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Nursing apprenticeships: Perceptions must change if we are to transform the workforce

To mark National Apprenticeship Week 2019 (March 4-8), Denise Baker, Head of the School of Allied Health and Social Care at the University of Derby, argues that nursing apprenticeships should not be overlooked and how, with the correct support, they can help transform the NHS workforce.

By Denise Baker - 4 March 2019

National Apprenticeship Week 2019 marks almost two years since the apprenticeship levy (a tax on larger employers to fund apprenticeship training) was introduced. A review of apprenticeship training in England was commissioned by the Government in 2012 and recommended a complete overhaul of apprenticeships, and a revolution in training has been happening ever since. The National Health Service makes an estimated apprenticeship levy contribution of £200m per year, meaning that there is both an opportunity and incentive to increase the number of apprenticeships in the sector.

I have been working on apprenticeships in health since 2014 and this most recent change has allowed me to think about how apprenticeships might be used in healthcare education, particularly degree apprenticeships which could lead to professional registration with the Nursing and Midwifery Council or the Health and Care Professions Council.

A review of evidence about apprenticeships since 1995 (when we last saw a real intervention from the government to shake up the apprenticeship system in the UK) revealed little primary research had been conducted (Baker, 2018). This, in itself, suggests that this is an area ripe for further exploration, especially at a time of development and implementation of new apprenticeship policy. However, research I have undertaken identifies three main areas where attention needs to be focused in order to make an apprenticeship successful:

Entering the apprenticeship

Research studies have shown that apprentices are far more likely to successfully complete their apprenticeship if they receive appropriate career guidance and a good understanding of their future career before they enter. Chan (2016) suggests that apprentices need to appreciate the realities of their future role rather than the "imaginings".

I know, from experience, that this is important in healthcare and we require applicants for our pre-registration programmes to have some form of appropriate work experience prior to embarking on their chosen programme. However, accessing meaningful work experience at the right time remains a challenge for many university applicants, so perhaps the apprenticeship route offers a sensible alternative? But, even after entering an apprenticeship, other factors may force apprentices to leave before completing, particularly for financial reasons. This is an area where the NHS and social care will potentially experience problems, where one employer may pay a significantly higher salary and apprentices may choose to move elsewhere for financial reasons.

The learning environment

In order for apprentices to have a good learning experience, evidence suggests that the apprentice route needs to be valued, planned and well organised in an organisation. Apprentices need space and time to develop into their new roles, with support from a suitably qualified guide or mentor. The government has tried to protect apprentices by introducing a requirement for them to have 20% 'off the job' training (equivalent to one day per week), but this does not account for the support offered to them for the remaining 80% of the time.

Employers who value apprenticeship training models are shown to have much better success rates. But, here, I believe, the NHS has a problem. There is a tension between 'getting the job done' and becoming a competent and productive worker; and having the time to develop all of the other personal skills and attributes associated with entering a healthcare profession. Several researchers identify the need to undertake formal learning as part of an apprenticeship, but that informal learning is just as important. As Unwin and peers note, the NHS focuses on the formal rather than informal element of professional development and prioritises trainees becoming competent in specific skills rather than taking time to see the wider picture - not ideal for any programme of development but particularly apprenticeships.

Perceptions of apprenticeships

While many of us have an understanding of what an apprenticeship is, this is likely to be associated with manual trades or labour. Now, as we see apprenticeships in many different areas of employment, including those which lead to a degree-level qualification, perceptions need to change. Again, the research evidence suggests that this is going to be difficult - apprentices in one study from the NHS were disadvantaged compared with 'traditional' learners and had poorer career development options compared with their counterparts (Turbin et al, 2014). Apprenticeships are sometimes seen as 'second class' options and, occasionally, even apprentices themselves think an apprenticeship is an inferior qualification.

Lessons need to be learned

Lessons from previous versions of apprenticeships need to be learned, especially regarding their bureaucratic nature. Employers have reported that this has put them off using apprenticeships in the past but current evidence would suggest that this remains a problem today.

There are, undoubtedly, advantages to apprenticeships both for employers and apprentices but, unless barriers are broken down and relationships built up, including that between employer and training provider, problems will persist.

Apprenticeships offer real opportunities for people to remain in employment and undertake professional development, including pre-registration education, but there are still hurdles to overcome. Systems need to be smoothed, perceptions changed, learning opportunities valued and careers guidance needs to be meaningful if we are to offer the NHS and social care the best chance of delivering successful apprenticeships which have the potential to transform the workforce.

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About the author

Denise standing by the balcony at the University's Kedleston Road campus in the atrium. She is wearing black rimmed glasses and a blue sleeveless top.

Denise Baker
Pro Vice-Chancellor and Dean of the College of Health, Psychology and Social Care

Denise is Pro Vice-Chancellor and Dean of the College of Health, Psychology and Social Care at the University. She previously managed pre-qualifying healthcare and our foundation degrees/higher apprenticeships. She is currently studying for a professional doctorate exploring how apprenticeship policy is being implemented in the National Health Service.

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