Much about the UK nursing workforce doesn’t compute. Care needs are rising but there is a shortfall in registered nurses.
By 2020 nearly half of nursing staff will be eligible for retirement but entrants to the profession are in serious decline. And rather than providing incentives for potential recruits, it seems obstacles are being placed in their way.
A key factor in this lopsided equation is the withdrawal of the student bursary in England, a move described by the RCN as a “disaster”.
The bursary was never a cash cow for nursing students. It didn’t make them rich or assure their financial security. But it helped, and it felt like an acknowledgement that nursing students, who face the highest total workload hours of all undergraduates, were a special case.
Why are nursing students a special case?
The RCN argues that nursing students require extra financial support because:
• they spend up to half of their degree on placement
• their courses are typically longer and extend beyond normal university semesters
• their placements come in blocks, meaning their opportunities to find part-time employment to support themselves are limited
• they are more likely to be from lower socio-economic backgrounds.
The bursary is now gone and its renaissance seems unlikely. But two years on, the impact of its passing remains.
The number of students who applied to start nursing programmes in England in September 2018 is down 11% since student funding was removed in 2016.
“Government decisions on student funding have left nursing in managed decline,” says Acting RCN Chief Executive Dame Donna Kinnair.
“We urgently need comprehensive workforce plans that safeguard recruitment and retention.
"This should include a range of incentives to attract more nursing students. It’s time for ministers to take decisive action to address the nursing shortage and keep patients safe.”
Ministers need to take decisive action to address the nursing shortage and keep patients safe
And those ministers had better hurry. Aside from the overall shortage of registered nurses – 40,000 vacancies in England alone – patients or clients in particular areas of care may be especially vulnerable. Learning disabilities, for example.
Earlier this summer, a survey of higher education institutions in England showed almost half had discussed discontinuing their learning disability nursing programmes from this September.
Learning disability nursing programmes tend to attract a greater number of mature applicants, for whom the bursary may have proved more appealing than a student loan.
Deterring those people, says RCN Policy Adviser Jonathan Barron, is a bad move. “Mature students are more likely to stay in the profession and bring a wealth of experience, which is so important for a role like nursing.
"More explicitly, they work in traditionally harder-to-staff areas, such as learning disabilities, and these are already areas where we have huge staffing problems all round the UK.”
Anne Corrin, RCN Head of Professional Learning and Development, says courses in other fields of nursing may follow suit. “I think the next most vulnerable would be mental health. There is variation but certainly mental health is at risk in some geographical areas.”
For students who come late to nursing, the financial burden of training can be crippling, although as former accountant Rupert Davies explains (see below), the rewards inherent in being a nurse can still outweigh the hardship.
Does this constitute a crisis?
As of August the bursary available to nursing students who first undertook a different degree was also scrapped, so many older students will be in the same position as those for whom nursing is their first degree.
A package of “golden hellos” for mental health and learning disability nursing students with other degrees, announced by the Government in May, appears to have been delayed by at least a year, undermining any attempts to increase student numbers for 2018/19.
So does this constitute a crisis? “I think it’s very serious,” says Anne. “The bottom line is that too many people are leaving the profession and too few joining. Uncertainty over Brexit is another compounding factor and grounds for optimism seem limited.”
Yet elsewhere in the UK, the student bursary lives on. In Scotland, for example, the Scottish Government has committed to maintaining the bursary, however this is not enough for student nurses to live on and access to a broader package of student support is being called for as part of an ongoing review.
New routes into the profession, such as apprenticeships and nursing associates may eventually plug some of the gaps, but these roles alone will not solve the workforce crisis. They constitute a trickle rather than a steady stream.
The most effective way to increase the supply of registered nurses is through the three-year degree programme and by extending the postgraduate route into nursing, insists Jonathan.
The Government promised to monitor, evaluate and intervene if necessary when it made the bursary changes, he adds. In the meantime, an RCN policy paper lays out costed options designed to increase the numbers of health care students.
• grants for students in recognition of time given during placements to the NHS and other health settings
• a stipend or fee paid by local employers to cover students’ living costs in return for a post-qualification contract, helping to meet local workforce needs
• means-tested grants, which would provide additional support to students from poorer backgrounds
• clarifying the criteria of the Learning Support Fund, which offers supplementary funding to the student loan.
“We’ve come up with these ideas which could potentially help,” says Jonathan. “But the key outcome here is an increase in patient safety. We must ensure the right number of registered nurses and nursing support staff with the right knowledge, skills and experience are in the right place at the right time to provide safe and effective care."
Adult nursing student Rupert Davies shares why he chose to go into nursing despite the financial difficulties.
"I’ve always been good at maths and fell into an accountancy career early on. But throughout my 13 years in finance, I never experienced the job satisfaction I craved or felt I was making a positive difference.
"I had some experience caring for older relatives, but it took the birth of my children to make me jump ship and move towards a more fulfilling career in nursing. I especially wanted to be a role model for my kids to emulate and help them aspire to do something they believe in.
"The main obstacle was the shift from a well-paid career to life as a student nurse, and the financial implications for my family.
"The bursary had ended, so I had to rely for the most part on student loans. Alongside this, my very supportive wife went back to work and we’ve had to dip into savings on occasion. We’ve had to scrimp in all areas and at the same time ensure we have the flexibility to deal with unexpected life events.
"Friends and family have been essential, especially in terms of child care, and the support and understanding of my university has been a huge help.
"I look back on my first year as a student nurse with a sense of pride and can safely say I have no regrets. The satisfying feeling after a long placement shift outweighs anything I felt in my previous career. I feel privileged to have found my calling and look forward to a rewarding nursing career."