Will nursing apprenticeships mark the end of the nursing university degree?

As the first nursing apprenticeships become available, Eleanor Bird asks what the apprenticeship scheme means for the well-established nursing degree

The NHS is facing a nurse recruitment crisis, and it doesn’t look like it will be solved by an increase in nurses coming through university.  

There has been a particularly sharp drop in the number of trainee nurses, hit hard by the removal of the NHS bursary in August, with more than 1,200 fewer student nurses starting an undergraduate degree this year.

Potential nurses used to have the option of a diploma to get into the profession, but changes introduced in 2013 meant all nurses needed to finish at least three years of formal university training. 

Criticised at the outset for potentially limiting the pool of people who could become nurses, and with nurses in increasingly short supply already, health secretary Jeremy Hunt has now announced plans for nurse apprenticeships, allowing students to ‘earn while they learn’ instead of paying to study at university. 

At the Conservative Party conference at the beginning of October, Mr Hunt expanded on plans for the degree apprenticeship scheme, committing to an overall 25% increase in training posts for nurses. 

He explained that trainees could complete a four-year apprenticeship scheme to become a degree-registered nurse while working in the NHS, without needing to complete a traditional university degree. Plans include 5,000 extra nursing associates being trained through the apprentice route in 2018 and 7,500 in 2019.

The plan is for the apprenticeship role to ease the nurse recruitment crisis, because as well as producing new nurses from scratch, it will also allow nursing associates already working in the NHS to qualify as fully registered nurses by completing a streamlined training programme. It is hoped the scheme will also attract other NHS staff, such as healthcare assistants.

But as bursaries for the traditional university course have been withdrawn, and with prospective students turning their backs on nursing, might the apprenticeship kill off the traditional degree route?

Cost versus time

‘Imagine being 18 now, and paying universities £27,000 so you can work and collect your clinical hours,’ Labour MP Eleanor Smith told Nursing in Practice (see page 26). ‘Do they really think people are going to do that? Not for long. You’ll see soon the dropout rates. There are high dropout rates anyway, but can you imagine thinking, I’m giving them money to work?’

There is certainly a high dropout rate at university level, with one in five student nurses leaving the university degree programme. But Anne Corrin, Royal College of Nursing’s (RCN)head of education, believes the university degree has its advantages. She explained that as well as taking longer, the apprenticeship may also be more competitive. 

She said: ‘I think some people want the experience of going to university, particularly those who don’t already have a degree. We also don’t know how many organisations are going to offer degree apprenticeships, so it may actually be more competitive than the university degree option.’

Despite the fanfare, there are currently only two sites offering the apprenticeship scheme: the Open University and Anglia Ruskin University. Although four universities – Derby, Gloucestershire, Greenwich and Sunderland – received funding from the Higher Education Funding Council for England for nurse apprenticeships last year, none of their courses have so far been approved by the Nursing and Midwifery Council (NMC). 

A further nine universities are developing nurse apprenticeship programmes and the Department of Health says ‘many more’ higher education institutes are planning to offer the programme from 2018.

Technically employed, nurse apprentices won’t need to pay any tuition fees and will receive a salary. Education, training and assessment will be paid for by employers from a £27,000 ‘apprentice levy’. Vacancies for apprentices will be advertised by NHS employers, with entry criteria to be decided by the employer and expected to be similar to university entry requirements.

Apprentices will split their time between their employer and university, although the focus will, of course, be on workplace training. Apprentices will train in a range of placement settings, earning full NMC registration in four years.

By comparison, the nursing degree takes just three years but is also more expensive, with tuition fees of at least £9,000 per year. Nurses previously received a bursary to support them while studying, but this was recently scrapped in favour of a repayable loan.

Given the hefty debt now associated with university training, many are reasonably asking why anybody would pick the university degree option over a fully funded apprenticeship.

‘We need to be careful that we don’t introduce any unfairness in the system,’ says Jane Beach, professional officer for regulation at the Unite union. ‘Those who go through the apprentice route won’t have paid anything, while the traditional degree will leave students with massive debt. And yet they’ll both produce graduates that will be on the same salary.’

Danny Mortimer, chief executive of NHS Employers, claimed that there was an ‘extra cost’ to apprenticeships that had not been factored in.

Speaking at a Commons select committee on nursing workforce, he said: ‘It is a really interesting route, but it does carry extra cost, which we don’t believe has been factored in. So while we welcome the route, the financing of it is tricky.’

Consistency in training

Of the concerns raised over the apprenticeship scheme, training standards have been at the forefront. Janet Davies, chief executive of the RCN, said: ‘We are concerned about the risk of students plugging the gaps in the current workforce at the expense of quality patient care and their own learning experience.’

She added that one of the pitfalls of the apprentice scheme is that it may be too hospital orientated. 

She said: ‘It is essential nurses of the future have a flexible education, which enables them to work in a variety of settings to deliver a 21st-century health and care service.’

Ms Corrin agrees that delivering a consistent standard of training in a hospital environment could be difficult. ‘There are some challenges in quality assurance when training is delivered through an apprenticeship, because some workplaces are not the best learning environments.

‘Employers need to think carefully about how to make health and social care settings good learning environments for all learners. That will be a real challenge.’

The Government, however, seems to support the idea of reducing academic training among nurses. Prime Minister Theresa May recently told LBC radio that on-the-job training for nurses is ‘very important’. 

Mrs May said: ‘We need to ensure that people who go into nursing aren’t just those who look on it as a degree opportunity’.

A return to the state-enrolled nurse?

Some suggest the move away from academic training and towards apprenticeships signals a return to the traditional state-enrolled nurse position that died out in the 1990s, when nurses were primarily trained in hospital settings.

The Government is adamant, however, that it does not intend to phase out university training for nurses. A spokesperson for the Department of Health said: ‘We are opening routes into nursing and [the apprenticeship] is just another way into the profession. By offering this level of flexibility, employers will be able to open up a career in nursing to people from all backgrounds and the NHS will have a nursing workforce equipped with the right skill mix needed for a modern-day health and care service.’

A university degree doesn’t suit everyone and while most people are in favour of the idea of an apprenticeship, proper support from the Government is less certain. 

‘There are lots of people who would like to be nurses but don’t want to go to university, because they want to continue earning and have families, for example, and I think the apprenticeship route will work for those people. I’m sure the degree and apprenticeship can co-exist. What I’m worried about is that neither will be properly funded by the Government,’ says Ms Corrin.

As the first nurse apprentices enter the workplace, the realities of the programme remain to be seen. What is universally agreed is that, whatever the route, every nurse must be trained to the same degree of quality and measured by the same outcomes and standards.