Breaking through: a bright spot in the nurse apprentice scheme

The nurse apprentice scheme has had a faltering start nationally but an initiative in Cambridgeshire is achieving success, with 22 healthcare support workers now having qualified

The nurse apprentice scheme has had a faltering start nationally but an initiative in Cambridgeshire is achieving success, with 22 healthcare support workers now having qualified

Picture: iStock

The government had hoped to see 1,000 apprentices a year working and training to become registered nurses, but the planned revolution has had a faltering start. However, one initiative, similar to the national scheme, is achieving success.

In Cambridgeshire, the first cohort of 22 healthcare support workers (HCSWs) completed their apprenticeships to become nurses in September.

Students worked three days a week on their usual jobs while undertaking an 18-month course on day release with Anglia Ruskin University. University fees were covered by Health Education England, and trusts continued to pay their staff at band 3 level during the degree pilot.

Showing them they’re valued

The students were drawn from a number of trusts, with the majority coming from Cambridge University Hospitals NHS Foundation Trust. The completion of the first course in September has seen the trust’s Addenbrooke’s Hospital develop 17 new registered nurses.

Luke Bage, senior nurse for pre-registration education at Addenbrooke’s, says: ‘We wanted to recognise the HCSWs that we have in the organisation, invest in them and show them how valued they are. We have amazingly skilled HCSWs but there was very much a glass ceiling.’

‘The people on the course had worked for us for a long time… they were finally getting an opportunity and really went for it’

Luke Bage

Addenbrooke’s Hospital, part of one of the UK’s largest hospital trusts, has like many employers struggled with nurse recruitment. In 2015, the Care Quality Commission put the hospital in special measures after inspectors recorded widespread and ‘significant’ shortages of nurses and other staff. It was rated good by the watchdog in January.

Under the route being trialled in Cambridge, all the applicants had to have a foundation degree, which takes two years, to be considered. This effectively allowed them to join part way through a nursing degree course and top up their qualification.

Mr Bage says the students, who went through rigorous trust and university selection processes, were extremely motivated and committed. Traditional undergraduate nursing courses have high levels of attrition, but only two dropped out of the original apprenticeship cohort of 24. ‘This was a testament to the determination of the people on the course,’ he says. ‘They had worked for us for a long time, for 15 years plus. They were finally getting an opportunity and really went for it.’


There were challenges along the way, Mr Bage says. The length of the course, at only 18 months, meant it could be a demanding process, with little slack to take time off for illness or family commitments.

Ward sisters and charge nurses also had to be persuaded of the long-term benefits of losing some of their skilled HCSWs for at least two days a week. While in theory students were generally working for 22.5 hours a week at their original jobs, 4.5 hours of that was allocated to self-directed study. ‘For ward managers that was challenging,’ Mr Bage says. ‘But the HCSWs have become amazing nurses who have fit right into the team.’

One of the first students was Nadine Beckwith, who has been at the trust since 2008, working initially as an HCSW on a cardiology ward. After she took her foundation degree, she worked as a band 4 assistant practitioner, training and assessing HCSWs in tasks such as venepuncture, cannulation and catheterisation.

‘I loved my job but there was a ceiling to the role and I had reached it – the traditional route into nursing wasn’t an option’

Nadine Beckwith

Without the apprenticeship, training to be a nurse would not have been financially possible, Ms Beckwith says. The removal of the bursary means that pre-registration students on a traditional course have no income for three years and have to pay fees of around £9,250 a year. ‘I loved my job but there was a ceiling to the role and I had reached it,’ she says. ‘The traditional route into nursing wasn’t an option.’

When the apprenticeship came up, she seized the opportunity. ‘I have been working in care since I left school, and it sounds corny but I just really like helping people. Being able to progress to a higher level to help people is a real privilege.’

The programme varied each week, with some placements full-time and others including three days of working as an HCSW and two as a student. The experience that all the staff already had of working in the hospital alongside nurses meant they were under no illusions about how demanding the training would be, she says. ‘We were quite well prepared for how hard it would be, and the recruitment process was tough. If you want something you are prepared to do the hard bit as well.’

Top-up training format

Anglia Ruskin University has been ahead of the national trend on developing nursing apprenticeship programmes, and has been working with local employers for several years on innovative work-based approaches.

The initial cohort, and a second cohort that started in January 2017, are part of a pilot that was built on students having already completed their foundation degree programme.

This top-up format is changing slightly as part of the national development of nursing apprenticeships. In September, the university started a full nursing apprenticeship degree programme that runs over 42 months. The plan for the future is that students taking the top-up route will join this programme for the final 20 months to complete their degree. The foundation degree that they take first is to be renamed as the assistant practitioner (nursing) higher apprenticeship programme.

‘These staff are likely to stay and that is a huge benefit to the trust. They have chosen those who are committed – attrition rates are very low’

Patricia Turnbull

Head of pre-registration nursing courses Patricia Turnbull says employers have worked closely with the university on the apprenticeship programmes. ‘They are growing their own. These staff are likely to stay with them and that is a huge benefit to the trust,’ she says. ‘They have chosen those who are committed. Attrition rates are very low. It seems that one of the motivators is that they do not want to go back to their own area having failed.’

She thinks that the two-phase top-up approach to apprenticeships will remain attractive to employers. ‘They can see the commitment of employees to the assistant practitioner programme, and who they want to support to continue and who they think will have the right attributes and skills.’

After graduating in September, Ms Beckwith now has the job she dreamed of on the cardiology ward where she started work as an HCSW almost a decade ago. ‘I walked in here on my first day and I could not stop smiling,’ she says. ‘There is a whole new level of accountability that comes with this role and uniform, but I have done this, I have worked my tail off and I am here.’

Snags slow nurse apprentice scheme nationally

Nursing apprenticeship programmes nationally have been hit by delays caused by funding issues and changes to Nursing and Midwifery Council education standards.

Nationally less than 30 individuals are believed to have started nursing apprenticeship courses in September, all at Anglia Ruskin University – well below the 1,000-a-year predicted by the government, a Nursing Standard investigation found.

Health secretary Jeremy Hunt unveiled the paid training role in 2016, championing it as a way of helping healthcare assistants and others reach their potential as fully trained nurses.

Employer support needed

RCN national officer Gary Kirwan says the relatively slow progress nationally is in part because universities are waiting to see the results of the NMC’s radical overhaul of education standards and employers are struggling to get to grips with the apprenticeship levy. While about four universities appear to be ready to offer courses in the spring, he says these are dependent on employers supporting students to attend.

‘It is moving very slowly and there is so much caution out there,’ he says. ‘We hear employers saying it is big ask, a four-year investment and they have to backfill the position, and no new money for it. Universities are in gear, but there have to be employers willing to send apprentices to them.’

Erin Dean is a freelance journalist

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