The NHS Long Term Plan sets out an ambitious programme of NHS service-delivery expansion and change (NHS England and NHS Improvement, 2019). It highlights the need to address workforce shortfalls and recognises the complexities of retention in the workforce, as well as student nurse attrition rates (Health Foundation, 2019).
Nurses are critical to the delivery of health and social care services, working across hospitals, community services, care homes and primary care. Nurses make up about a quarter of all NHS staff (National Audit Office (NAO), 2020) and registered nurses comprise the largest proportion of the professionally qualified workforce within the UK. In 2019, there were 706 252 people on the professional Nursing and Midwifery Council (NMC) register (NMC, 2020).
However, despite overall increases in the number of registered nurses, there have often been substantial reductions for some types of nurse, such as learning disability nurses (NAO, 2020). Furthermore, activity in hospital and community health services has significantly outpaced the growth in nurse numbers (Health Foundation, 2019). The NHS has reported a nursing vacancy rate of 12% (NAO, 2020) and around 80% of vacancies are filled by temporary staff (NAO, 2020).
The Long Term Plan set a target of reducing nursing vacancy rates to 5% by 2028. However, the Royal College of Nursing (RCN) (2018) has likened workforce planning to a patchwork quilt whose threadbare pieces were hardly stitched together at all. Too few students are joining the workforce and international recruitment has become more challenging with Brexit and the COVID-19 pandemic.
This must change. The first strategy from Health Education England, expected in summer 2020, must address the lack of accountability in current arrangements and explain how demand for nurses can be reconciled with the supply of nursing staff.
The RCN (2018) suggested that there should be new grants and the ability to write-off fees, backed up by a high-profile national campaign to incentivise people to join what is a rewarding, inspiring and challenging profession. In 2020, the NHS Business Services Authority (NHSBSA) announced that the Government will be providing additional funding support to healthcare students starting their course from September 2020. Students on eligible courses starting their second or third year will also be able to apply for the additional funding. This funding would include a payment of £5000 each academic year with additional payments of up to £3000 per academic year for students in some specialisms, regions struggling to recruit or to help students cover childcare costs.
The chronic national nursing workforce shortage has been compounded by the decrease in the number of students completing their degree and entering the workforce (Gilbert and Brown, 2015). Most future nurses come from higher education institutions, and while student nurses are introduced to the theory of clinical practice, the realities can be quite different. Student nurses are often placed in clinical environments that are significantly understaffed and underfunded, and many students choose to leave nursing studies. Of 19 566 UK nursing students who began 3-year degree courses that were due to finish in 2018, 4695 left their courses early or suspended their studies—an astounding attrition rate of 24% (Health Foundation, 2020). With the stress of contemporary nursing practice, understaffing, underfunding, the impact of Brexit, and COVID-19, it is expected that there will be a substantial increase in this rate, further impacting the future nursing workforce.
During such demanding times, the attitude and empathy that nurse academics and clinical nurses have towards supporting students can help to lower this attrition rate. A positive clinical learning environment that provides the opportunity to integrate theoretical knowledge into nursing care and prepares students for a practice-based profession can influence the learning experience (King et al, 2018).
Nursing students are not ‘traditional’ students in the usual sense of higher education because they are expected to learn and achieve in both an academic and a clinical environment. While maintaining high academic standards, nurse lecturers must also train nurses for practice, and for working within a diverse profession. By contrast, student nurses must also adapt to, and experience, student life while also understanding the realities of what it means to be a nurse (Dunbar and Carter, 2017).
For students who cross the boundaries between clinical placements and academic work, a sense of ‘belongingness’ is a prerequisite for learning and personal and professional development (Dunbar and Carter, 2017). This requires both academic and clinical staff to foster environments in which students can feel safe, secure, develop effective bonds, and feel sufficiently secure to reveal concerns, express anxieties and ask for support.
These students are the future of nursing. Our role modelling, and their sense of belongingness, are pivotal for their academic and clinical experiences, and instrumental in preparing them for their role as confident and competent practitioners. It is, therefore, imperative that student nurses are not discouraged from continuing in their chosen profession.