Analysis

New year will bring new routes into nursing

Nursing degree apprentices, and nursing associates, will change the landscape of the profession.

In September 2017, the first nursing degree apprentices are due to be working on wards in England.


New faces of nursing arrive in 2017.
Picture: Neil Webb

This new cohort will combine degree-level training with working over at least four years.

The controversial new entry route for nursing education was announced by health secretary Jeremy Hunt in November. He claimed that the current routes shut out ‘the most caring, compassionate staff’.

The universities of Derby, Gloucestershire, Greenwich and Sunderland are due to start offering the course in September.

Planning stage

The details about how this will happen are being finalised by universities, employers, the Department of Education and the Nursing and Midwifery Council (NMC), which regulates all nurse education courses.

Significant issues to be worked out include approval for the final assessment point, and nursing degree standards.

It is also not clear yet how the apprentices will divide their time between working and education, or what amount they will be paid while working.

2,300 hours

of clinical practice are required on pre-registration nursing degree programmes

What is known is that apprentices will have to meet the same standard of 2,300 hours of clinical practice, and the same amount of time in education, that nursing students on traditional degree courses have to meet. 

Critics have voiced concerns that it is a backwards step for the profession. King’s College London professor of nursing policy Anne Marie Rafferty described apprenticeships as a way to exploit nursing students by using them to staff services. 

Supporters of the scheme say more routes into the profession are needed due to nurse shortages, as well as the rising cost of a nursing degree with the introduction of fees and the scrapping of the bursary in England from August 2017.

Work and education

University of Derby head of prequalifying health care Denise Baker says it is likely that apprentices will spend between one and two days a week working as a healthcare assistant (HCA), and the rest in education. One uncertainty is whether they will combine work and education every week, or alternate between working and education in regular blocks. 

Their time working as an HCA will not count towards practice hours because they will not be supernumerary, Ms Baker says. She adds that initial plans at the university involved starting the course with 30 apprentices, comprising 10 each from three employers – one community trust and two acute trusts. 

But since Mr Hunt’s announcement, Ms Baker says there has been so much interest from employers, including care homes, that the number of places may increase.

‘In the East Midlands we are struggling with recruitment and have about 250 nursing vacancies,’ she says. ‘We are not alone in this and have to think about doing things differently. For our local trusts, the option to grow your own and to support people who are talented and loyal in your workforce is highly attractive. It is a time of fantastic opportunity for our support workers.’

Funding plans

The cost of the training will be met by large employers via an apprenticeship levy payable from April 2017. Those with an annual pay bill of more than £3 million will have to ringfence 0.5% of this total to fund apprenticeships. 

Smaller employers, such as nursing homes, will have 90% of the funding subsidised, says Ms Baker.

September 2017

is when the first cohort of nursing degree apprentices is expected to start

RCN deputy director of nursing Stephanie Aiken agrees that more routes into nursing are required, especially with costs to students on standard courses set to rocket next year. However, she feels that the planning stage is being rushed. ‘It is worryingly fast,’ she says. ‘There are concerns that the pace doesn’t allow for a robust quality assurance framework around it.’

There are also concerns that nursing degree apprentices could be confused with nursing associates, who are also being given a work-based training opportunity. The first cohort of 1,000 nursing associates, intended to bridge the gap between HCAs and registered nurses, will begin their training by the end of January.

Nursing Associates are likely to be regulated by the NMC, and, if they wish, be able to continue their education to become a registered nurse. 

Critical voices

Concerns about apprenticeships affecting quality of training have been voiced by many nurses. In a snapshot Twitter survey by Nursing Standard, with 54 votes, 54% said it would not be a positive change for the profession, while 31% thought it would. 

54%

of Nursing Standard readers surveyed believe the degree apprenticeships programme will not be a positive change for the profession

Lecturer Marissa Dainton, writing on the Nursing Standard Twitter feed, said it ‘gives the impression of devaluing the academic underpinning of the profession’. Lecturer Moira McLoughlin feared it was ‘dumbing down training and education’. Others pointed out that apprentices would still need to complete the same number of hours of education and practice as those qualified via the traditional route.

University of Southampton chair of health services research Peter Griffiths says the apprenticeships could provide a useful new route into nursing, but emphasised that academic standards must be maintained. He adds that research has found that mortality is higher when registered nurses have lower levels of qualification.  

‘These courses must be as academically rigorous and challenging as standard routes to ensure there is no dilution of education,’ says Professor Griffiths. ‘Compassion is a necessary component of nursing, but it is not the only attribute needed.’

Routes to becoming a registered nurse

Existing pre-registration degree courses
What: A three-year nursing degree taken at a university, with placements in practice. 
When: Already available.
Cost: From August 2017, nursing students in England will have to pay up to £9,250 a year in fees, and the bursary that was available to support students will be scrapped. Loans will be available, however.
Number of participants: About 20,000 students a year.

Nursing degree apprenticeships
What: A part-time programme taking at least four years, combining education and working.
When: Likely to start in September 2017.
Cost: No charge to the apprentice, who will earn a part-time wage from their employer while working as a HCA. Fees will be paid by the employer.
Number of participants: 1,000 apprentices a year.

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