By Lisa Attrill, Lecturer Adult Nursing, University of Plymouth (lisa.attrill@plymouth.ac.uk)

Demands on healthcare keep growing to support an ageing demographic, increasing burden of chronic disease, complexity of care, technological advancements and increasing patient expectations. This is challenging for nursing, further hit by the recent pandemic, increase in nurses retiring from the register and an increased reliance on international registrants¹ to shore up the NHS nursing workforce. Hence a key aim within the NHS Long Term Workforce Plan (LTWP)² is to increase the supply of UK trained nurses; although this has been hampered recently by downturns in student nurse numbers in England over the last four years by on average 6.7% per year.³ Thereupon, requiring actions to ‘train,’ ‘retain’ and ‘reform’ education, increasing alternative routes and apprenticeships into professional roles, supporting people to progress their careers, and working and training in different ways.² At the same time, there has been increasing development of intermediate non-registered healthcare and NMC registered nursing roles between the levels of healthcare assistant (HCA) and registered nurse (RN). In England, roles such as Assistant Practitioners (AP) and Nursing Associates (NA), bridging the skills gap at band 4 on the NHS Career Framework;⁴ their qualification commonly underpinned by a foundation degree or equivalent.

Recognition of Prior Learning (RPL):

For these band 4 NHS staff, career progression to RN is a viable and often attractive option for both staff and employers, whereby recognition of prior learning (RPL) allows entry at a more advanced programme stage; commonly year two of a three-year undergraduate programme. Further facilitated of late, through apprenticeships, enabling employers to ‘grow’ their own. ‘Direct entrant’ students undertake a shortened or truncated programme, credited with practice hours and academic credits commensurate with their previous qualification. A process variably referred to as ‘articulation,’ ‘advanced standing,’ ‘recognition’ or ‘accreditation’ of prior learning. The NMC endorse RPL up to a maximum of fifty percent of the programme⁵ which equates to 18 months of a three-year programme; reflected also in the NHS Long Term Workforce Plan, to widen access and attract more students.² For many of these students therefore, their ‘first year’ experience of university is displaced to second year.⁶ The literature speaks of the criticality of this ‘first year’ in familiarisation to university life and workings, peer network establishments and acculturation to academia. Transitions similarly experienced by direct entrants, who join a cohort who have moved onto the next stage (year two), where first year transition pedagogies are reduced or withdrawn; and there are greater expectations of learner autonomy; which Delly likens to playing a game without being appraised of the rules; outlined in the previous year when they were not there.⁶

Direct Entrant Student Experience

A qualitative descriptive study undertaken in a Higher Education Institution (HEI) in Southwest England in 2019, explored the experiences of direct entrants (Assistant Practitioners, AP) on entering a three-year undergraduate nursing programme in year two of the programme following RPL.⁷ Semi-structured one-to-one interviews were conducted and analysed thematically (n=5). Three main findings emerged around learner preparedness, challenges in transitioning and, integration and support. The participants experienced transition challenges across academic, clinical, and social domains; with perceptions of academic and clinical unpreparedness; as well as feelings of being ‘different’ and ‘forgotten,’ particularly in year of entry (year two). This was compounded by inconsistent awareness of their entry pathway across faculty and cohort peers. Academic challenges related to differing pedagogies across previous education experiences (within further education institutions – FE) and that of university (HE), despite previous study at same academic level as entry (level 5). The value of bespoke induction processes and support from their direct entrant peers was evident. Clinically, the role transition from AP to student nurse and then to RN posed identity challenges, noting criticality of adopting a mature attitude, self-confidence and mentor support and knowledge of pathway, particularly in their first placement on programme.⁷

Albeit pre-covid, and limited geographically to one HEI, the findings from this study may be transferable to contemporary programmes whereby more students are joining at more advanced entry points (with RPL) with establishment of roles such as the Associate Nurse, many of whom may progress to RN. Similarly transferring students from one HEI to another, and some masters nursing students who join truncated programmes may experience similar transitions in joining a larger established cohort and with differing prior academic and healthcare experience. The challenge is for HEIs, faculty and clinical areas to understand the requirements of direct entrants to undergraduate nursing programmes at points later than year one. Widening access and alternative pathways may see increased nursing students following non-traditional entry routes, but they remain the minority within larger cohorts and still risk getting lost in the crowd. They can be more vulnerable academically, clinically, and socially, simply due to their entry point and need time and support to transition. Understanding the student experience is imperative to provide proactive support, prevent attrition and enable success.

References

1. Nursing and Midwifery Council (NMC) (2024) The NMC register: 1 April 2023-31 March 2024. London: Nursing and Midwifery Council. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/data-reports/july-2024/annual-data-report-march-2024.pdf (Accessed: 24 November 2024).
2. NHS England (2023) NHS Long Term Workforce Plan. https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf (Accessed: 12 November 2024).
3. RCN (2024) NHS Long Term Workforce Plan will be 10,000 new nurses behind target by 2025, Press release 04/06/2024. Available at: https://www.rcn.org.uk/news-and-events/Press-Releases/nhs-long-term-workforce-plan-will-be-10000-new-nurses-behind-target-by-2025 (Accessed: 12 November 2024).
4. Skills for Health (2010) Key elements of the Career Framework, 2^nd Bristol: Skills for Health.
5. Nursing and Midwifery Council (NMC) (2018) Standards for pre-registration nursing programmes. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/2024/standards-for-pre-registration-nursing-programmes.pdf (Accessed: 24 November 2024).
6. Delly, P. (2016) “Your brain just freaks out!” – Understanding VET articulants’ transition experience using Bourdieu’s notions of habitus and field. Journal of Academic Language & learning, 10(1), A20-A34.
7. Attrill, L. and Stebbings, A. (2023) An exploration of assistant practitioner’s (nursing) experiences of joining an undergraduate nursing degree programme: a qualitative descriptive study. South West Clinical School Journal, 3(3), https://doi.org/10.24382/503h-3061