Nursing student attrition: are we losing the battle?
A quarter of all UK nursing students fail to complete their degree studies in one go
A quarter of all UK nursing students fail to complete their degree studies in one go
Attrition on nursing degrees is stubbornly high, with one in four (24%) students dropping out of their degree studies before graduation– a similar level to last year.
A Nursing Standard investigation, in collaboration with independent charity the Health Foundation, shows that despite political pledges to tackle the issue, students are still suspending their studies or leaving courses early in worrying numbers, and at a time when the NHS needs nurses more than ever.
Nursing students who leave their courses blame finances, academic issues, placement quality, workload and lack of support.
Why nursing students leave university early
Nursing students have shared vivid accounts of the pressures that led them to leave university.
Grant Byrne recalls that trying to fit in part-time work to support his studies was a factor in his failing his third year of a nursing degree at Glasgow University in 2013.
‘I was working too many hours in my job, which became a real issue for me,' he says.
‘It was just the wrong point in my life - I had a lot of personal issues and things kept getting in the way of my course, so I failed my last exam.'
Mr Byrne subsequently applied for a place on an adult nursing course at Queen Margaret University in Edinburgh, where he is about to enter his final year.
universities in the UK now offer nursing degree programmes
‘This time I was more strict about the number of hours I wanted to work alongside university,' he adds.
'You learn from your mistakes.’
For University of Southampton mental health nursing student Jess Redway, a period of ill health caused her to suspend her studies, and she is about to begin her second year after a year out.
‘Halfway through my second placement I became quite unwell with mental health issues and I reached the point when I realised I wasn’t well enough to practise anymore.’
Thinking of quitting your course? Things to consider
Queen Margaret University in Edinburgh runs a ‘stay-on-course’ programme, which aims to identify students at risk of falling behind in their studies, or dropping out.
Well-being adviser Laura Dickson advises:
- You are not alone Many students feel overwhelmed by the demands of the course and often life throws up additional challenges. Reach out to someone you trust and take advantage of support networks
- Don’t suffer in silence People can’t offer help if they don’t know what’s going on. Speak to your personal tutor, lecturer, GP or student support services. Take a friend if this feels more comfortable
- Get help early Record the situation and make sure someone knows about it, so there is evidence if you need to appeal or apply for extenuating circumstances
- Look after yourself Eat well, don’t skip meals and try to drink sensibly – alcohol doesn’t solve problems. Get some fresh air and go for a walk. Rest and relaxation are as important as study
- Try to keep things in perspective Speaking to someone about what’s bothering you can make things feel more manageable. Sleep on it and see how you feel the next day
With a beleaguered UK nurse workforce drop out rates matter
Registered nursing vacancies stand at 40,000 in England alone.
Queen's Nursing Institute chief executive Crystal Oldman says student attrition must be taken into account in the final version of the NHS People Plan, the health service's strategy on how to recruit and retain staff, due to be published shortly.
‘We would like to think that has been considered, because it needs to be part of the narrative around planning,' she says.
In 2015, the Department of Health (DH) told Health Education England (HEE) to halve the student attrition rate. The Reducing Pre-Registration attrition and Improving Retention (RePAIR) project was set up to achieve this.
A report published by the training body last year recommended a standard definition of attrition across all healthcare programmes to aid workforce planning. But a year on, no single accepted definition exists.
HEE regional chief nurse and RePAIR project lead John Clark says work is ‘ongoing’ to agree ‘the most appropriate metrics’ on defining and measuring attrition.
A RePAIR implementation programme is underway and there is a toolkit to help universities reduce attrition.
How this study measures attrition
Nursing Standard contacted all 81 UK universities offering nursing degree courses.
Using the Freedom of Information Act, we asked them how many nursing students started three-year programmes in 2015, and how many completed in 2018.
Some argue that examining universities’ completion rates on the basis of whether students have completed on time – the method adopted by Nursing Standard – is a crude measure of attrition.
of universities with nursing courses responded to Nursing Standard's request for data
The reasoning goes that students who do not complete on time may continue their studies later and so not be captured in this data.
Out of the 81 universities, 59 responded, while two declined to supply data on grounds they believed the information was commercially sensitive.
The fact that attrition rates remain static is worrying, according to nursing workforce expert James Buchan.
‘It is problematic that we continue to have to rely on the use of Freedom of Information requests to get this information into the public domain,' adds Professor Buchan, a Health Foundation senior visiting fellow and professor in the health and sciences faculty at Queen Margaret University.
‘It is critical we focus on improving attrition rates, yet we continue to have to push those with the information to release it for wider scrutiny.’
Nursing students are crying out for better financial support
In March, the Closing the Gap report, produced by the Health Foundation, Nuffield Trust and the King’s Fund, said nursing students in England should receive an annual cost-of-living grant in addition to the means-tested loans they receive now.
The report said this would help allay the financial worries that put many people off studying nursing in the first place, or lead students to quit their studies.
Health Foundation senior economist Ben Gershlick warns: ‘The shortage of nurses in NHS trusts currently stands at 40,000 vacancies but projections reveal that they could grow to over 100,000 in the next decade, posing a major threat to the ambitions in the NHS long term plan.
And with risks to the inflow of nurses coming from abroad, it is even more essential to secure the supply of nurses training in the UK.’
‘Most important will be addressing the financial problems that trainee nurses currently face while studying that also deter people from starting a nursing degree in the first place. 'And action should also be taken to increase the number of nurses training as postgraduates, including covering the cost of their tuition fees.
This of course won’t come for free – we, together with The King’s Fund and the Nuffield Trust, have recommended that the government invest an extra £560 million by 2023-34 to fund these vital measures.’
In 2018, the RCN began its Fund our Future campaign, which calls for £1 billion a year it says has been taken away to be returned to nursing education funding in England.
The college highlighted difficulties faced by nursing students after the bursary was abolished in England in 2017.
RCN general secretary Dame Donna Kinnair says: ‘If we are to attract people on to nursing courses and retain them all the way through to completion, the government must urgently commit to a sustained investment in further education through the provision of proper tuition and maintenance support.’
Responding to our investigation, a Department of Health and Social Care spokesperson highlighted grants were available through the Learning Support Fund to students who are eligible. These annual non-repayable grants include help with placement travel costs, a £1,000 child dependants allowance and up to £3000 exceptional hardship fund.
'NHS organisations are providing support to newly qualified staff, including developing flexible working and career development opportunities,' the spokesperson added.
Kindness, compassion and a smaller student cohort
The University of Liverpool's attrition rate stands at 15% – well below the UK average of 24%.
Head of nursing Vicky Thornton says an important factor is having a smaller cohort of 70 students a year at most.
‘We need to be able to offer support, guidance, kindness and compassion and, with those numbers, we can achieve that,' she says.
UK universities declined to provide data as it was ‘commercially sensitive’
Staff keep in regular touch with students on placement and carry out placement visits.
‘It doesn’t matter how much you try to prepare students, if it is somebody’s first time going out on the ward and they see something upsetting, it is difficult.
‘For an 18-year-old this can be challenging, but if they know the people to call and have a debrief with, this will stop them feeling uncomfortable about seeing something difficult on wards.’
Perhaps other schools should follow Liverpool’s example – but with so many nurse places to be filled smaller cohorts may also be problematic. Whatever the solution, given the current staffing crisis of nurses something must be done to reduce attrition and make sure student nurses are ready and able to complete their training.
‘The whole place was being run by students’
Charlotte Hall fulfilled a childhood dream of following her mother and grandmother into nursing when she started a degree in children’s nursing in 2014.
However, she says a combination of financial pressures, bad placement experiences and a lack of university support led her to drop out at the end of her first year.
At the time, all nursing students in England still received a bursary. Because she was living at home, Ms Hall says her NHS bursary only amounted to £180 month, which she said did not even cover the cost of travel and parking.
On her second placement, she was placed on an acute adult emergency medical unit. She says she felt completely out of her depth.
‘I had no mentor or nurse to work with,' she recalls.
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'I was given a bay of patients to myself, had to deal with admissions and discharges alone, and then the sister gave me the bleep.
‘I emailed my link lecturer to tell him the whole place was being run by students, I was being trusted with far too much responsibility and it was an unsafe environment for patients.
‘He told me – “don’t worry, you will be a better nurse for it”. It was my first experience of a ward-based environment and I thought, is this what I’ve got to look forward to?’
Ms Hall left her course at the end of the first year. Last November, she began work as a healthcare assistant and now plans to apply for 2020 entry to a master’s degree in nursing.