supportive, aspirational role models within their organisations.

Find out more about Nursing Associate Higher Apprenticeships at the University of Derby: www.derby.ac.uk/apprenticeships/ nursing-associate-higher-apprenticeship

1 Holt P, Budd C and Whitehead W (2018). Maintaining student enrolment after the removal of bursaries, Nursing Times 114(7), 56-59.

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