GP practices are ‘often reluctant’ to take on nursing students because of funding constraints and a limited number of practice supervisors or assessors, a new report has said.
Health think tank the Nuffield Trust has published a review of practice learning requirements for nursing students, in partnership with the Florence Nightingale Foundation (FNF) and commissioned by the Nursing and Midwifery Council (NMC).
The review revealed ‘highly varied’ learning experiences and supervision for nursing students, including confusion over practice learning hours and difficulties in accessing some placement areas such as GP practices and in community settings.
The research draws on existing literature, as well as focus groups and interviews with experts, staff, stakeholders and students, and has been described as a ‘key juncture’ within the NMC’s wider review into nursing and midwifery students’ practice learning.
The report called for clearer guidance and consistent standards for practice learning, alongside better organisation and coordination of placements.
And it flagged ongoing issues around the difficulties faced by nursing students trying to secure placements in primary care, social care and other community settings.
Researchers said data on practice learning opportunities within general practice was ‘limited’ but pointed to a survey from the Queen’s Nursing Institute in 2015 which suggested only 27% of GP employers offered placements to pre-registration nursing students, compared to 62% offering placements to medical students.
‘As independent businesses, GP surgeries are often reluctant to take on student nurses unless there is sufficient funding attached to cover costs,’ the report said.
‘There are also often a limited number of registrants in settings outside hospital care to act as practice supervisors or assessors.’
There was also ‘resistance’ from some students who were concerned that placements outside of hospital settings ‘might not provide opportunities to achieve their proficiencies’.
The report highlighted good examples of programmes allocating students to a primary care network, ‘which allocates and rotates students’ placements across members – enabling them to achieve their multidisciplinary skills and experience different aspects of care’.
More widely, the report suggested key areas for action around practice learning, including:
- Clearer guidance and consistent standards
- Better organisation and coordination of placements
- Strengthening supervision and assessment
- Uncertainty around practice learning requirements
- More evidence needed on simulated practice learning
As part of the research, the minimum 2,300 hours of practice learning requirement for nursing students was explored.
Report authors said they ‘repeatedly heard confusion’ over what counted as a practice learning hour and what should be counted as theory, and that there was ‘insufficient protection’ of students’ supernumerary status and learning time.
The report suggested that universities suggested they wanted ‘greater flexibility’, but that there was ‘not clear agreement’ among focus group participants or stakeholders on whether the minimum hours requirement should change.
‘There was consensus among stakeholders, including in our public and patient engagement, that the quality of practice learning mattered more than the duration of practice learning, and that the current approach led to variable experiences and failed to account for different students’ needs,’ the report said.
‘Some stakeholders suggested that the number of practice learning hours could be safely decreased, and this could support a more sustainable supply of clinical staff.
‘However, others expressed concerns that doing so could undermine the status of the professions involved and be perceived as a response to funding and service pressures rather than a desire to improve patient care.’
Billy Palmer, workforce lead at the Nuffield Trust and one of the report’s lead authors, said: ‘On paper, practical education requirements for the UK’s nurses, midwives and nursing associates are comprehensive, and in many areas go further than other countries.
‘But in reality, day-to-day pressures and a lack of supervisory capacity are routinely leading to varied implementation and support for students.
‘Our review heard widespread consensus for more focus on the quality of training, not just learning hours accrued or tasks ticked off.’
The NMC had announced in January that it was commissioning independent research into practice learning requirements to help ensure they ‘continue to equip students with the knowledge and skills to deliver the best possible care for people across a diverse range of care settings’.
Today, Sam Foster, executive nurse director of professional practice at the NMC, said the report findings would be ‘instrumental on our journey to review, and improve, students’ practice learning experience’.
‘We will now work with our independent steering group and stakeholders to shape recommendations to bring to our Council.’
Natasha North, director of academy at the Florence Nightingale Foundation, said: ‘Practice learning placements are the way that nursing and midwifery students learn the real-world art and science of caring.
‘High quality practice learning extends the knowledge that students gain in the classroom, giving them supervised opportunities to develop practical skills and professional behaviours.’
A version of this story was first published on our sister title Nursing in Practice.
