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The nursing profession is currently facing a double dilemma in both recruiting and retaining sufficient nurses in an attempt to meet the health needs of our growing population.
This challenge to recruit has become increasingly complex following the introduction of tuition fees, withdrawal of bursaries, and the UK’s imminent departure from the European Union (EU).
Data recently obtained from the Universities and Colleges Admissions Service (UCAS), demonstrated a 30% reduction in applications to nursing from England, and a 33% reduction from the EU in comparison to previous years.
A rather depressing picture but as clinicians and academics, what can we possibly do?
The Conservative government, in their new manifesto, have recently announced that all student nurses on an English degree course will receive an annual grant of £5,000 to help with their living costs.
In addition, there will be additional payments of up to £3,000 available for students in regions or specialisms struggling to recruit, or to help students cover childcare costs.
Although this sounds positive, there is some skepticism surrounding whether this will actually be delivered and, indeed, if this is anywhere near enough financial support to make any impact.
We carried out a survey with a number of undergraduate nursing students at the university – both those newly enrolled onto their nursing degree programme, and those in their final year, regarding attrition rates within the profession.
Interestingly, many similar comments were made whichever stage of training they were at.
The students talked about the ‘reality of the job’. They had gone into nursing wanting to make a difference to peoples’ lives, to care for people and to try to make them better. Or if they weren’t going to make them better then they wanted to provide their patients with a pain-free, dignified end-of-life care package.
In reality, this does not appear to be happening. This was attributed to several reasons but primarily, low staffing levels, a lack of support from senior staff (due to the staffing levels) and a lack of confidence or knowledge about the situation the student finds themselves in (again linking this to staffing levels).
In addition, from extreme demand from many other aspects of the role (paperwork, meetings, ineffective communication channels resulting in inefficient working and so on), the students felt that their expectations were unmet.
They felt frustrated, inadequate and subsequently thought about the possibility of withdrawing from the programme. The students described the realism of entering into what they had originally perceived to be a caring profession.
“Career disillusionment is a consequence associated with inconsistency”
While they had experienced many aspects of exceptional care, they had also noted how despondent many clinicians were, how exhausted and weary they were, despairing at times. This, in turn, is discordant with their previous perceptions of nursing and nurses.
Career disillusionment is a consequence associated with inconsistency – disillusionment over nurses being undervalued, underpaid and overworked was a recurring theme. This may, indeed, be instrumental in many nurses’ decision to withdraw from their training, and if qualified, withdraw from the profession.
Stress was also cited as a contributory factor – feeling stressed about their academic workload, their clinical placements, and the constant juggling of both aspects.
The fear of making a mistake while on placement is a very real issue, and the students discussed the discrepancy between ‘ideal’ and ‘real’ practice on the ward. The students described finding themselves unsupported, unsupervised and out of their depth due to the simple problem of ever-increasing workloads and ever-decreasing staffing levels.
Financial issues were also a huge contributory factor. Trying to survive financially while contemplating both clinical placements and academic workloads is described as a ‘logistical nightmare’.
The opportunity to have a part time job is greatly reduced due to the hours required for clinical placement – in addition to keeping on top of academic deadlines.
Students described ‘living on the breadline’ and the media portrayal of nurses using food banks is, in reality, becoming very tangible.
So, what are the answers? It would seem to be a never-ending cycle. More and more nurses are leaving the profession, the demands are increasing and students are unsupported due to a lack of available support within clinical placement (because, in turn, nurses are leaving).
“The discrepancy between expectations and experience, stress and career commitment, are all very complex issues”
It would appear that there is no ‘magic’ funding available for the return of bursaries, and all levels of the profession are becoming increasingly despondent.
Drastic measures are required. The discrepancy between expectations and experience, stress and career commitment, are all very complex issues that may intrinsically influence a student’s decision to withdraw from their training (or indeed leave the profession if qualified).
Discontinuation/leaving is often complex and may be a multi-faceted decision – this needs to be addressed, and plausible solutions devised as a matter of extreme urgency.
Any suggestions welcome…
Fiona Cust is senior lecturer in children’s nursing, Staffordshire University