Charlotte's Web
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Jeremy Hunt has announced a new apprenticeship route into nursing today which will be piloted in September 2017 and will offer places to 2000 nursing apprentices.

The course will take 5 years (as opposed to 3 or 4 for the current degree route) and students will have their place funded by the NHS trust in which they are working. They will also be paid for working in their original HCA role alongside their training.

Read the full story here:
http://www.bbc.co.uk/news/health-38146395

What are your thoughts on this?
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moonkatt
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Mr Hunt said: "Nurses are the lifeblood of our NHS, but the routes to a nursing degree currently shut out some of the most caring, compassionate staff in our country.
I'd like to know how he means "shut out".

I've no issue with us supporting people into nursing, however this should not include the watering down of the actual qualification.
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MissDetermined
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So not much different to the 4 year OU option then? They also get paid a HCA wage.
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mdowling
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(Original post by moonkatt)
I'd like to know how he means "shut out".

I've no issue with us supporting people into nursing, however this should not include the watering down of the actual qualification.
People without the qualifications to do a degree like GCSES
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InArduisFouette
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(Original post by moonkatt)
I'd like to know how he means "shut out".

I've no issue with us supporting people into nursing, however this should not include the watering down of the actual qualification.
and here in lays the problem ... \

if 'shut out '

because they are the sole / main earner and could not afford to run their household on student funding ... then all well and good

if shut out because there isn;t funding for Access courses or other level 3 education to demonstrate current experience of study and/or psubject prerequisite knowledge ... and it;s a pissing match between education and health ...

otherwise we run the risk of falling back down the slippery slope into 2 tier registration, Nursing all ready suffers for beign late to the party with HE preparation for practice in that it will be another 20 years before we are 'rid' of legacy Trained Nurses , where the legacy professionals in PT and OT are are gone
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wbnurse
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Which crazy fool is going to study to be a nurse for 5 years. All for 21k. You could be an astronaut instead
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ButterflyRN
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I have really mixed feelings about the associate role. I think if done correctly it can prove beneficial for our tired and significantly understaffed RN's to take some of the load off our shoulders although I suspect that it will more than likely go tits up. In my opinion 5 years is far too long to gain a qualification for the role. It doesn't take 5 years to study for the degree so why will it take longer for the associate role? I also think that the length of time to study for it will put a lot of people off. I am pretty sure that AP's didn't have to study for 5 years for their qualification to become an AP and the roles are going to be very similar but maybe with a few more added responsibilities. I don't see why they can't teach them anatomy and physiology which should be mandatory and then run specific clinical skills workshops so they can learn skills relevant to their area then get signed off on competencies like us RN's would when we learn additional skills relevant to our role e.g. IV infusions, cannulas, phlebotomy etc.

I am not sure if it is the same for other trusts but I know that we don't have many AP's anymore and that our HCA's got debanded from 3 to 2, unless they were in a role where they need extra skills such as ED, clinics etc. This meant that they stopped doing some of their additional skills which really did help the RN's out. I also think that when they made nursing degree only it alienated a lot of people, even more so now there is no bursary available. I understand the rationale behind it because the role is forever changing, expanding and going in different directions which is great because many of us love new challenges, but whilst we grow and expand, we sadly don't have as much time to do some of the basic nursing tasks that we were once able to do. We need something to bridge that gap.

I don't think that any old Tom, **** and Harry should be able to apply for this role. I think that only very experienced HCA's should be able to apply.I know that a lot of HCA's in our hospital feel stagnant because they can't learn new skills and they can't afford to go and do their nursing. Most HCA's that I worked with on my ward were really eager to learn new things and were very competent at identifying problems. If the patient's pressure areas are going red, breaking down, excoriated etc. they would come and ask me to look and ask if I wanted an air flow mattress and 2 hourly turns. They often recognise retention, constipation, UTI's etc. and will get urine dips and bladder scan and some of them would be on the ball and will have already done it. It's the same for observations, they know when something is abnormal and often act on it, such as getting the patient to lay down if they had a low BP and encourage them to drink, putting a fan on a pyrexial patient etc. Even these simple things can help an RN out. So if we teach them the rationale behind what they are doing then I am pretty sure that many of them will do an excellent job.

I know that as an RN it is extremely difficult at times to run a team when you are the only trained nurse on that team. I found that in my old job it was very heavy and demanding as the only trained and I literally did not stop all day so I burned out from it and had a spectacular breakdown. Sometimes I like working on my own because I am a control freak and I know where I am at with all the things I need to get done, but when it was every shift it was hard work. Some days I felt like I hardly knew my patients and I don't think that's acceptable. It was so nice when I was given the luxury of a 2nd trained nurse, even if it was just for the morning shift because you can split the jobs and then help out a bit more with the personal care etc.

Many trust's are in crisis and I don't think very many of the wards in my hospital are staffed to their full establishment. We are in severe need for more RN's but with the way things are going, the problem is only going to get worse. We have to be realistic and accept that we have such a problem recruiting nurses and if the only way we can begin to solve the problem or at least alleviate some of the pressure from our RN's then this could be a good move and I know loads of people who are already very interested in it which is positive. We as a workforce are burning out fast and we cannot continue to go on like this. People are going off sick left, right and centre, myself included. More nurses with bad backs, nurses who are run down because they have been overworking and taking on lots of overtime and more nurses going off with stress related illnesses.

If done correctly this could be a good move until we figure out another solution to our RN recruitment problem but I have my doubts and reservations and it already leaves me full of dread and disappointment.
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PaediatricStN
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I'm glad you've started a thread on this, as I was going to because I do need a bit of a rant and a place to share my thoughts.

The Apprentice scheme announced is damaging to our profession. I don't see where or how the academia will be included. To get nursing as a degree only profession was a hard slog, and now I feel we've taken a step backwards. There's no recognition for the skills and knowledge required and it completely devalues what all those previous to them have worked for in obtaining a degree/diploma. I also fail to see how the apprenticeship facilitates moving into advanced roles, like CNS, ANP etc which often require Masters degree level study.

The associate scheme I also disagree with. It aims to bridge the gap between HCA and RN apparently. Why not just up-skill the current Band 2 workforce? We're convoluting the system. Parents get confused now between myself (B5 Staff Nurse) and a HCA - even when I explain when I say hello in the morning. Let alone if we add another tier in.

Certainly in paeds I don't see a need for this role. Some shifts we don't have a HCA at all. We as RNs just crack on.

They're also saying this new role will allow administration of medicines. I'd like to know more about what that will involve - holding a neb, fine. Drawing up and administering oral meds or IVs, I certainly hope not.

I'm hoping that in paeds we will be immune to both the apprenticeship and associate schemes given the uniqueness of our care and better RN staffing ratios.

It's a real shame the government have announced these things without properly realising where nurse education has gone wrong. There are still massive attrition rates for nursing degrees, yet thousands of applicants are turned down. So to my mind, we are simply selecting the wrong people. The government haven't explored WHY people are leaving. You and I know, based on our experiences of seeing student colleagues depart, but do the government really know. I think they should have surveyed ex student nurses who left the degree. Was it down to a lack of knowledge about the role? We're they not academic enough for the course? Was it finances? Find out this and you could have put together some kind of attrition risk factor matrix to go alongside an application to help them choose. I also think the interview process and maths/English tests should be standardised so we get more consistent quality across the student workforce.

There also seems to be a biased towards those with previous care experience. But these people often have children & mortgages etc. Most of those who dropped out in my cohort were the ones who, on paper, had loads of clinical experience and looked like a brilliant applicant. In reality they had so many extra pressures they couldn't handle it. Many were also completely unmouldable and thought they knew everything already. Some of these people were also in their fifties. This sounds harsh, but it's realistic... 5 to 10 years working as an RN before retirement is hardly a massive return on investment for the NHS. Someone in their twenties or even thirties could give at least 30 years service.

Then there's the issue of preceptorship, and of course pay, to help with retention of staff.

In my eyes we should perhaps first be ensuring the maximum number possible of nursing degree places turn into qualified RNs, and looking at other retention solutions, before we start looking at other entry routes to boost the numbers.
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Sarah Green
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It doesn't make sense, they are getting rid of the bursary due to funding problems but instead they are going to pay the HCA wages and course fees instead?
I can imagine students dropping out of the degree course to go for the apprenticeship option instead, it would definitely be financially beneficial to them. You will have paid HCAs training over 5 years to be a nurse working alongside unpaid university students who will also be paying university tuition fees for 3 years.
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moonkatt
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Nurses are strange creatures.

Demand to be respected a a profession and say they should be paid more

Move training back to an older model of apprenticeships and roll out an equivalent of the old SEN.

This is clearly driven by the old guard at the top of the profession who think the way they trained was the best way. Perhaps it was decades ago, but times move on.
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PaediatricStN
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(Original post by Sarah Green)
It doesn't make sense, they are getting rid of the bursary due to funding problems but instead they are going to pay the HCA wages and course fees instead?
I can imagine students dropping out of the degree course to go for the apprenticeship option instead, it would definitely be financially beneficial to them. You will have paid HCAs training over 5 years to be a nurse working alongside unpaid university students who will also be paying university tuition fees for 3 years.
You make a valid point about funding. Given the repayments and amounts of debt written off by the government, I actually think they will be worse off for changing to a loans system, rather than just 'giving' students money in the form of the bursary. The amounts that have not been paid are written off after 30 years and I expect they are/will be extortionate.

Despite the financial differences, who will be receiving the better education which therefore benefits patients more, the nurse apprentice or the university nursing student? I think university education is better.

Tuition fees won't really effect a student's day to day living costs/financial position, given that they are only repaid once earning over £21K, and even then the amount is minimal.
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Sarah Green
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(Original post by PaediatricStN)

Despite the financial differences, who will be receiving the better education which therefore benefits patients more, the nurse apprentice or the university nursing student? I think university education is better.
The nursing apprenticeship is also a degree so theoretically they will both be taught to the same standard. One paid over 5 years, the other unpaid with tuition fees over 3 years
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InArduisFouette
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(Original post by Sarah Green)
It doesn't make sense, they are getting rid of the bursary due to funding problems but instead they are going to pay the HCA wages and course fees instead?
I can imagine students dropping out of the degree course to go for the apprenticeship option instead, it would definitely be financially beneficial to them. You will have paid HCAs training over 5 years to be a nurse working alongside unpaid university students who will also be paying university tuition fees for 3 years.
5 years rather than 3 , and i bet like the OU students now their theory time will not be class room block just some study days thrown into 'HCA weeks' ... because much of the study will be standard OU style materials ...
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InArduisFouette
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(Original post by Sarah Green)
The nursing apprenticeship is also a degree so theoretically they will both be taught to the same standard. One paid over 5 years, the other unpaid with tuition fees over 3 years
PRSOM

the 'saving will be that the turstys will work the HCA side of the role for more than the 1/3rd of the 5 years it should make up and the 1/3rd of the time that should be spent on theory won't be becasue the students will have rostered HCA shifts with a few study daysd and the odd 2 week block - like OU students have for all subjects.
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InArduisFouette
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(Original post by moonkatt)
Nurses are strange creatures.

Demand to be respected a a profession and say they should be paid more

Move training back to an older model of apprenticeships and roll out an equivalent of the old SEN.

This is clearly driven by the old guard at the top of the profession who think the way they trained was the best way. Perhaps it was decades ago, but times move on.
Associates are not equivalent to ENs ... they will be band 4s and that's it ... no 'senior associate' who can take charge when none of the RNs can be bothered to cover that shift ... no one day having a full case load of RN duties , next day be doing HCA work ... that is why the EN ended up as band 5 under AFC as although there were relatively few 'unconverted' ENs left they were taking charge , they were shfit leaders etc etc ... and the law allowed that -

20 ish years ago there was discussion about whether it was acceptable for Nursing homes substantive 'shift' nurses to all be ENs and take shift to shift responsiblilty with the substantive RNs being the Deputies / heads of care and the General Manager - RNs on shift meant zero hours staff or agency or the deputies acting down ... there is absolutely nothing that prevents that.
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InArduisFouette
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(Original post by PaediatricStN)
There also seems to be a biased towards those with previous care experience. But these people often have children & mortgages etc. Most of those who dropped out in my cohort were the ones who, on paper, had loads of clinical experience and looked like a brilliant applicant. In reality they had so many extra pressures they couldn't handle it. Many were also completely unmouldable and thought they knew everything already. Some of these people were also in their fifties. This sounds harsh, but it's realistic... 5 to 10 years working as an RN before retirement is hardly a massive return on investment for the NHS. Someone in their twenties or even thirties could give at least 30 years service.
<snip>
expecting many 55 -60 year olds to be taking up the course ?

someone who is 40 now , 45 on registration would have a state pension age of 67 and 'new' NHS pension normal retirment age of 67 ( although any service in the older pension would have normal retirment ages of 60 or 65 depending which bit ... unlikely that therer will be many who manage to have both special class/ MHO rights and much if anythign i nthe new pension - and irrelevant to this discussion as special class needed a registration back in the day)
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PaediatricStN
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(Original post by Sarah Green)
The nursing apprenticeship is also a degree so theoretically they will both be taught to the same standard. One paid over 5 years, the other unpaid with tuition fees over 3 years
I'm not sure if that same standard can be guaranteed if there is no involvement from a HEI. (I'm hoping there will be). An "Apprentice" is define as someone learning something from a skilled employer, which implies decreased, or no, theoretical input. The decisions and roles nurses now take on, as well as the necessity to provide rationale for one's decisions (Particularly with the "sueing culture" we have now) requires degree education. As a nurse I am an independent practitioner, responsible for my decisions and actions, I don't blindly follow Drs instructions as nurses of many years ago did.
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Sarah Green
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(Original post by PaediatricStN)
I'm not sure if that same standard can be guaranteed if there is no involvement from a HEI. (I'm hoping there will be). An "Apprentice" is define as someone learning something from a skilled employer, which implies decreased, or no, theoretical input. The decisions and roles nurses now take on, as well as the necessity to provide rationale for one's decisions (Particularly with the "sueing culture" we have now) requires degree education. As a nurse I am an independent practitioner, responsible for my decisions and actions, I don't blindly follow Drs instructions as nurses of many years ago did.
I totally agree. I'm a student nurse and what we learn in university is very different to what we learn in practice. In university we learn why we do things a certain way, we also learn the correct way of doing tasks. A bit like learning to drive a car, you learn from a driving instructor and then once you qualify you adapt your own driving style.
People often undervalue what a nurse does, nurses often know the patients so much better than the doctor hence the need as you say to sometimes overrule them, for example if medication isn't understood in detail mistakes can easily be made
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lilibet01
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(Original post by PaediatricStN)
I'm glad you've started a thread on this, as I was going to because I do need a bit of a rant and a place to share my thoughts.

The Apprentice scheme announced is damaging to our profession. I don't see where or how the academia will be included. To get nursing as a degree only profession was a hard slog, and now I feel we've taken a step backwards. There's no recognition for the skills and knowledge required and it completely devalues what all those previous to them have worked for in obtaining a degree/diploma. I also fail to see how the apprenticeship facilitates moving into advanced roles, like CNS, ANP etc which often require Masters degree level study.

The associate scheme I also disagree with. It aims to bridge the gap between HCA and RN apparently. Why not just up-skill the current Band 2 workforce? We're convoluting the system. Parents get confused now between myself (B5 Staff Nurse) and a HCA - even when I explain when I say hello in the morning. Let alone if we add another tier in.

Certainly in paeds I don't see a need for this role. Some shifts we don't have a HCA at all. We as RNs just crack on.

They're also saying this new role will allow administration of medicines. I'd like to know more about what that will involve - holding a neb, fine. Drawing up and administering oral meds or IVs, I certainly hope not.

I'm hoping that in paeds we will be immune to both the apprenticeship and associate schemes given the uniqueness of our care and better RN staffing ratios.

It's a real shame the government have announced these things without properly realising where nurse education has gone wrong. There are still massive attrition rates for nursing degrees, yet thousands of applicants are turned down. So to my mind, we are simply selecting the wrong people. The government haven't explored WHY people are leaving. You and I know, based on our experiences of seeing student colleagues depart, but do the government really know. I think they should have surveyed ex student nurses who left the degree. Was it down to a lack of knowledge about the role? We're they not academic enough for the course? Was it finances? Find out this and you could have put together some kind of attrition risk factor matrix to go alongside an application to help them choose. I also think the interview process and maths/English tests should be standardised so we get more consistent quality across the student workforce.

There also seems to be a biased towards those with previous care experience. But these people often have children & mortgages etc. Most of those who dropped out in my cohort were the ones who, on paper, had loads of clinical experience and looked like a brilliant applicant. In reality they had so many extra pressures they couldn't handle it. Many were also completely unmouldable and thought they knew everything already. Some of these people were also in their fifties. This sounds harsh, but it's realistic... 5 to 10 years working as an RN before retirement is hardly a massive return on investment for the NHS. Someone in their twenties or even thirties could give at least 30 years service.

Then there's the issue of preceptorship, and of course pay, to help with retention of staff.

In my eyes we should perhaps first be ensuring the maximum number possible of nursing degree places turn into qualified RNs, and looking at other retention solutions, before we start looking at other entry routes to boost the numbers.

Just to defend the mature students! No one goes into nursing to retire 5 years later. The retirement age is going up and up. I don't see myself retiring until I am 67+ (I am physically fit, run, eat properly, not overweight etc). I have completed my family and will not be taking a career break.
Personally I think that my working for the NHS for 15-20 years is actually pretty good!

On the apprenticeship question? I am opposed, it is a dumbing down of the profession.
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moonkatt
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(Original post by zippyRN)
Associates are not equivalent to ENs ... they will be band 4s and that's it ... no 'senior associate' who can take charge when none of the RNs can be bothered to cover that shift ... no one day having a full case load of RN duties , next day be doing HCA work ... that is why the EN ended up as band 5 under AFC as although there were relatively few 'unconverted' ENs left they were taking charge , they were shfit leaders etc etc ... and the law allowed that -

20 ish years ago there was discussion aobut whether it was acceptable for Nursing homes substantive 'shift' nurses to all be ENs and take shift to shift responsiblilty with the substantive RNs being the Deputies / heads of care and the General Manager - RNs on shift meant zero hours staff or agency or the deputies acting down ... there is absolutely nothing that prevents that.
However, a large number of nurses and the general public are lauding the associate nurse role as a return to the good old days of EN's. This apprenticeship training route is also seen as a return to the old hospital based educational model.

(Original post by PaediatricStN)
I'm not sure if that same standard can be guaranteed if there is no involvement from a HEI. (I'm hoping there will be). An "Apprentice" is define as someone learning something from a skilled employer, which implies decreased, or no, theoretical input. The decisions and roles nurses now take on, as well as the necessity to provide rationale for one's decisions (Particularly with the "sueing culture" we have now) requires degree education. As a nurse I am an independent practitioner, responsible for my decisions and actions, I don't blindly follow Drs instructions as nurses of many years ago did.
The NMC have said they won't budge on their criteria for this model of training, so I imagine universities will be involved one way or another. However, it's the NMC and there's a fair bit of politics involved in the launch of all of this so.....

(Original post by mdowling)
People without the qualifications to do a degree like GCSES
To apply for this associate practitioner role at my trust you need a minimum of 5 GCSEs including maths and English language. This will no doubt be the minimal educational criteria the university expect for someone to embark on a foundation degree.
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