graduate-only pre-registration mental health nursing programmes

8/12/2019 Graduate-Only Pre-registration Mental Health Nursing Programmes

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FOLLOWING THE REVIEWof pre-registrationnurse education in the UK, the Nursing andMidwifery Council (NMC) (2009) confirmed thatall pre-registration nursing programmes will beprovided at graduate-only level from 2010.Graduate-only programmes may be viewedas a way to integrate nurse education into highereducation (Burke and Harris 2000). Theseprogrammes may also help to address the negativeview of nursing and its lack of equal status withinhigher education (Sellers and Deans 1999,Miers 2002). Ultimately, the introduction ofgraduate-only programmes may help to ensurethat nursing achieves a similar status to otherprofessions (Hancock 1997).

The implementation of graduate programmeswill ensure that nurses are knowledgeable,competent and better equipped to address futurepublic health challenges (Davies 2008). It hasbeen suggested that the introduction of theseprogrammes will improve the efficiency ofli i l h ill b fid

care (Newton 1997). Effective care willultimately help to reduce patient mortality(Tourangeau et al2006).

Purchasers of nurse education suggest thatgraduate nurses are more likely to meet therequirements of future healthcare organisations

because of their enhanced expertise and skills(Burke and Harris 2000). Tourangeauet al(2006)also identified that graduate nurses will be lesslikely to leave the profession after registration.

The perceived benefits of graduate-onlyprogrammes have been challenged. Ward (2002)questioned the proposed relationship betweengraduate nurses and improvements in patientcare, suggesting that the added academic contentof current pre-registration nursing programmeshas not resulted in significant improvements.Kyrkjeb and Hage (2005) claimed that nursingeducation does not occur in a vacuum and thata hidden curriculum plays an important partin shaping students values, attitudes andbehaviours. It is suggested that nursingstudents are sometimes exposed to clinicallearning situations of mixed quality and thatimprovements in patient care will be achievedonly with significant cultural change throughoutthe total educational system (Institute ofMedicine of the National Academies 2003,Kyrkjeb and Hage 2005).

Recruitment

While there may be disagreement about thepotential advantages and disadvantages ofgraduate-only pre-registration nursingprogrammes, the initiative may create additionalrecruitment and retention problems foremployers and providers of mental healthnurse education.

Historically, nursing has tended to recruitentrants from a narrowly delineated populationmainly students who have failed to achieve thenecessary qualifications for entry to preferrededucation programmes or careers (Buchan 2003).E i id i di id l i h h

Graduate-only pre-registration

mental health nursing programmesODonnell H (2010) Graduate-only pre-registration mental health nursing programmes.

Nursing Standard. 24, 39, 42-46. Date of acceptance: March 12 2010.

&art & science mental health

Summary

This article examines the perceived benefits of graduate-only

pre-registration programmes in mental health nursing, and the potential

social aspiration and attrition problems that may result. A number of

strategies are identified to assist student integration into higher

education and minimise any increase in attrition rates.

Author

Hugh ODonnell, nurse lecturer, school of nursing and midwifery,

Queens University, Belfast. Email: [email protected]

Keywords

Academic qualifications, education, mental health,

nursing careers

These keywords are based on subject headings from the British

Nursing Index. All articles are subject to external double-blind peer

review and checked for plagiarism using automated software. For

author and research article guidelines visit the Nursing Standardhome page at www.nursing-standard.co.uk . For related articles

visit our online archive and search using the keywords.


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by attaining added social respectability andenhanced personal aspirations. Those engagedin directing reform in nurse education shouldconsider the effects of any proposed policy changeon social mobility and gender equality (DAntonio2004). It is not known, as yet, how the introductionof graduate-only pre-registration programmes willaffect social mobility. However, it is possible that

some individuals and sections of society who havealready experienced inequality, for examplemature entrants who previously had theopportunity to enter higher education with GCSE(general certificate of secondary education)qualifications, may become increasingly excludedfrom participation in nurse education. It isimportant that nursing retains its capacityto provide added social aspirations withina professional paradigm (Nelson 2002).

Mental health nursing has found it difficultto attract new students. While other nursing

specialties have tended to recruit young femaleschool leavers, mental health nursing has usedopen access routes to recruit a broader range ofpotential students, including entrants who tendto have more modest educational qualifications(Buchan 2003). It is unclear whether the academicand age profile of new entrants to mental healthnursing will alter following the introduction ofgraduate-only programmes. However, recruitmentto mental health nursing may remain difficultbecause of the negative attitudes that manypotential students have towards it and its services(Stevens and Dulhunty 1997, Happell 2001,Davidson and Connery 2003).

A potential future recruitment crisis inmental health nursing may be avoided byincreasing the number of assistant practitionersrecruited to support nurses. It has beensuggested that the introduction of skill mixinitiatives will eventually lead to improvementsin organisational effectiveness and the qualityof patient care (Buchan and Dal Poz 2002).Having greater numbers of assistantpractitioners may mean that some activitiesthat nurses carry out can be delegated, whichwill allow the nurses to engage in more complexcare interventions.

The recruitment of assistant practitionersto undertake roles that were previously thereserve of mental health nurses is notuniversally supported. Some believe thattheir introduction will eventually threaten thefuture of mental health nursing and that thisinitiative is motivated by economic factorsrather than patient-centred care (Warne andMcAndrew 2004). McKenna et al(2004)suggested that it will blur professional roles,and that these practitioners may be delegatedd i h d h i i di id l i

It is worth noting that while arguments usedto support graduate-only nursing programmesfrequently refer to its positive effects on patientcare, concerns are also expressed about theeffects that assistant or associate practitionerswill have on patient care (Brannon 1990,Zimmermann 1995).

Attrition

One estimate of student attrition rates suggeststhat 25% of nursing students leavepre-registration nursing programmes beforecompletion (Buchan 2006). Attrition also appearsto be higher in nursing students than in otherhigher education student populations (House ofCommons Committee of Public Accounts 2008).Scotland is reported to have the highest rate ofnursing student attrition in the UK. This isthought to be a direct result of the decision

to increase the number of non-traditionalstudents, for example those who have notachieved A level qualifications, entering theprofession at a time when insufficient systems andresources were in place to support this studentpopulation (Waters 2006).

Because of the recruitment difficulties, mentalhealth nursing programmes have tended to recruita disproportionate number of non-traditionalstudents those who have not previouslyachieved A level qualifications. This trend hascontinued following the integration of nursinginto higher education, even though evidencesuggests that students with less impressiveacademic profiles are at heightened risk ofacademic difficulties and subsequent attrition(Yorke 1997, Leathwood and OConnell 2003,Lawrence 2005, Smith 2007).

The development of foundation degrees is oneway to address the academic profile deficits ofsome students who enter mental health nursing.Foundation degrees are aimed at assistingnon-traditional students to develop the skillsand capabilities necessary to adjust to highereducation study. Foundation degrees are a mixof academic and vocational study. The profile ofstudents who have commenced these degrees isreported to be broadly consistent with studentswho previously completed the Higher NationalDiploma programmes that permitted entry intohigher education (Quality Assurance Agencyfor Higher Education 2005). Students withouttraditional entry qualifications may completefoundation degrees and gain accreditation ofprevious learning achievements. This allowsthem to progress to professional courseswithin higher education, such as nursing(Webbet al2006).

F d i d f ll d


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believed their introduction will help address theacademic drift towards an elitist model that someobservers claim dominates higher education(Parry 2005). Foundation degrees are flexible

in design and structure and offer practicalbenefits to employers in that they expose futurestaff to the realities of study and the workenvironment. The development of foundationdegrees has a number of potential advantagesfor higher education organisations, especiallyas they aim to increase student participationat a time when competition between providersis increasing.

There are, however, those who are critical offoundation degrees. Gibbs (2002) questioned theuse of the word degree for this largely vocational

programme of study and suggests it serves tocreate an illusionary parity of status with studentsundertaking other undergraduate courses. Webbet al(2006) said that whether their introductionwill democratise higher education, or merelydifferentiate further between students andcourses, remains unclear. They suggested that thevalue of foundation degree courses, and theirpotential parity with other qualifications, canbe determined only following rigorous empiricalinvestigation (Webb et al2006).

A multitude of potential problems could ariseif student attrition from mental health nursingcourses persists or increases after the introductionof graduate-only pre-registration nursingprogrammes. Nursing students who withdrawwill experience feelings of disappointment andpersonal distress (ODonnell 2009), and otherstudents may experience feelings of vulnerabilityand demoralisation (Lloyd 2008). Nurse teachersmay experience guilt and feelings of failure whenstudents decide to leave (Symanski 1991).

A decline in the future mental health nursingpopulation because of student attrition may havea negative effect on the services future capacityto meet the populations needs.

Increased student attrition rates frompre-registration programmes may have negativeeffects on providers of mental health nurseeducation. The financial cost of an increase inattrition can be significant. It may include factorssuch as lost bursary effects, additional costsassociated with educating replacement nurses,and indirect costs such as time lost by nurseteachers and mentors as a result of students whosubsequently leave the programme.

Future contracting and funding arrangementsare calculated by the number of nursing students

h l i i i

courses may be interpreted as an indicator ofprogramme weakness or a reflection of poorstudent support (Johnes and McNabb 2004).Schools of nursing with low student progressionrates may find it more difficult to recruit mentalhealth nursing students in the future becauseof a negative public image (Lipley 2000),and commissioners of nurse education may

turn to alternatives if providers demonstratehigh student attrition rates. This would havea significant effect on those providing mentalhealth nurse education and potentially threatenthe tenure of those engaged in this areaof education.

Future of mental health nursing

Those responsible for mental health nurseeducation should anticipate and plan forincreased attrition following the introduction of

graduate-only pre-registration programmes, andrecognise the need for a co-ordinated andsystematic response to help minimise this risk.Strategies that might help to resolve nursingstudent attrition are outlined in Table 1.

Higher education providers of mental healthnurse education should develop more effectiverelationships with feeder providers to ensure thatfuture students have the necessary skills andcapabilities to adjust and cope with degree-levelstudy. Pre-university study programmespermitting entry to pre-registration coursesshould provide a cultural context that equipsstudents with the independent study skillsnecessary for successful academic adjustmentwithin higher education. Nurse educationproviders should also assemble morecomprehensive information on students atthe point of entry to help accurately determinethe academic and other needs that individualsmay require to progress and successfullycomplete graduate-only pre-registrationmental health nursing programmes.

Education providers should have a clearunderstanding of students expectations.Unrealistic expectations have been blamed forheightened student stress, academic adjustmentproblems and attrition (Howard 2001, Lastand Fulbrook 2003, Knox 2005, Jeffreys 2007,Smith 2007). Realistic expectations ofgraduate-only mental health nursingprogrammes may be achieved through effectivecareer advice, availability of more accuratecourse content information, and effectiveselection procedures. The selection processshould test the accuracy of studentsexpectations of the content and academicchallenges of graduate-only programmes.

Th i id h i i



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academic support systems, tutoringarrangements and the availability of otherlearning assistance may assist integration intohigher education and reduce attrition rates(Colton et al1999, Schnell and Doetkott 2003,Braxton et al2004). The introduction of peermentoring may also have a positive effecton the levels of social involvement and

academic self-confidence of future mentalhealth nursing students. Effective peermentoring arrangements may result inmeaningful student engagement and helpachieve positive commitment (Mangold et al2003, Padgett and Reid 2003).

Following the introduction of graduate-onlypre-registration nursing programmes,attendance and progression should bemonitored closely, as non-attendance iscommon among nursing students performingless well academically (Jeffreys 2007,

McCarey et al 2007). Students may employnon-attendance strategies to suppress the stressassociated with academic difficulty (Jones and

Johnston 1997). Those engaged in mentalhealth nurse education should provideappropriate support to students experiencingacademic-related stress. It is also important thateducation providers recognise the costs and

Strategies to resolve nursing student attrition

TABLE 1

Strategy Action

Develop effective Ensure that further education programmes

relationships with and other relevant pre-university feeder

organisations programmes adequately prepare future

students for graduate-only study.Assess student Identify whether students have realistic

expectations expectations of graduate-only courses and

their academic demands.

Provide nursing students Ensure students have access to comprehensive

with higher education information regarding graduate-only programmes

information and their academic demands to ensure they

are adequately prepared.

Provide higher education Help prepare future students by giving them the

transition courses skills and capabilities necessary to cope with

the transition to higher education.

Provide student support Ensure that academic and/or pastoral support

is in place, as well as effective peer mentoring

and personal tutor arrangements.

Promote wider student Provide access to taster experiences.

participation

Measure student Monitor student progress to help detect

progression disengagement or stress. Provide access

to further support if required.

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organisational complications associated withpoor attendance and attrition.

Those responsible for the delivery ofgraduate programmes should maintain

positive relationships with clinical colleaguesto ensure they are prepared for the introductionof graduates, and have the necessaryguidance and support to enhance andreview student performance.

Conclusion

It is critical that those responsible for the deliveryof graduate-only pre-registration programmesin mental health nursing support studentintegration into higher education to minimisethe risks associated with increased studentattrition. The quality of these programmes must

be maintained so as not to disadvantage nursingstudents who hope to undertake additional study,or potentially discredit the integrity andcredibility of mental health nurse educationin the future NS


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