Collectively tackling student attrition

Abstract

London has been in the headlines in the last month over planned reductions in adult nursing student numbers (Barrow, 2012). There are divided views on the merit of these reductions in both the NHS and the higher education sector, however, one question is central to the ongoing debate on student numbers: Why do so many students leave nursing courses before graduation and registration? This question affects the whole profession from the nurse at the bedside to the one sitting at the boardroom table; we all need to take collective responsibility for the next generation of nurses. Student attrition from nursing courses impacts the number of students who need to be recruited to meet ongoing demands for newly qualified nursing staff. Numbers need to be ‘artificially’ high to offset the impact of the loss over the course of a programme leading to registration. Millions of pounds of taxpayers’ money are lost annually through students not completing their courses. In any health economy this kind of wastage cannot and should not be tolerated. The research literature and professional press offer many reasons and speculations as to why students leave courses. The quality of selection processes, the impact of first clinical placements on students, academic failure, pressures of family or personal life and financial hardship all play a part. With the unprecedented expansion of student numbers in the 1990s to meet an increased workforce demand, the political emphasis was on increasing the supply of newly qualified nurses rather than dealing head on with student attrition and the retention of qualified nurses within the NHS. I believe a more effective approach would have been to maintain a realistic number of places and focus on reducing student attrition and increasing registered nurse retention rates within the NHS. Improving career progression and the working environment for nurses would have produced a more cost-effective and stable nursing workforce for the current decade. NHS employers and the profession need a way forward that will stabilize the nursing workforce and assure the quality and credibility of newly qualified nurses. However, the current debate is at risk of being diverted into futile discussions on the rights and wrongs of reducing student numbers while ignoring the fact of student attrition from nursing courses. This is now an urgent issue given the prospect that a hard-pressed NHS will be commissioning fewer nursing students in the future. NHS employers, universities and the profession need to join together and tackle the long-standing issues that affect student attrition and deliver a viable and attractive career structure that will retain nurses for longer. The latter can only be done by also addressing the continued ambiguity of the status and future role of the assistant practitioner/support worker and the role of the registered nurse within the clinical team. Despite the obvious concerns, there are potential benefits to a reduction in commissioned students. Fewer places will result in more competition: the universities will be able to select only the best candidates which will, in theory, improve standards of care in the long run. However, selection will have to value both the academic ability and personal qualities needed to be a nurse. In my opinion, academic attainment and having a caring, compassionate outlook cannot be mutually exclusive in this profession.