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How to prevent a nursing student retention crisis

Nursing students have been at risk of burn-out since Covid-19. Rachel Maxwell discusses how nursing schools can heighten engagement and prevent withdrawals.
This article is more than 1 year old

Rachel Maxwell is Principal Advisor (Academic, Research and Consultancy) at Solutionpath

The Covid-19 pandemic has seen an enormous spike in interest in the nursing and allied health professions.

Applications to study nursing courses increased by more than a third among eighteen year old and mature applicant cohorts alike for 2021 –  inspired in large part by the pandemic, according to a January 2022 report from UCAS and Health Education England.

As any Dean of Health can attest, applicants for nursing courses have a rather different profile from the average applicant to higher education. They are more likely to be female, and more likely to be applying as a mature student – and therefore much more likely to have responsibilities outside study – and more likely to come from an area with the lowest levels of HE participation than the highest.

Though 99 per cent of the nursing applicants UCAS surveyed were confident that they had made the right choice of career, there’s no doubt that nursing and midwifery, and nursing associate courses are tough – requiring significant intellectual, emotional, and physical stamina. So while it’s right to celebrate the enhanced profile of this vital profession, including its enormous impact for widening participation, health faculties will continue to be concerned about the risks of early withdrawal among nursing and allied health students.

A leaky pipeline

The challenge of retaining healthcare professionals has come into even sharper focus since the Covid-19 pandemic, as the toll on the profession – including students – has become apparent. A BMJ editorial in October 2021 cited evidence that the pandemic has been associated with an increase in anxiety, depression, and post-traumatic stress disorder among nurses. And while the authors, health academics David Barrett and Roberta Heale, celebrate the rise in profile of the profession and associated increase in applications to study nursing at university, they also warn that the gains may be offset by an increase in nurses leaving the profession.

Some level of attrition is to be expected where individuals discover the profession is not right for them, or experience significant life changes, but for decades now the level of attrition in pre-registration nursing has been at a scale that suggests deeper change in the support and advice available to students is needed. This is especially true in England where the annual rate of attrition from nursing courses has typically been around 25 per cent but according to the Nursing Standard, spiked to 33 per cent in 2020. The cost to individuals, organisations, and the public, of attrition from nursing courses is enormous.

The Health Education England RePAIR project and toolkit, published in 2018, brought together the available evidence to suggest general structural points of intervention to improve the retention of nursing and midwifery students. These include finance, pre-enrolment information, course organisation and academic support, placement experience, and support from peers and mentors.

Now health faculties are building on this analysis to develop an individual lens to help providers of nursing education spot where a student is struggling and take pre-emptive action to support that student in ways that are adapted to their personal circumstances.

During 2020 we analysed data from three universities to design a model of student engagement that is distinctive to nursing courses, using learner engagement analytics. We assessed existing data on engagement and withdrawal, building a model that enabled us to establish a single measure for engagement for each student and predict as “at risk” up to 90 per cent of students who went on subsequently to withdraw.

We also found that first year undergraduate nursing students were the most likely to be at risk of withdrawal compared to other allied health professional students in the study. Extrapolating from that data, universities can identify the nursing students most at risk of early withdrawal and target support and intervention accordingly.

Game changing

Having a single source of data is really, really valuable,” says Fiona Barchard, curriculum and programme lead in pre-registration nursing at the University of Northampton where StREAM was adopted as part of a university-wide initiative looking at retention, continuation, and progression. “You haven’t got bits of data in all sorts of different areas which you’re trying to put together, you can really see each student’s progress in one space. So the team can gather around the student to encourage, and develop and support them and help them be successful.

At Northampton, two members of student support staff have been assigned to offer student support specifically in nursing, with a particular focus on students in their first year – there’s a published case study about the model here. Fiona considers it to be very important that those staff are themselves from a nursing background. “You really need that identified student nurse experience and advice and support, and to make sure that students are getting the right information,” she says.

“In a pre-StREAM world, all of this data was available but on lots of different systems, so you spent more time working out who to intervene with than actually intervening,” says Michelle Dickson, school registrar for the school of health and life sciences at Teesside University.

When I need to see students about their attendance, sometimes they don’t realise how much individual absences are adding up. In a conversation you can actually sit and look through it together, see some of the patterns, and explore why those patterns are the case. That helps because you can also see what’s normal for the student to inform your actions – you can look back across a longer period or compare one student against their whole cohort to help inform whether you should be concerned.

As a result of that proof of concept we are working with a cohort of universities to roll out the model in their health faculties and developing a community of practice for those engaged in supporting the retention of nursing students. We’ll be working closely with those partners to build a rich picture of student engagement and develop interventions that could help students stay on track, succeed and achieve their aspirations to enter the nursing profession.

Among those joining the project is the University of Worcester, where head of digital learning and teaching Elaine Swift has been working to set up the system for the past six months. “It’s important not to let perfection be the enemy of good when it comes to data. We conducted some early work that showed even with just our VLE logins we had quite a good fit and that gave us confidence to get started with the system,” says Elaine.

At Worcester, working with staff to understand and make the most of the system from the very beginning has been the most important thing. “Most of our staff who have been exposed to the system so far have found it relatively intuitive to use, but probably more importantly it’s been thinking about how having that data can inform changes to business practice that come with having that holistic picture of student engagement,” says Elaine.

It’s also about ensuring that we’ve identified the key users of the system – for some institutions it’s the student success team but we’ve decided to go with personal academic tutors, because it’s about that relationship between staff and students and about enriching that conversation to make sure that students understand their strengths and weaknesses and that we can really facilitate and support them on their learning journey.

“It has been quite a 24 months for the NHS, and for nursing and other academic colleagues within schools trying to weather the Covid changes and any impact on the courses,” says Michelle Dickson. “We have so many wonderful, committed, passionate colleagues, skilled at supporting students, but there are so many pressures. So getting that data first hand, and giving them any space, that bit of extra space to do something about it, is going to make such a difference.”

This article is published in association with Solutionpath. Solutionpath is working with six universities to pilot approaches to supporting the retention and success of nursing students and has an ongoing programme to expand the use case throughout 2022. Click here to find out more and join the community of practice.

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